The Differential Diagnoses For Knee Pain Assignment
The Differential Diagnoses For Knee Pain Assignment
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SUBJECTIVE DATA:
Chief Complaint (CC): Knee pain
History of Present Illness (HPI): Andrew Wallace is a 15-year-old African American male patient who presented earlier today with swelling and pain in both of his knees. He reported feeling dull pain for 2 weeks. The patient also reported a clicking sound in one of the knees and sometimes both knees. The patient also reported a catching sensation under the patella. He applied ibuprofen gel to both his knees twice daily. He has applied the rest, ice, compression, and elevation (RICE) but the pain and the swelling persist. He rated the severity of her pain at 6/10 for both knees. The Differential Diagnoses For Knee Pain Assignment
Medications:
- No medication used
Allergies:
Sulfur drugs – skin rash; environmental- none; food-none
Past Medical History (PMH):
No major illness
Past Surgical History (PSH): No history of surgery
Sexual/Reproductive History:
No history of sexual intercourse
Personal/Social History:
Never smoked
Denied ETOH or illicit drug use.
Immunization History:
COVID-19 Vaccine #1 3/18/2022 #2 5/15/2022 Pfizer BioNTech – Comirnaty
Booster shot 6/13/2022 Pfizer BioNTech – Comirnaty
Influenza Vaccination 8/26/2016
Up-to-date with all childhood vaccines
Significant Family History:
Father – Obese
Mother— Type 2 diabetes
Siblings – No major illness
Lifestyle:
Andrew Wallace is the firstborn in a family of two girls and two boys, born of African American parents, living with both parents in the city in an area with minimal crime and good public transportation although his family owns two cars. Wallace’s family has medical insurance, lives a healthy lifestyle, and eats balanced diet meals. Wallace actively participates in physical activities including soccer and cycling. The Differential Diagnoses For Knee Pain Assignment
Review of Systems:
General: Pain and swelling in both knees; no fever, chills, night sweats; presence of discomfort while moving; no recent weight gains or losses of significance.
HEENT: Eyes: Negative for visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat
Neck: No pain, injury, or history of disc disease or compression.
Respiratory: No shortness of breath, cough, or sputum
CV: Negative for chest pain, chest pressure, or chest discomfort. No history of paroxysmal nocturnal dyspnea, orthopnea, or arrhythmias. No palpitations or edema.
GI: No abdominal pain or blood. No diarrhea, nausea, vomiting, or anorexia.
GU: Negative for change in urinary pattern, dysuria, or incontinence. Normal urination urgency, hesitancy, odor, and color.
MS: Knee pain with no other joint pain; positive for clicking sound in the knee; negative for stiffness, back pain, or muscle pain; swelling on palpation; negative for skin coloring, rashes, or heat around the knee.
Psych: Denies history of anxiety or depression. Negative for sleep disturbance, delusions, or mental health history. No homicidal or suicidal history.
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Neurological: Negative for headache, dizziness, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.
Hematologic: No anemia, bleeding, or bruising. No history of clotting difficulties or transfusions
Endocrine: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia. No unintentional weight loss or weight gain.
Allergic/Immunologic: Allergic to penicillin. No known immune deficiencies.
OBJECTIVE DATA
Physical Exam:
Vital signs: B/P 138/90 mm Hg, left arm, sitting, regular cuff; P 90 and regular; T 98.6 °F Orally; RR 14 non-labored; Wt: 128 lbs; Ht: 5’9; BMI 18.9
General: A&O x4, NAD, appears comfortable
HEENT: PERRLA, EOMI, oronasopharynx is clear
Neck: Carotids no bruit, jvd or thyromegaly
Chest/Lungs: Negative for wheezing, negative for scattered rhonchi
Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses +2 bilat pedal and +2 radial
ABD: Nabs x 4, no organomegaly; no suprapubic pain or tenderness
Musculoskeletal: Symmetric muscle development; muscle strengths 5/5 all groups. The Differential Diagnoses For Knee Pain Assignment
Neuro: CN II – XII grossly intact, DTR intact
Diagnostics/Lab Tests and Results:
Complete Blood Count – Leukocytosis
Erythrocyte Sedimentation Rate – Within normal values
Rheumatoid Factor – Negative
CRP – Within normal values
Kee X-Ray
Magnetic resonance imaging
Assessment:
Differential Diagnosis (DDx):
- Chondromalacia patellae
- Juvenile Rheumatoid arthritis
- Osgood-Schlatter disease
- Patellar tendinitis
- Ligament sprain
Primary Diagnosis:
- Chondromalacia patellae
PLAN: [This section is not required for the assignments in this course, but will be required for future courses.] The Differential Diagnoses For Knee Pain Assignment
Differential Diagnosis (DDx)
Anatomic structures assessed as part of the physical examination in determining the cause of knee pain include ligaments, cartilage, condyle, patella, and tendons, the bones at the knee including the tibia, fibula, and femur (Ball et al., 2019). Some of the special maneuvers performed in knee assessment include palpation of the knee and the surrounding areas and passive, Lachman test, and active range of motion (ROM) of the knee. This will help determine the presence of edema and whether there is heat in the knee. The range of motion of the knee helps in determining the affected structure by assessing whether the pain is associated with passive or active motion or both. Pain felt with both passive and active motion is associated with joint pathology while pain that occurs only during active motion is associated with diseases outside the knee joint. Also, a complete neurological examination which involves a complete assessment of sensory and motor function and deep tendon reflexes is recommended (Dains et al., 2019)The Differential Diagnoses For Knee Pain Assignment.
Differential diagnoses for knee pain include Osgood-Schlatter disease, chondromalacia patellae, juvenile rheumatoid arthritis (JRA), Patellar tendinitis, and ligament sprain (Dains et al., 2019). This was considered based on the documented clinical data of the patient (Sullivan, 2018). Osgood-Schlatter disease is characterized by an inflammation of the area just below the knee where the patellar tendon attaches to the tibia. Pain and tenderness are felt when pressure is applied to the tibial tubercle. Chondromalacia patellae is characterized by the deterioration and softening of the cartilage on the undersurface of the patella (kneecap). It is associated with knee pain during active motion such as walking on stairs, kneeling, sitting cross-legged, squatting, or kneeling. The patient experiences these symptoms together with dull, aching pain felt even when the patient is resting. Patellar tendinitis occurs when the tendon connecting the kneecap (patella) to the shinbone is injured. It is characterized by stiffness, swelling, and pain in the knee. Juvenile rheumatoid arthritis is characterized by swelling of the knee, stiffness, heat, and knee pain. A rheumatoid factor test is done to confirm JRA. Negative RF indicates no presence of JRA. Osgood-Schlatter disease, chondromalacia patellae, patellar tendinitis, and JRA are common in children and adolescents and are associated with elevated levels of white blood cells, ESR, and CRP (Dains et al., 2019). A ligament sprain is the tearing or stretching of the ligament and is characterized by swelling, pain, heat, and limited movement. A negative Lachman test confirms no ligament sprain. Radiography results also ruled out fractures (Ball et al., 2019). Considering the subjective and the objective data together with laboratory and radiography results, the primary diagnosis is therefore Chondromalacia patellae.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Sullivan, D. D. (2018). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis The Differential Diagnoses For Knee Pain Assignment.
Differential Diagnoses for Knee Pain
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. Additional history needed to determine the cause of the knee pain include the nature of the onset of the pain whether gradual or sudden, factors that alleviate or gravitate the pain, and severity of the pain according to the patient; the presence of swelling or redness; sensation associated with movement such as snap, pop, or click; the presence of stiffness or movement limitations; events associated with the knee pain such as time of the day, daily activities, strenuous events, exercises, the specific type of movements, injuries; character of the episodes as to whether it gets better or worsens as the day progresses; treatment efforts such as physical therapy, rest, ice, heat, reduction of weight, exercise, splints or braces; medications that the patient has used for this condition and other conditions if the patient has; and allergies in regard to drugs, food, and environment (Ball et al., 2019)The Differential Diagnoses For Knee Pain Assignment.
Also to be considered is the past medical history of the patient and their immediate families such as parents, siblings, and offspring. Past medical history entails details such as immunization status and the dates the patient received the immunizations; past major or chronic illnesses experienced by the patient and their first-degree relatives, and cause of death if any; genetic disorders in the family; arthritis in the family such as rheumatoid, osteoarthritis, ankylosing spondylitis, gout; congenital anomalies or skeletal deformities; past traumatic events; and past major surgeries (Sullivan, 2018). The social history of the patient should also be taken. This includes the history of smoking, alcohol consumption (ETOH), or illicit drug use both previously and currently; occupation; education; family status; lifestyle and diet; and hobbies (Ball et al., 2019)The Differential Diagnoses For Knee Pain Assignment.
Physical examination entails a full examination conducted from head to toe and entails what the investigator sees, hears, and feels on the patient during the physical exam. Anatomic structures assessed as part of the physical examination in determining the cause of knee pain include ligaments, cartilage, condyle, patella, and tendons, the bones at the knee including the tibia, fibula, and femur (Ball et al., 2019). The first step in the physical examination is assessing the vital signs using various devices. Vital signs include temperature, blood pressure, pulse, respiratory rate, weight, and height (Dains et al., 2019). The general examination also checks for the presence of weight loss or gain, weakness, chill, or fever. The next step involves assessing whether the patient is alert and oriented to person, place, time, and event. The next step is to assess the head, eye, ear, nose, and throat (HEENT). This checks for the presence of change in vision, hearing, and difficulty in breathing. Procedures that follow include skin to check for rashes or itchiness; cardiovascular to check for pain, discomfort or edema; genitourinary to check for urine consistency, color, or burning; neurological to check for the presence of headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities; and musculoskeletal to check for stiffness and pain in the knee joint (Dains et al., 2019)The Differential Diagnoses For Knee Pain Assignment.
Some of the special maneuvers performed in knee assessment include palpation of the knee and the surrounding areas and passive and active range of motion (ROM) of the knee. This will help determine the presence of edema and whether there is heat in the knee. The range of motion of the knee helps in determining the affected structure by assessing whether the pain is associated with passive or active motion or both. Pain felt with both passive and active motion is associated with joint pathology while pain that occurs only during active motion is associated with diseases outside the knee joint. Also, a complete neurological examination which involves a complete assessment of sensory and motor function and deep tendon reflexes is recommended (Dains et al., 2019). Diagnostic lab tests to be done in order to determine the cause of knee pain include Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), Rheumatoid Factor (RF), and C-reactive protein (CRP). Radiography such as knee X-Ray and magnetic resonance imaging (MRI) is also done to rule out some diseases and injuries.
Differential diagnoses for knee pain include Osgood-Schlatter disease, chondromalacia patellae, juvenile rheumatoid arthritis (JRA), Patellar tendinitis, and ligament sprain (Dains et al., 2019). Osgood-Schlatter disease is characterized by an inflammation of the area just below the knee where the patellar tendon attaches to the tibia. Pain and tenderness are felt when pressure is applied to the tibial tubercle. Chondromalacia patellae is characterized by the deterioration and softening of the cartilage on the undersurface of the patella (kneecap). It is associated with knee pain during active motion such as walking on stairs, Kneeling, sitting cross-legged, squatting, or kneeling. Patellar tendinitis occurs when the tendon connecting the kneecap (patella) to the shinbone is injured. It is characterized by stiffness, swelling, and pain in the knee. Juvenile rheumatoid arthritis is characterized by swelling of the knee, stiffness, heat, and knee pain. A rheumatoid factor test is done to confirm JRA. Positive RF indicates the presence of JRA. Osgood-Schlatter disease, chondromalacia patellae, patellar tendinitis, and JRA are common in children and adolescents and are associated with elevated levels of white blood cells, ESR, and CRP (Dains et al., 2019). A ligament sprain is the tearing or stretching of the ligament and is characterized by swelling, pain, heat, and limited movement. A positive Lachman test confirms ligament sprain. Radiography is also done to rule out fractures (Ball et al., 2019)The Differential Diagnoses For Knee Pain Assignment.
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References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Sullivan, D. D. (2018). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis The Differential Diagnoses For Knee Pain Assignment