Author: Arthur Boyd, MD, ALM, EdM
Co Author #1: George Friedhoff DO
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM
Continue knee pain after NSAIDs and physical therapy.
Patient is a 30 year old former runner with multiple marathon experiences who has had chronic left knee pain for the last 4 years following a left tibial plateau fracture. The patient has deep left knee pain, patellofemoral pain, pain with lunging, lateral joint pain that is aggravated by walking and going upstairs.
So far the treatment consisted of: non-weight bearing on crutches for 8 weeks, 1 year of physical therapy, and cortisone injections. This initially improved to allow for limited weight bearing physical activity, but then regressed to deep pain with severe physical limitations.
Patient denied fever, chills, night sweats and weight loss.
General: mild pain/tenderness. Otherwise, well-developed, well -nourished,no acute distress, alert and oriented 3x
MSK: positive palpable click, positive posterior medial tenderness there is positive instability with assessment. Tenderness along medial joint line, rotational sign(+)and MacMurray(+), positive patellofemoral grind test ROM: flexion-active:80 degrees Ext-active:-2 degrees Flexion-Passive: 100 degrees Extension - Passive:full Thessaly Test: Positive. No increased Q angle or internal rotation or external rotation of the hip, normal alignment was intact. No effusion was noted on the knee. Patient had slight hyperextension noted of bilateral knee. Gait: Limp noted. Neurovasc: intact
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