Patient Information:
Age: 55
Gender: Male
Occupation: Construction Worker
Socioeconomic Status: Lower-middle class
Presenting Complaints:
The patient presented with the following complaints:
- Swelling and discomfort behind the knee.
- Pain and stiffness during walking and bending the knee.
- Restricted range of motion in the affected knee.
- Feeling of tightness or aching sensation.
History of Presenting Complaints:
The patient noticed the swelling and discomfort behind the knee about three months ago. The symptoms gradually worsened over time, especially after prolonged periods of walking or physical activity. The patient also mentioned occasional episodes of sharp pain in the knee.
Chief Complaints:
- Swelling and discomfort behind the knee.
- Pain and stiffness during movement.
- Restricted range of motion.
Past Medical and Surgical History:
The patient had a history of osteoarthritis in both knees, with previous treatment involving non-steroidal anti-inflammatory drugs (NSAIDs) for symptom management. There was no history of previous knee surgeries or significant medical conditions.
Family History:
There was no significant family history of joint disorders or knee-related issues.
Socioeconomic Status:
The patient belongs to the lower-middle class and has limited access to healthcare resources. Financial constraints may affect treatment options and follow-up care.
Present and Pre-morbid Functional Status:
The patient’s present functional status is limited due to pain and stiffness in the affected knee. He experiences difficulty with activities requiring knee flexion and extension, such as climbing stairs, prolonged standing, and squatting. The pre-morbid functional status was relatively normal, with occasional knee discomfort during strenuous activities.
General Health Status:
Apart from the knee-related issues, the patient reported no significant health concerns or comorbidities. He had no known allergies to medications.
Vitals:
Blood pressure: 130/80 mmHg
Heart rate: 75 bpm
Respiratory rate: 16 breaths per minute
Temperature: 98.6°F (37°C)
Aggravating Factors:
Prolonged walking or physical activity exacerbates the swelling, discomfort, and pain in the affected knee.
Easing Factors:
Resting, elevating the leg, and applying cold compresses temporarily alleviate the symptoms.
Examination:
- Visual inspection reveals swelling and fullness behind the knee.
- Palpation confirms the presence of a fluid-filled mass, consistent with a Baker’s cyst.
- Range of motion is restricted, particularly during knee flexion and extension.
- The affected knee joint shows signs of mild effusion and tenderness.
- No signs of redness, warmth, or joint instability are observed.
Sleep and 24-hour Pattern:
The patient experiences occasional sleep disturbances due to discomfort and pain in the affected knee, but there are no significant changes in sleep patterns or sleep quality.
Duration of Current Symptoms:
The patient has been experiencing symptoms of swelling and discomfort behind the knee for approximately three months.
Mechanism of Injury/Current Symptoms:
There was no history of direct trauma or injury to the knee. The symptoms of swelling, discomfort, and restricted range of motion developed gradually without a specific triggering event.
Progression Since the Current Episode:
The symptoms have gradually worsened since the onset of the condition, especially with increased activity levels and prolonged weight-bearing on the affected knee.
Significant Prior History:
The patient’s significant prior history includes osteoarthritis in both knees and previous treatment with NSAIDs for symptom management.
Previous Treatment:
The patient had been managing his osteoarthritis symptoms with over-the-counter NSAIDs, including ibuprofen, as needed. No other specific treatments or interventions were previously administered.
Diagnostic Test/Imaging:
- Ultrasound or MRI may be performed to confirm the presence of a Baker’s cyst and assess its size and location.
- X-ray imaging may be used to evaluate the knee joint and rule out other potential causes of symptoms, such as osteoarthritis or fractures.
Differential Diagnosis:
- Baker’s cyst
- Osteoarthritis
- Meniscal tear
- Ligamentous injury
- Deep vein thrombosis
Postural Observation:
The patient may exhibit a slight antalgic gait due to discomfort and limited range of motion in the affected knee.
Precaution and Contraindications:
Avoid activities that exacerbate pain and discomfort, such as excessive walking or strenuous exercises.
Caution against applying excessive pressure or massage directly on the cyst.
Functional Movement Analysis (Sign):
Decreased range of motion during knee flexion and extension.
Quick Screening Tests/Clearing of Additional Joint Structures:
- Lachman’s test to rule out anterior cruciate ligament (ACL) injury.
- Varus and valgus stress tests to assess collateral ligament integrity.
- McMurray’s test to assess meniscal integrity.
Range of Motion (ROM):
Limited range of motion during knee flexion and extension, with pain and discomfort.
Special Tests:
- Ultrasound or MRI to confirm the presence and size of the Baker’s cyst.
- X-ray imaging to evaluate the knee joint and rule out other possible causes of symptoms.
Assessment:
The patient’s assessment indicates the presence of a Baker’s cyst, likely secondary to osteoarthritis in the affected knee.
Problem List/Complaints:
- Swelling and discomfort behind the knee.
- Pain and stiffness during movement.
- Restricted range of motion.
Treatment:
- Conservative management, including rest, activity modification, and elevation of the affected leg.
- Pain relief using over-the-counter NSAIDs.
- Physical therapy to improve range of motion and strengthen the muscles surrounding the knee joint.
- Aspiration of the cyst or corticosteroid injection may be considered for symptomatic relief in severe cases.
Prognosis:
With appropriate treatment and management, the prognosis for Baker’s cyst is generally favorable. However, without addressing the underlying cause (e.g., osteoarthritis), recurrence of the cyst is possible.
Goals:
- Reduce swelling and discomfort in the affected knee.
- Improve range of motion and functional mobility.
- Manage pain and stiffness during movement.
- Prevent recurrence of the cyst.
Interventions:
- Educate the patient about the nature of Baker’s cyst, its relationship to osteoarthritis, and the importance of adherence to the treatment plan.
- Administer NSAIDs for pain relief as needed.
- Prescribe physical therapy exercises to improve knee range of motion and strengthen surrounding muscles.
- Monitor the response to conservative management and consider additional interventions if necessary.
Patient Education:
- Educate the patient about the importance of rest and activity modification to reduce symptoms.
- Provide instructions on proper use of NSAIDs for pain management.
- Teach the patient stretching and strengthening exercises to improve knee function.
- Discuss the potential benefits and risks of cyst aspiration or corticosteroid injection if indicated.
Patient/Family Education:
- Involve family members in discussions to ensure their understanding of the condition and treatment plan.
- Encourage family support for activity modification and adherence to the prescribed exercises.
- Discuss the importance of creating a supportive environment at home to facilitate the patient’s recovery.
Discharge Plan:
Provide a detailed home exercise program with instructions on frequency and technique.
Schedule follow-up appointments to monitor progress and adjust treatment if necessary.
Advise the patient to seek medical attention if symptoms worsen or new symptoms develop.
Provide contact information for healthcare professionals to address any concerns or questions.