Author: Bradley Jaskulka, MD
Editor: James Robinson, MD
Senior Editor: James Robinson, MD
Editor: Marc Hilgers, MD, PhD, FAMSSM
Senior Editor: Marc P. Hilgers, MD, PHD
26 year old male ENT Resident with no past medical history presents to Primary Care Sports Medicine clinic in January with complaints of left knee and left hip pain.
He states he injured left knee 3 months prior to presentation while playing soccer. He was planted on the left leg while kicking and felt the knee shift. He did not feel a pop in the knee. No immediate swelling. In the following days, he noticed worsening pain while riding his bike. He denies locking, catching and instability of the knee. He has been applying ice. No previous surgery to the knee. Further questioning revealed, he frequently rides his bike on trails. He also went camping in the Upper Peninsula of Michigan where he went hiking and biking. He denies rashes, fevers and constitutional symptoms.
Well-nourished male. No distress. BMI 24.77. BP 125/79, HR 84. Pain 3/10. Walks with normal gait. LE: neurovascularly intact. 2+ dorsalis pedis pulse. Knee Exam: supine exam - ROM 0-140 degrees bilaterally. No tenderness along joint lines. Negative Lachman's, Anterior and Posterior drawer signs. Negative McMurray. Negative Patellar apprehension. Negative posterior sag sign. Extensor mechanism intact. Standing exam - Normal alignment. Able to bear weight. Ambulates with a normal gait.
Left hip exam: ROM normal bilaterally. No pain with internal and external rotation of flexed hip. Log roll negative. No pain with axial loading. Straight leg raise negative. No tenderness to palpation of the iliotibial band or trochanteric bursa. No limb length discrepancy.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.