When An Mri Misses A Knee Injury - Page #1

Author: Louis Gerena, MD
Co Author #1: Ricardo Colberg, MD
Co Author #2: Lyle Cain, MD
Senior Editor: Carolyn Landsberg, MD
Editor: Jacob Miller, MD

Patient Presentation:
A 20-year-old male presented with right knee pain from an injury sustained during jiu-jitsu practice.

A 20-year-old male presented with right knee pain from an injury sustained during jiu-jitsu practice. He reported they were practicing some ground maneuvers. He had no problems while on the floor, but once he stood up, he felt and heard a pop in his right knee, and then the knee immediately locked while in flexion. He was unable to extend his knee at all and had pain on the lateral knee. He went to the ER where the knee was slowly straightened and then put in a knee immobilizer. He followed up with a physician who examined him and suspected a meniscal tear. MRI was ordered and showed sprained ligaments but no meniscal tears. The physician remained suspicious for a tear and referred the patient to the orthopedic surgeon. Two weeks later, he presented reporting his pain was rated 1/10 and his knee had not locked again.

Physical Exam:
GAIT AND STATION: Normal gait without assistive devices. Station normal.

RIGHT KNEE: No deformity. No discoloration. No atrophy. No tenderness to palpation. No crepitation. Small effusion. Active range of motion: Extension 0 degrees, flexion 135 degrees. Passive range of motion: Not limited. Strength: 5/5 quadriceps. 5/5 hamstrings. Negative Lachman's. Negative posterior drawer. Negative valgus instability. Negative varus instability. Negative medial McMurray's. Positive lateral McMurray's. Normal patella mobility. Negative patellar apprehension.

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