Patient Information:
Patient Name: Majid Ali
Date of Birth: 15th June 1990
Date of Admission: 10th August 2023
Date of Discharge: 25th August 2023
Presenting Complaints:
Patient is 33-year-old male, presented with complaints of persistent pain, swelling, and limited range of motion in his right knee. He mentioned that the pain started insidiously a few months ago and has been gradually worsening. He reported difficulty in walking, climbing stairs, and performing activities that involve bending the knee.
History of Presenting Complaints:
Majid recalled no specific traumatic incident that triggered the symptoms. The pain initially started as a mild discomfort but progressed to a sharp, localized pain in the medial aspect of his right knee. The swelling was intermittent but worsened after prolonged standing or activity.
Chief Complaints:
Pain in the right knee, localized to the medial side.
Swelling around the knee joint.
Limited range of motion, particularly during flexion.
Past Medical and Surgical History:
Majid had no significant past medical history, chronic illnesses, or surgical interventions related to his knee or any other body part.
Family History:
There was no family history of knee-related disorders or joint issues.
Socioeconomic Status:
Majid had a middle-class socioeconomic background and worked as an office administrator.
Present and Pre-Morbid Functional Status:
Before the onset of symptoms, Majid led an active lifestyle, frequently participating in jogging and light gym workouts. He had no history of knee problems or joint-related limitations.
General Health Status:
Majid’s general health was otherwise stable, with no ongoing illnesses or medications.
Vitals:
Blood Pressure: 120/80 mmHg
Heart Rate: 70 bpm
Respiratory Rate: 16 breaths per minute
Temperature: 98.6°F (37°C)
Aggravating Factors:
Pain and swelling were aggravated by prolonged standing, walking, and activities that required flexing of the knee joint.
Easing Factors:
Rest and elevation of the affected knee provided some relief from pain and swelling.
Examination:
Physical examination revealed tenderness over the medial femoral condyle of the right knee. There was mild effusion, and crepitus could be elicited during passive and active knee flexion. The range of motion was limited, with pain reported during flexion beyond 90 degrees.
Sleep and 24-hour Pattern:
Majid reported difficulty falling asleep due to pain and discomfort. His sleep was often disrupted, leading to fatigue during the day.
Duration of Current Symptoms:
The symptoms had been present for approximately 5 months.
Mechanism of Injury/Current Symptoms:
Majid denied any specific traumatic event. The gradual onset of pain and limited range of motion suggested a possible degenerative process rather than an acute injury.
Progression Since the Current Episode:
Majid noted a gradual worsening of his symptoms over the past few months. Initially, he could perform most activities with minor discomfort, but the pain and limitations had progressively increased.
Significant Prior History:
There was no significant prior history of joint-related issues or similar symptoms.
Previous Treatment:
Majid had attempted over-the-counter pain medications and intermittent rest for symptom relief, but no formal medical treatment had been sought before his presentation.
Diagnostic Test/Imaging:
X-rays and an MRI of the right knee revealed an osteochondral lesion in the medial femoral condyle, consistent with osteochondritis dissecans.
Differential Diagnosis:
Meniscal Tear
Ligamentous Injury
Patellofemoral Syndrome
Osteoarthritis
Postural Observation:
Majid displayed a slightly antalgic gait with a mild lean to the left side to offload the painful right knee.
Precaution and Contraindications:
Weight-bearing activities and high-impact exercises were contraindicated to prevent exacerbation of the condition.
Functional Movement Analysis (Sign):
Observation of Majid’s gait revealed decreased knee flexion during the swing phase of walking, likely due to pain and stiffness.
Quick Screening Tests/Clearing of Additional Joint Structures:
Lachman’s Test and Anterior Drawer Test were negative for ligamentous instability.
Range of Motion (ROM):
Passive and active knee flexion was limited to approximately 90 degrees due to pain.
Special Tests:
McMurray’s Test and Thessaly Test were negative for meniscal involvement.
Assessment:
Majid presented with osteochondritis dissecans of the right knee, resulting in pain, swelling, and limited range of motion.
Problem List/Complaints:
Medial knee pain and tenderness
Swelling around the knee joint
Limited knee flexion range of motion
Sleep disturbances due to pain
Treatment:
Pain management with non-steroidal anti-inflammatory drugs (NSAIDs)
Activity modification and rest
Physical therapy to improve joint mobility and muscle strength
Knee brace to offload the affected area
Referral to an orthopedic specialist for consideration of surgical intervention if conservative measures fail
Prognosis:
With appropriate management, including conservative treatments and potential surgical intervention if needed, Majid’s prognosis for symptom relief and functional improvement is positive.
Goals:
Reduce pain and swelling
Improve range of motion and joint mobility
Restore functional ability and quality of life
Interventions:
Pharmacological pain management
Physical therapy for joint mobilization and strengthening exercises
Patient education on activity modification and joint protection
Surgical consultation if conservative treatments are ineffective
Patient Education:
Majid was educated about his condition, the importance of adherence to treatment, activity modification, and the potential need for surgery if conservative measures do not yield desired results.
Patient/Family Education:
Majid’s family was educated on providing support during his recovery, encouraging adherence to treatment plans, and helping create a conducive environment for his rehabilitation.
Discharge Plan:
Majid was discharged with a prescription for NSAIDs, instructions for physical therapy sessions, and a knee brace. A follow-up appointment was scheduled with the orthopedic specialist in four weeks to assess progress and consider further interventions if needed. He was advised to gradually resume activities as pain and function improved.