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?
Assessing Musculoskeletal Pain: Knee
Patient Initials: MA Age: 15 years Gender: Male
Chief Complaint (CC): “My knees hurt, panful and with clicking sound. I experience catching sensation under the patella. ” The additional history will be assessed by asking questions related to the onset of the pain in terms of acute or gradual, duration of the pain and its associated symptoms and previous treatment for the pain.
History of Present Illness (HPI): MA is a high school sophomore who came to the doctor complaining of knee pain. He is an active basketball player for his school team. He started experiencing knee pain in the last week. He claims to be suffering clicking sounds from both knees.
Location: bilateral knees.
Onset: Eight days while playing basketball.
Character: Dull intermittent pain.
Associated signs and symptoms: A catching sensation under kneecaps.
Timing: For the past 8 dyas.
Exacerbating/ relieving factors: gets worst while patient treks to school. The pain subsides with mediciation rest and ice pack.
Severity: 7 on a pain scale of 1-10 after pain medication Ibuprofen 200mg 2 tabs orally was taken and 10/10 worst pain level after a trek to school.
Allergies: No allergy to medication but allergic to shellfish.
Past Medical History (PMH): The patient sprained his left knee four months ago, and history of Rheumatic fever during his early childhood.
Past Surgical History (PSH): No history of medical surgery.
Sexual/Reproductive History: None. The patient is not sexually active.
Personal/Social History: Denies smoking, drinking alcohol, or using any other drugs.
Immunization History: All immunizations are up to date as per the parents. Received flu vaccine 10/5/19.
Significant Family History: MA lives with his parents. Both grandfathers have diabetes, his mother is obese. His two other siblings are healthy. The family has a history of obesity.
Review of Systems: MA has presented a complaint of dull knee pain that he experiences in both knees. The pain is clicking and accompanied with a catching sensation under the patella. The pain mostly persists during physical activity.
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