Question

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. in determining the causes of the knee pain, what additional history do you need? what categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

Answer 1

1.a.Additional history may include ,experiencing pain while involving in weight bearing activities.

b.Pain while climbing stairs,especially when it comes to bending of knee ,it will be really painful,as knee pain is associated with patellofemoral joint.

c.Nocturnal pain,(knee pain occurring during night)

d.Presenting history of TB,HIV ,Cancer

2.The categories used to differentiate knee pain are

a.Lateral knee pain,refers soreness on the outer portion of your knee.

b.Medial knee pain ,refers to pain that occurs on the inside of your knee.

c.Anterior knee pain,pain occurs at the anterior portion of your knee.

3.The specific differential diagnosis for knee painare

a.Fracture related to Trauma

b.Malignancy

c.DVT

d Septic Arthritis.

4.Physical examination is as important as Subjective examination.

1.Observe the patient ,check for swelling and listen for audible cracks during weight bearing or mobilization.

b.Ask the patient to flex and extend the injured knee and compare it with non injured knee.

c.Palpation for point tenderness

d Evaluation of ligaments for injury.

4.Performing special tests such as Ligament Stability tests,Meniscal tests,Scoop and Glide test for knee and patella.

The anAtomic structures which are assessed during the physical examination are

a.Quadriceps Angle

b. Cruciate ligaments.

c.Collateral ligaments.

d.Menisci

The special maneovers performed are

a.Lachman test

b.Anterior drawer test

c.Pivot test.

d.Joint line tenderness

e.McMurray test

f.X-ray