I need a response to this assignment
CC: “Complains of dull pain in both of his knees”
HPI: The 15-year-old Caucasian male complains of dull pain in bilateral knees. Complains of catching under unilateral or both knees. Onset gradual but increasing over time, especially in last two weeks. Dull knee pain and catching sensation behind the right knee cap. Rarely, notices the clicking in the left knee but continues to have less pain. Pain is worse with exercise and activity. Pain eases with rest, elevation and ice. Patient rates the right knee at 8/10 and left knee 6/10
PMI: Tonsillectomy at 5-year-old, Flu vaccination 2019 season, HPV immunization completed 2019, Tetanus 2019, hospitalizations
CURRENT MEDICATIONS: None
SH: RR is a middle school student at Austin Middle School. He plays football and basketball with the school. He is a nonsmoker and his household members are nonsmoking. He does not use alcohol and his father drinks 1-2 drinks/monthly and his mother does not drink. He lives in the house with both his parents. He makes good grades.
GENERAL: no weight loss, no chills, no fever, no fatigue.
CV: Negative for palpitations or flutters, negative for hypertension. No edema noted to bilateral upper extremities. No edema to lower extremities.
GI: No nausea/ vomiting no diarrhea, no stomach pain.
PULMONARY: Denies cough, shortness of breath or labored breath.
MUSCULOSKELETAL: Normal gait, ambulates without assistance or limb.
NEUROLOGICAL: No headaches, dizziness, syncope, paralysis, ataxia, and denies numbness and tingling in the extremities. Denies seizures. Denies trauma.
PSYCHIATRIC: No depression or anxiety
VITALS: BP 120/68, P 86, RR 18, O2% 95%, 5’8”, 140#, BMI 21.3
GENERAL: Patient is a well-nourished 15-year-old Caucasian male. He is pleasant and cooperative. Complains of dull pain to knees. Right>left knee has catching sensation
CV: Heart sounds auscultated S1 and S2, no S3, no murmurs, no gallops noted.
GI: Flat abdomen, Bowel sounds normoactive in all 4 quadrants. No masses palpated.
PULMONARY: Chest symmetrical, unlabored breathing, Clear lung sounds in all fields, Percussion tympanic in all fields.
MUSCULOSKELETAL: Abnormal gait with limp favoring the right. Ambulates without assistance. No neck or back pain. Full ROM. Symmetrical bilateral upper extremities, no joint edema of pain. Full ROM. Full strength bilateral 5/5. Bilateral hip flexion 90 without pain, good strength 5/5. Right knee appears to have +1 edema to lateral aspect of knee and no bruising. Right knee is tender with palpation at the popliteal and tibiofemoral joint. Right knee is negative for the McMurray test. Negative Thessaly test to right knee. Right knee is positive at the Q angle 15 with clicking. Negative leg strength 4/5. Negative Thessaly’s test. Pain is passive and controlled range of motion. The left knee has no edema noted. Left knee has full ROM with pain, negative McMurray’s test, negative Thessaly test. Left knee Q angle at 15 degrees with clicking in knee. The left knee strength is 5/5. Bilateral ankle is symmetrical. Right ankle ROM intact, flexion 20 degrees and extension 45 degrees, strength 5/5. Left ankle ROM intact, flexion 20 degrees and extension 45 degrees, strength 5/5.
NEURO: Bilateral brachioradialis reflexes 2+ expected, bilateral triceps reflex 2+ expected, bilateral patellar reflexes 2+ expected, bilateral Achilles reflex 2+ expected. No clonus noted bilaterally.
DIAGNOSTIC RESULTS: 4-view x-ray of the bilateral knee, MRI of the bilateral knee without contrast as indicated below.
Assessment of the adolescent male with knee pain includes asking if he can determine the exact source of the pain. Questions of the severity, frequency, and length of pain are important. What does the patient do to relieve the pain? Has the patient tried to rest, ice, and anti-inflammatories? Is there a specific injury? Additional testing on knees is the ballottement test for fluid on the knee, anterior and posterior drawer test, and varus and valgus stress test for unstable ligaments (Ball et al., 2019). Measure and compare the size of the limbs assists in diagnosing. Maneuvers, physical examination, and radiological diagnostic studies assist practitioners in finalizing diagnosis, however, the information the patient gives us is just as important.
Ball, J.W., Dains, J.E., Flynn, I. A., Solomon, B.S., & Stewart, R. W. (2019). Musculoskeletal system: Keypoints. In Seidel’s guide to physical examination: An
interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby
Dains, J.E., Baumann, L. C. & Schneibel, P. (2019). Lower Extremity Pain. Advanced Health Assessment and Clinical Diagnosis in Primary Care (6th ed.). St.
Louis, MO: Elsevier Mosby
Patel, D., & Villalobos, A. (2017). Evaluation and management of knee pain in young athletes: overuse injuries of the knee. Translational Pediatrics 6 (3). (pp.
190-198). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532199/pdf/tp-06-03-190.pdf