Author: Michael DaRosa, DO
Co Author #1: Kevin Gebke MD
Editor: Kevin deWeber, MD, FAMSSM, FAAFP, FACSM, RMSK
A 14 year old, previously healthy male golfer and basketball player presented to an orthopedic knee clinic with 1 week of worsening right lateral knee pain.
The pain started on the first day of basketball tryouts and progressively worsened over the next three days, finally causing him to sit out of basketball on day 4 of tryouts. The pain localized just proximal to his lateral femoral condyle and was described as sharp, non-radiating and 9/10 in severity. The pain was first noticed during a set of lunges. There was no twisting, trauma, popping, catching, locking, or giving-way episodes. HIs pain was worsened by running, especially downhill. After practice walking was painful, and he observed a small amount of swelling. The pain would keep him up at night. Ibuprofen had provided some pain relief, and his pain had improved slightly since sitting out of basketball tryouts over the last four days.
Past Medical History: He denied any history of knee problems.
The patient was well-appearing, height 5â€™8â€™â€™, 145 lbs. Vital signs were normal. He was alert, oriented and in no acute distress. HEENT: No lymphadenopathy. CVS: Heart RRR, no murmur. Pulses +2 in both extremities. Pulm: Lungs clear bilaterally. Abdomen: Soft, non-tender, non-distended. MSK: Normal gait. Right Knee: on inspection there was a mild deformity and swelling just proximal to the lateral femoral condyle, but no erythema Case Photo #4 . On palpation this was a tender, fixed, firm mass with mild overlying soft tissue edema. There was full and painless ROM at knee and hip. Muscle strength was 5/5 and painless bilaterally at the hip and knee. A Nobles compression test was positive. other tests including Ober, FADIR, FABER, McMurray, Lachman, Varus/Valgus stress, patellar grind, posterior drawer, dial, and Garrick were negative.
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