On Segond Thought Not So Pathognomonic - Page #1

Author: Mohammad Ibrahim, DO
Co Author #1: Andrew Cunningham, M.D.
Senior Editor: Natalie Stork, MD
Editor: Kiyomi Goto, DO

Patient Presentation:
A 12-year-old obese female presented to her primary care physician for right knee pain and instability symptoms that started acutely 2 weeks ago during a soccer game.

While playing goalie, she experienced a non-contact injury while pivoting to chase down a ball. She had immediate pain causing her to fall to the ground. She developed an effusion the following day and has been ambulating painfully since the injury. At presentation, the pain is located in the anterior aspect of her right knee. The pain is worse with deep flexion activities, ascending and descending stairs, and sitting down or standing up from a seated position. The pain improves by avoiding deep flexion activities, using a compression brace, and resting. She does note popping when swimming but denies any clicking or giving out symptoms.

Physical Exam:
Exam of the right knee revealed a moderate to large effusion. There was pain to palpation of the medial and lateral patellar facets. Range of motion was 0-110 degrees with pain on full flexion. No laxity on varus and valgus stress. Lachman and patellar apprehension testing were limited due to pain. Anterior and posterior drawer tests were negative. McMurray test was limited due to pain. The patient had intact light touch sensory testing at L3-S1 without deficit. The right leg was warm and well-perfused.

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