Author: Christopher Hicks, MD
Co Author #1: David J. Hryvniak DO, University of Virginia, Department of Physical Medicine and Rehabilitation and Sports Medicine
A 74 year old female with history of Rheumatoid Arthritis presents with left lateral knee pain and instability.
Denied trauma or inciting event. Lateral knee pain just distal to knee joint. Pain was sharp and radiated down the leg.
Described instability of the knee and lower leg, "the bone popping in and out". Instability occurred with ambulation and stair climbing. She also had associated numbness and tingling down the lateral side of the leg when the instability dies occur. Instability occurred up to 20 times per day.
Initially seen by an orthopedic surgeon, recommend conservative measures: rest, Physical Therapy, ice and Non Steroidal Anti Inflammatory medications. However without resolution or improvement of her symptoms
Well appearing female in no acute distress. Vital signs normal.
Neurologic Exam: Full 5 out of 5 strength throughout the lower extremity. Sensation to light touch intact. Reflexes are 2 plus and symmetric.
MSK: Inspection showed no erythema, effusion, swelling. Non antalgic gait. Full Range of motion. Tenderness to palpation along the left proximal tibia fibula joint; Varus, valgus, and patella laxity bilaterally; Negative McMurray test but did cause fibular head subluxation with audible pop and pain. Noted side to side difference with palpation of the tibia-fibular joint bilaterally. Left fibular head siting more anterolateral when compared to right
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.