Author: Alexander Lloyd, MD
Co Author #1: Kentaro Onishi, DO
Editor: Margaret Gibson, MD
Senior Editor: Margaret Gibson, MD
Editor: Natasha Desai, MD
Senior Editor: Margaret E. Gibson, MD
A 13-year-old female swimmer presented with 1 year of left medial knee pain that began while swimming. The pain started with a tearing sensation in her knee during a breaststroke race causing severe pain followed by swelling. She saw several sports medicine physicians and was treated with NSAIDs and physical therapy for medial collateral ligament and medial meniscus injury for more than 6 months without significant improvement. She reported ongoing sensation of knee catching and periodic swelling with persistent, severe pain. Of note, she also developed episodic bruising over the medial femoral condyle with deep knee flexion accompanied by worsening allodynia several months after her initial injury. She had resorted to using crutches because of the pain severity.
No significant past medical or surgical history. The patient was not taking any medications aside from Tylenol and occasional NSAIDs for her pain. She had no history of prior knee injuries or knee problems.
Circular bruising was visible over the medial femoral condyle area with significant allodynia. Sensation was noted to be decreased in surrounding areas in comparison to the right. There was a focal area of severe tenderness at the posteromedial aspect of the knee joint. Subsequent examination was limited by pain. Tracking of the patella was normal without apprehension, tenderness or discomfort exhibited with patellar pressures. The knee had no swelling, erythema or warmth and was stable to ligamentous testing. Hip exam was normal. Strength was normal with full active and passive ROM, but any type of movement increased her pain.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.