Pulling The Trigger With A Loaded Differential: Persistent Knee Pain In A Marathon Runner - Page #1

Author: Caitlin Waters, MD
Co Author #1: Navid Mahooti, MD

Patient Presentation:
A 52 year old male marathon runner presents to the primary care sports clinic for routine annual exam with complaints of left medial knee pain.

Nine months prior to presentation, the pain began and was aggravated by running greater than 2 miles with catching and mild swelling following runs. The pain was worsened by prolonged sitting, flexion and he was unable to attain full extension. NSAIDs only provided temporary relief. He was no better after home exercises and formal PT. An ultrasound guided corticosteroid injection into the left distal hamstring sheath provided enough relief to get through a half marathon, but pain persisted. MRI was performed and showed a medial meniscal tear. The patient was referred to orthopaedic surgery and underwent arthroscopic surgery. 6 months later, despite surgery, the patient's pain was no better.

Physical Exam:
Inspection, ROM, and special tests of the knee reveal a benign knee exam. There is 2+ tenderness with palpation of trigger points along the left adductors which reproduces his symptom of pain at the medial knee. Case Photo #2 [Photo 3}

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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