Author: Patricia Leone, DO
Co Author #1: Clifford Stark, DO
Editor: Rahul Kapur, MD
20 year old African-American female with 7-8/10 right knee pain following minor trauma 3 weeks ago
A 20 year old female recreational runner was referred to Sports Medicine at Chelsea with a 3 week history of worsening right knee pain following minor trauma. The patient banged her right knee against the lever behind the front seat of a car as she was exiting. She was attending college in Buffalo, NY when the injury occurred. The patient experienced knee swelling, pain and the inability to bear weight following the injury. She went to the ER two days later where she was treated with ibuprofen, crutches, and RICE. She was told her x-rays showed no fracture or dislocation and was diagnosed with a patellar contusion. The patient was then referred to an orthopedic surgeon who ordered an MRI and added a knee immobilizer to the treatment regimen. During the next 3 weeks, her symptoms worsened with this conservative management, resulting in a referral to a sports medicine physician. During her visit at our facility, her knee pain was posterior when standing and anterior while sitting with the knee in slight flexion. Her pain was 7-8/10 in severity, sharp at times, intermittent, positional, and aggravated by walking, full knee flexion, and standing.
Patient was in obvious pain and distress, walking with crutches and wearing a compression brace on her R knee. Examination of the patientâ€™s R knee revealed a large effusion with crepitus and generalized tenderness. This tenderness was most severe medially, even to very light palpation and percussion along the saphenous nerve distribution. Allodynia was noted and tenderness was disproportionate to what would be expected with internal derangement. R knee range of motion was decreased in flexion (80 degrees) and extension (-10 degrees) due to pain. There was pain with resisted knee flexion/extension and patellar grind testing. McMurrayâ€™s test produced pain, but no clicking. Valgus /varus stress and Lachmanâ€™s tests were negative. Hip exam revealed full range of motion of bilateral hips.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.