Author: Nikki Castel, BS
Co Author #1: Justin Young, MD
Editor: Linda Mansfield, MD
Senior Editor: Marc P. Hilgers, MD, PHD
23 year-old female with a past medical history significant for asthma and IBS presented with left medial knee pain for 2 weeks.
She was running in an area that is very hilly, training for a half marathon, and felt the pain at the 4-mile point. She had been running every day, and her longest run was 17 miles. Due to the pain, she started walking. Over the next 2 weeks, the pain got progressively worse so she came to see a sports medicine doctor. Pain is 5/10 at rest and 10/10 with running. Pain aggravated with activity and alleviated with cold compress and rest. She reportedly has regular menstrual periods; her last menstrual period was 3 weeks ago. She has no history of fractures. Remainder of the review of systems is negative.
Vital signs were within normal limits. Her body mass index was 17.7. In general, she was a healthy pleasant female in no acute distress. Her left knee had full range of motion with flexion and extension to 135/-5 degrees. There was no effusion. Strength was intact. Patellar compression test was negative for pain or crepitus. Clarke's inhibition test was negative for patellar instability. There was no ligamentous laxity to varus or valgus stress testing at 0 and 130 degrees. Lachman's test, anterior drawer, and posterior drawer tests were negative. There was pain to palpation over the medial knee, specifically over the joint line. McMurray's testing produces pain but no crepitus. There was no patellar tendon tenderness, pes anserine bursa tenderness, or distal IT band tenderness.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.