CC: Dull knee pain which may occasionally occur in one or both knees. Presents as a catching sensation under the patella.
HPI: The patient is a 15-year-old male who presents to the ER with knee pain that has been persistent for a few days now. The patient describes the pain as intermittent and sporadic, which comes “on and off” and with varying intensity. The pain often lessens at rest and is exacerbated by physical activity like running and riding a skates board.
Delegate your assignment to our experts and they will do the rest.
Further History: To determine the etiology of the pain, it is important to obtain the following further information: the onset of the pain, exact duration, previously tried treatment and responses to the treatment, aggravating factors, character, location, and severity of the pain. Past medication history including medication, allergies, and procedures such as knee surgery, personal and social life including leisure and level of physical activity and history of alcohol and drug abuse are also important ( Vakili-Basir et al., 2019). Also, the activity or event preceding the onset of the condition may be useful in determining the cause. Family history may also be an indication of the condition.
Objective Information
Vitals: HR-101, Temp- 98.1, BP-134/66, RR-24.
No indication of tingling, numbness, or loss of sensation in the lower extremities.
ROS
HEENT: Intact vision and sense of smell. No dizziness, sinus infections, or headache.
Respiratory: Denies pain while breathing and shortness of breath.
CVS: Denies chest pain. No indication for chest palpitation or murmur.
Gastrointestinal: No abdominal pain, nausea or vomiting, rectal pain, and changes in bowel habits.
Musculoskeletal: Difficulty in moving knees, limited ROM for lower limbs. Dull pain and occasional swelling in both knees, especially after strenuous physical activity and sports. Clicking on movement of the knees. Q angle is greater than 10 o bilaterally.
Neurological: Denies seizures, numbness, memory impairment, and problems with coordination. Awake and alert with spontaneous movement.
Endocrine: Denies intolerance to extreme temperature changes, polydipsia, and polyuria. Reports no endocrine conditions.
Hematologic: No history of blood transfusion or bleeding disorders.
Immunologic: Denies immune deficiencies and allergic reactions to drugs, food, and environmental allergens.
Assessment
Physical Examination
Anterior and posterior drawer test, patellofemoral assessment, and palpation. Radiologic examination, i.e., X-rays and MRI, are essential in localizing the pain and identifying which part of the knee is injured.
The physical examination is important in identifying the condition through the differential diagnosis of possible joint conditions. Knee pain may result from physical injury or pathological conditions such as gout and arthritis ( De Oliveira Silva, 2018).
Differential Diagnoses
Juvenile rheumatoid arthritis
Indicated by knee joint stiffness and soreness. Joint swelling may also be present musculoskeletal assessment in ROS is important in diagnosis. Symptoms less with physical activity. Common symptoms are fatigue and weight loss. However, the patient does not present these symptoms ( Hsu & Siwiec, 2018).
Patellar tendinitis
The predisposing factor is strenuous physical activity and persistent stress on the patella. Often presents after intense physical activity. Symptoms are exacerbated by physical activity such as jogging, running, jumping, or skating. Pain often originates from the proximal posterior central aspect of the tendon. MRI exam may indicate high signal intensity in this region ( Vakili-Basir et al., 2019).
Chondromalacia Patellae
Characterized by deterioration and softening of the cartilage beneath the patella. The condition is highly prevalent among young, active, and athletic individuals. Predisposing factors are intense physical activity, which also exacerbates the pain ( Vakili-Basir et al., 2019). Also common in persons with a history of knee trauma.
Medial meniscus tear
This condition often occurs following a twisting injury incurred in sports or physical activity with intense movement. Symptoms of joint clicking may be present. Other presenting symptoms are swelling, reduced ROM, and difficulty in movement and extension (Reid et al., 2010).
Patellofemoral joint syndrome
Highly prevalent in both young and elderly, physically active individuals. Mainly caused by intense physical activity which results in patella overuse and consequently painful catching sensation on the knee. The pain lessens with reduced physical activity or with rest and is increased by intense physical activity ( McNeilan, & Jones, 2017).
References
De Oliveira Silva, D., Rathleff, M. S., Petersen, K., Azevedo, F. M. D., & Barton, C. J. (2018). Manifestations of pain sensitization across different painful knee disorders: a systematic review including meta-analysis and metaregression. Pain Medicine , 20 (2), 335-358.
Hsu, H., & Siwiec, R. M. (2018). Osteoarthritis, Knee. In StatPearls [Internet] . StatPearls Publishing.
McNeilan, R. J., & Jones, G. L. (2017). Patellofemoral Pain Syndrome. In Orthopedic Surgery Clerkship (pp. 343-345). Springer, Cham.
Reid, C. R., Bush, P. M., Cummings, N. H., McMullin, D. L., & Durrani, S. K. (2010). A review of occupational knee disorders. Journal of occupational rehabilitation , 20 (4), 489-501.
Vakili-Basir, A., Gholami-Fesharaki, M., Rowzati, M., & Maghroori, R. (2019). The Effects of Personal and Occupational Risk Position on Musculoskeletal Disorders.
