12.Wk8DisRe2
Kris/Sin (ignore this)
Choose a classmate who was assigned a different case study than you. Analyze the possible conditions from your colleagues' differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning. (Doesn’t need to be super in depth. 2 paragraphs and 2-3 source will be fine)
Post:
Patient Information:
NS, 15 y/o, Male, Caucasian
S.
CC: Dull pain in bilateral knees.
HPI: He describes that sometimes one or both knees will click and that there is a catching sensation under the patella. This started a week ago. The knees will sometimes ache and feel like they are going to give out on him. It will often occur during and after playing soccer. He reports that his mother sometimes will give him Motrin and that it helps to relieve the pain along with some rest and ice after the soccer games. He reports the pain is currently a 0/10 but when it is it’s worse it will be a 6/10.
Current Medications: Motrin 200mg every 4-6 hours as needed for the pain; daily multivitamin.
Allergies: denies medication allergies. Denies food and environmental allergies. Denies latex allergies.
PMHx: immunizations are up to date, denies past major illnesses and surgeries. Denies any trauma or injuries.
Soc Hx: no smoking or use of illicit drugs. Enjoys playing sports and is currently enjoying soccer. Denies that he is dating currently but reports he likes females. He eats a nutritionally balanced diet with adequate fruits and vegetables. Denies drinking soda or energy drinks. He attends school and is in the 9th grade and reports good grades. Reports he has friends and a supportive family.
Fam Hx: father is 45 y/o with hypertension; mother is 45 y/o and has asthma; 13 y/o sister is without medical issues. Maternal grandmother is 68 y/o and has hypertension and hyperlipidemia as well as maternal grandfather who is 69 y/o; paternal grandmother is 69 y/o and has hypertension and hyperlipidemia; paternal grandfather passed away at 70 y/o of a stroke.
ROS:
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: reports a clicking and catching sensation under patella.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
Physical exam:
GENERAL: NS is a well-developed, well-nourished 15 y/o Caucasian male who is alert and cooperative. He is a good historian and answers questions appropriately.
Vital Signs: BP- 106/65; P- 88; R-18; O2- 100%; Temp- 98.2; Weight- 115; Height- 5’7”
SKIN: No rashes or itching. No redness or bruising noted.
NEUROLOGICAL: reflexes intact
MUSCULOSKELETAL: point tenderness over the patellar tendon. Reduced ROM in the knee with edema present. Positive McMurray test. Positive drawer test. Positive Lachman test.
LYMPHATICS: No noted lymphadenopathy in the axillary, inguinal, supraclavicular
Diagnostic results:
1. Xray: joint line elevation has been shown to increase patellofemoral compression forces and altered knee kinematics (Lutz, Trubrich, Kappe, Reichel, and Bieger, 2018).
2. MRI: specific imaging characteristics in a common location after sports injury allows for early identification (Rapp, Barrera, and Ho-Fung, 2019).
3. Ultrasound: helps identify the presence of a hypoechoic region on an ultrasonographic image (Hutchison, Houck, Cuddeford, Dorociak, and Brumitt, 2019).
A .
Differential Diagnoses:
1. Torn meniscus: patients report "mechanical symptoms," the sensation of knee catching or locking (Sihvonen, Englund, Turkiewicz, Järvinen, and Finnish Degenerative Meniscal Lesion Study Group, 2016).
2. Patellar Pain Syndrome: is characterized by anterior, retro patellar or peripatellar pain and its etiology is multifactorial including quadriceps weakness, excessive flattening of the medial arch and instability of the forefoot influencing internal rotation of tibia, compensatory internal rotation of femur, and consequent patellar malalignment (Kaya, Aksahin, and Doral, 2018).
3. ACL injury: The anterior cruciate ligament (ACL) is the region where spraining or tearing is most prevalent when the knee is injured (Yoo Na, Jungwon, Young Hoon, Jaewoong, Yu Ri, Min soo, Young chan, Hue Jung, 2020).
4. Patellar tendinitis: Patellar tendinopathy was identified based on a player’s symptoms (pain with palpation) (Hutchison, Houck, Cuddeford, Dorociak, and Brumitt, 2019).
5. Iliotibial band syndrome: It is a non-traumatic overuse injury caused due to repetitive flexion and extension of knee which results in repetitive friction of ITB over the lateral femoral epicondyle (Baruah and Vijayakumar, 2020).
P.
This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Baruah, S., & Vijayakumar, R. V. (2020). Cross-Sectional Study to Identify Iliotibial Band Syndrome Causes among Treadmill Runners and Its Impact on Functional Activities. Indian Journal of Physiotherapy & Occupational Therapy, 14(1), 265–270. https://doi-org.ezp.waldenulibrary.org/10.5958/0973-5674.2020.00047.7
Hutchison, M. K., Houck, J., Cuddeford, T., Dorociak, R., & Brumitt, J. (2019). Prevalence of Patellar Tendinopathy and Patellar Tendon Abnormality in Male Collegiate Basketball Players: A Cross-Sectional Study. Journal of Athletic Training (Allen Press), 54(9), 953–958. https://doi-org.ezp.waldenulibrary.org/10.4085/1062-6050-70-18
Kaya, D., Aksahin, E., & Doral, M. N. (2018). Functional hyper-extension deficit of the knee and patellar dimple sign in patellofemoral pain syndrome. A preliminary study. Muscles, Ligaments & Tendons Journal (MLTJ), 8(4), 473–476.
Lutz, B., Trubrich, A., Kappe, T., Reichel, H., & Bieger, R. (2018). The epicondylar ratio can be reliably used on X-ray of the knee to determine the joint line. Archives of Orthopaedic & Trauma Surgery, 138(9), 1287–1292. https://doi-org.ezp.waldenulibrary.org/10.1007/s00402-018-3003-0
Rapp, J. B., Barrera, C. A., & Ho-Fung, V. M. (2019). Morel-Lavellée lesions: MRI characteristics in the pediatric patient. Pediatric Radiology, 49(4), 559–565. https://doi-org.ezp.waldenulibrary.org/10.1007/s00247-018-4328-0
Sihvonen, R., Englund, M., Turkiewicz, A., Järvinen, T. L. N., & Finnish Degenerative Meniscal Lesion Study Group. (2016). Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. Annals of Internal Medicine, 164(7), 449.
Yoo Na, K., Jungwon, B., Young Hoon, K., Jaewoong, H., Yu Ri, K., Min soo, L., Young chan, K., & Hue Jung, P. (2020). Full recovery of near complete tear of anterior cruciate ligament without surgery: a case report. Medicine, 99(18), e19899. https://doi-org.ezp.waldenulibrary.org/10.1097/MD.0000000000019899