Author: Stephanie Giammittorio, DO
Co Author #1: Carly Day, MD
Editor: Jeremy Close, MD
A 68-year-old marathon runner presented with complaints of bilateral, right greater than left, knee and posterior leg pain for 4 years. It started while training to do 4 marathons in a 12-week period, however he denied any specific injury. The pain was up to 7/10, penetrating, and located in the posterior thigh and anterior knee with occasional vague distal radiation. His right leg felt weak when pushing off during running. He was symptom free at rest and only had pain while running. He denied any back pain, numbness, tingling, or bowel and bladder changes. Previously other physicians diagnosed him with patellar tendinitis, patellofemoral pain, and hamstring tendonitis. He did 2 courses of PT with gait analysis, which only gave him minimal relief. He tried a neoprene sleeve for his thigh and multiple patellofemoral knee braces which did not help. Use of anti-inflammatory gel was unsuccessful. He modified his activity and tried cross training but continued to have pain. Previous MRI of his hamstrings showed proximal tendinitis bilaterally. He has run 32 marathons in the past. He has been running 40-50 miles per week with a 25 mile long run
Carotid Artery Stenosis
Left Ventricular Hypertrophy
Examination of the lumbar spine was notable for no tenderness to palpation, mild decreased range of motion with both flexion and extension with mild back pain at end range lumbar flexion. His lower extremity strength was intact. There was no tenderness over the ischial tuberosity or mid belly hamstring. His hip range of motion was 45° of external rotation and 20° of internal rotation bilaterally without pain. There was no tenderness throughout bilateral knees. Knee range of motion was notable for full extension and 140 degrees of flexion bilaterally. Distal sensation and pulses were normal. His foot exam was notable for mild pes planus with normal hindfoot alignment
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.