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Running Into Trouble - Page #1
 

Author: Oksana Klimenko, MD
Co Author #1: Stephanie Klimenko, ASHS, EMT
Senior Editor: Drew Duerson, MD
Editor: Stephanie Aldret, DO

Patient Presentation:
Acute worsening of bilateral knee pain in a recreational runner

History:
An 18-year-old female with hypermobile Ehlers-Danlos syndrome presented with acutely worsening bilateral knee pain. There was no specific mechanism of injury.

She localized the pain to the medial aspect of both knees, greater on the right than the left. Symptoms were intermittent and worsened with walking, running, and both concentric and eccentric hamstring activation. She denied mechanical symptoms but reported a sensation of instability.

The pain initially began 9 months earlier when she started training for a half marathon. She averaged approximately 10 miles of running per week. Earlier in the month of presentation, the pain in her right knee acutely worsened during a run, leaving her unable to walk comfortably for several days. The pain subsequently persisted even at rest.

She denied prior knee injuries. Cross-training, ice, stretching, acetaminophen, and ibuprofen provided only temporary relief.

Physical Exam:
The patient appeared well and in no acute distress.

Examination of both knees demonstrated no swelling or joint effusion. Range of motion was normal with baseline hyperextension bilaterally.

There was mild tenderness to palpation over the lateral patellar facets bilaterally with a positive patellar grind test on both sides. Significant tenderness to palpation was present along the proximal medial tibial border of the right knee.

Medial and lateral McMurray tests, Lachman test, posterior drawer test, valgus stress testing, and varus stress testing were negative bilaterally.

Strength testing demonstrated 5/5 knee flexion and extension bilaterally without reproduction of pain.

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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