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Zebra's Exist: A Rare Finding In A Common Presentation - Page #1
 

Author: Christopher Mulholland, DO
Co Author #1: John Luksch, DO
Senior Editor: Carolyn Landsberg, MD
Editor: Jennifer Gaitley, MD

Patient Presentation:
A 72 year old female presents to the office with chief complaints of right knee and hip pain for five years.

History:
The knee pain is primarily in the anterior knee. The knee feels stiff and particularly painful with walking and using stairs. She denies a history of trauma but reports being told she had degenerative changes in her knee and some stenosis in her back at L4. She reports that prior injections to her knee have offered some relief. She reports knee pain as moderate and hip as mild in severity. The hip pain is lateral. She states the pains do not wake her from sleep. She reports no radiation, numbness or tingling in the lower extremity and denies a history of alcohol use or chronic oral steroid use.

Physical Exam:
Patient is a well appearing female in no acute distress. She has some paraspinal hypertonicity without midline tenderness. Examination of her hip shows no atrophy or edema. There is tenderness over the right greater trochanter, and she has lateral pain with FABER. FADIR, log roll and heel strike were negative.Her right knee shows superolateral fullness consistent with mild effusion. Her patella tracked laterally with deep flexion and she demonstrated a positive patellar compression test. Lachman, anterior and posterior drawer tests were negative, as was varus and valgus stress testing. She had a negative McMurray exam. Neurological testing was unremarkable.

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

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