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Knee-cap And Gown: Atraumatic Knee Pain Nearly Benched Student From Graduation - Page #1
 

Author: Abbey Santanello
Co Author #1: Natasha Desai MD
Co Author #2: Natasha Desai MD
Co Author #3: Natasha Desai MD
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: Justin Rothmier, MD, FAMSSM

Patient Presentation:
23-year-old male masters student presented to orthopedic urgent care (UC) with left knee swelling, redness of medial thigh, and decreased range of motion and flu-like symptoms.

History:
He denied any recent knee injury. Initial exam showed effusion, decreased ROM, and medial thigh swelling/erythema. X-rays were reportedly negative. Arthrocentesis in UC resulted in 15mL of clear yellow fluid containing WBC 887 and blood work revealed an ESR 42 and WBC count 10. He was given antibiotics for cellulitis and presumed reactive arthritis and discharged.

He presented 2 weeks later to the orthopedic office with continued knee swelling and difficulty walking. Ultrasound examination found synovial thickening and a trace effusion. His cellulitis had resolved. MRI and rheumatology evaluation recommended, but he returned to clinic 4 weeks later, prior to his MRI, requesting repeat knee aspiration, so he can walk at his graduation. Case Photo #1

Physical Exam:
At that visit, the patient reported a 15-pound weight loss. He was afebrile in no acute distress, but an antalgic gait. Examination of the left leg revealed a trace effusion, but no erythema or induration. There was lateral distal thigh swelling just proximal to the knee, where there was also fluctuance. His ROM was nearly full, but painful. A soft tissue aspiration yielded 72mL of serosanguinous fluid sent for culture. MRIs of the femur and knee were expedited, but yet delayed by the patient undergoing final academic exams.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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