Author: Josiah Situmeang, BA
Co Author #1: Justin Mark J. Young, MD
Co Author #2: Jill Inouye, MD
Co Author #3: S. Nicholas Crawford, MD
Editor: Mandeep Ghuman, MD
Senior Editor: Mandeep Ghuman, MD
Editor: Robert Baker, MD, PhD, ATC
The patient was a 25-year-old male football running back who presented with right knee pain. The pain was located on the right anterolateral, posterolateral, and medial knee radiating down the anterolateral lower leg and foot. The quality of the pain was dull, achy, sometimes sharp, numb, and tingly, with severity ranging from 3-7 out of 10. The pain was constant, exacerbated by standing, walking, kneeling, bending rising from a seated position, and relieved partially by rest. A right foot drop is noted without other sensorimotor complains, radiating symptoms, or bowel or bladder function changes.
The patient is a football running back who was practicing in a non-contact situation and running sprints. He lost his footing and hyperextended his knee as he tried to recover. He felt a painful, numb, tingly pop at the knee, went down, and had to be helped off of the field. The knee was initially very painful, and he was unable to bear weight on or bend the knee. His past medical history is significant for a shoulder surgery for an unrelated injury.
Vitals: BP 140/82 mmHg, Height 6ft 4in, Weight 242 lb, BMI 29.47 kg/m2.
Range of motion was limited and painful with right lower extremity knee extension/flexion arc 5-100 versus left lower extremity 0-130.
Palpation revealed a tender right knee medial and lateral joint line, and a tender posterolateral joint.
Muscle testing yielded 5/5 strength for both lower extremities except for 0/5 strength of the right lower extremity ankle dorsiflexion, ankle eversion, and extensor hallucis longus.
Sensation was intact to light touch throughout both lower extremities except for right lower extremity hypoesthesia and dullness to pin prick in the distribution of the common peroneal nerve.
The knee examination revealed anterolateral pain and crepitus with right lower extremity patellar glide and compression and single leg squat maneuver, medial pain and crepitus with right lower extremity McMurray and hyperflexion maneuvers, and positive right lower extremity Anterior-drawer and Lachman maneuvers. Guarding limited the right lower extremity pivot-shift and reverse pivot shift maneuvers. The patient was negative for posterior drawer maneuver, Dial maneuver, or for medial or lateral laxity.
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