Author: Brett Wilhoit, MD
Editor: Ashwin Rao, MD
11 year previous healthy male presented to clinic with left medial knee pain after a fall.
Patient states that he suddenly developed left knee pain after twisting his leg while riding a kick scooter 2 days ago. He reports stiffness and maximal tenderness over the medial aspect of the knee. Patient denied hearing a “pop”. He tried icing and compression over the site of pain with minimal relief. X-rays were obtained and negative. Initial treatment recommendations included ice, crutches with toe touch weight bearing, a knee brace set at 30 and 70 degrees, and physical therapy.
Patient returned for follow up nine days later and physical exam revealed a joint effusion with decreased pain over MCL area. There were range motion limitations at full extension and full flexion. Given these findings, he was sent for an MRI of the left knee.
Past Medical History- He denies any previous knee problems.
ROS- As per history, otherwise negative including no fever, numbness, tingling, or weakness.
GEN: 5’1” 85lb. 11yo male in no acute distress.
CV: symmetric pulses bilaterally (DP, PT, popliteal), RRR.
MSK: No deformity of left knee. Slight effusion appreciated. TTP over medial aspect of joint along MCL. Pain was present with valgus stress but no laxity was appreciated. Full extensor/flexor mechanism integrity was confirmed, though significant stiffness and hesitancy is noted with extension and flexion. Anterior Drawer, Lachman’s, and McMurray’s tests were negative but difficult to perform due to swelling and muscle spasm.
NEURO: Alert & Oriented x 3, sensation intact without any focal deficits.
All other systems examined and unremarkable.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.