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Continued Knee Pain After Treatment - Page #1
 

Author: Arthur Boyd, MD, ALM, EdM
Co Author #1: George Friedhoff DO
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM

Patient Presentation:
Continue knee pain after NSAIDs and physical therapy.

History:
Patient is a 30 year old former runner with multiple marathon experiences who has had chronic left knee pain for the last 4 years following a left tibial plateau fracture. The patient has deep left knee pain, patellofemoral pain, pain with lunging, lateral joint pain that is aggravated by walking and going upstairs. <br>So far the treatment consisted of: non-weight bearing on crutches for 8 weeks, 1 year of physical therapy, and cortisone injections. This initially improved to allow for limited weight bearing physical activity, but then regressed to deep pain with severe physical limitations. <br> <br>Patient denied fever, chills, night sweats and weight loss.

Physical Exam:
General: mild pain/tenderness. Otherwise, well-developed, well -nourished,no acute distress, alert and oriented 3x <br>MSK: positive palpable click, positive posterior medial tenderness there is positive instability with assessment. Tenderness along medial joint line, rotational sign(+)and MacMurray(+), positive patellofemoral grind test ROM: flexion-active:80 degrees Ext-active:-2 degrees Flexion-Passive: 100 degrees Extension - Passive:full Thessaly Test: Positive. No increased Q angle or internal rotation or external rotation of the hip, normal alignment was intact. No effusion was noted on the knee. Patient had slight hyperextension noted of bilateral knee. Gait: Limp noted. Neurovasc: intact

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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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