Author: Amy Skaria, MD
Co Author #1: Dennis Cardone, DO
Co Author #2: Bret Jacobs, DO
Editor: Kristian von Rickenbach, MD, MSc
Senior Editor: Kristine Karlson MD
A 40 year old male presented with a one year history of bilateral lateral knee and proximal calf pain. His left side hurt more than his right.
The pain was worse with activity, prolonged standing, walking and heavy lifting. It improved with rest as he had been out of work for a month after an appendectomy with improvement of symptoms. He tried acetaminophen and ibuprofen without relief. He denied any trauma, acute injury, or recent changes in his activity level. He denied any swelling, erythema, locking or instability of his knees as well as denied any numbness, tingling, or weakness of his legs. His prior work-up included negative bilateral venous dopplers and normal exertional ankle-brachial index studies.
The patient's past medical history was notable for a "right leg fracture" at age 13 secondary to an equestrian accident. He worked as a doorman and building superintendent. He denied use of tobacco products and reported alcohol intake socially.
Bilateral Lower Extremity:
Inspection: No erythema, edema, ecchymosis, or effusions. No skin lesions.
Palpation: No medial or lateral joint line or condylar tenderness. Tenderness over left lateral gastrocnemius and left fibular head. Neurovascularly intact.
Range of Motion: Hips, knees, and ankles with full range of motion without pain.
Special Tests: Hop test reproduced pain on the left. Negative special tests included negative Ober's, Noble Compression, varus and valgus stress, Lachman's, posterior drawer, and McMurray tests.
Strength: Bilateral, full 5/5 hip, knee and ankle strength, without pain.
Stance/Gait: Neutral standing alignment. Pes plantus, Non-antalgic gait.
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