1steval

Maeghan is a 15 year old white female kindly referred for left knee pain. This young lady has a history of acute onset of left anterior knee pain a week ago. She relates she was riding in a car, had been in the car about twenty minutes when she suddenly felt severe left anterior knee pain. She has no specific history of an injury to it, either acutely or remotely. She has not had locking, buckling, collapsing or giving way. Not much in the way of swelling. It has been predominantly anterior knee pain to the point that she is having some difficulty walking.

Reveals a well-developed, well-nourished white female in no acute disress. Her overall alignment shows slight valgus alignment of her knee. She does have some bilateral squinting of the [atella, left perhaps a little worse then the right. There is no effusion of the joint. Collaterals are intact to varus and valgus stress at 0 and 30 degrees. Lachman's test is negative. There is no posterior or posterolateral rotary instability. There is some minial discomfort expressed by patient when either the medial or lateral joint lines are palpated but nothing severe. McMurray's test is totally unremarkable. She has no deinite patellofemoral crepitance but she does have a positive inhibition. Apprehension is negative. Tracking appears normal. Q-angle appears normal. Patellar tendon, fat pad and tibial tubercle all apear normal. The left hip exam shows full range of motion without pain. Distal neurologic and vascular exams of the left lower extremity are intact.

I told Mom that her History and Physical and x-ray findings are not conclusively diagnostic of anything. I am most concerned that this is chondromalacia of the patella, although I could not exclude the possibility of a medial meniscal tear. I see no eveidence on x-ray that this is a tumor or anything serious. Her hip exam also is benign so I would doubt this is referred pain from her hip. I have elected to recommend changing her from Voltaren to Advil 600mg three times a day to take with food or milk. I have told Mom she could develop some nausea, vomiting, diarrhea, easy bruising, etc. If those happen, she is to stop it immediately. She is also to work on VMO exercises, avoid aggravating activity such as squatting, kneeling, stair climbing, etc. Since she is so painful, I have recommended that she go on some crutches for a few days until the acute pain subsides and she gets enough medication on board to reduce the inflammation. I will follow her up again in a few weeks. If her symptoms change, get worse, she is to let us know and I will see her shortly thereafter.

Avoid Kneeling, Squatting, Walking up and down stairs and hills.

Avoid Extending the knee from a 90 degree angle.

Avoid lateral lef raises that extend the hip outward.

Avoid sitting for long periods of time.

Avoid activities which include squatting, sitting with knees bent, and deep knee bends.

Avoid running and jumping.

Quad Set: Straighten knee. Rotate leg outward, tense the muscles in front of thigh as tight as possible and hold tension for 6 seconds, release.
Straight Leg Raise: Straighten knee and tense muscle as above, keep knee as straight as possible and lift 3 to 6' inches upwards. Hold for 6 seconds.
Progressive Short Arc Set: Same postion as above, place small towel roll under knee( to create a small bend), straighten (lift foot upwards until leg is straight) knee and hold extended for 6 seconds.

Bicycle riding: Important that seat is adjusted properly.

Swimming: Best when knees are kept relatively straight when kicking.