Patient Information:

Name: John Smith

Age: 28

Gender: Male

Occupation: Software Engineer

Socioeconomic Status: Middle class

Date of Presentation: 2023-07-15

Presenting Complaints:

John Smith presented to the clinic with complaints of persistent pain in both knees, more pronounced in his right knee. He described the pain as a dull ache located around the front of the knee, especially when he climbs stairs, runs, or sits for an extended period. The pain has been gradually worsening over the past three months, affecting his daily activities and his ability to engage in his regular running routine.

History of Presenting Complaints:

John initially noticed mild discomfort during his runs, which he attributed to overtraining and ignored. However, the pain persisted and gradually intensified, leading him to seek medical attention. He attempted to alleviate the pain with rest and over-the-counter pain medications, but the symptoms persisted despite his efforts.

Chief Complaints:

Persistent bilateral knee pain, worse in the right knee.

Pain aggravated by running, climbing stairs, and prolonged sitting.

Decreased ability to maintain his regular running routine.

Discomfort affecting daily activities and lifestyle.

Past Medical and Surgical History:

No significant prior medical conditions or surgeries.

Family History:

No family history of knee-related issues.

Present and Pre-morbid Functional Status:

Prior to the onset of symptoms, John had an active lifestyle and regularly engaged in running and other cardiovascular exercises. He had no known functional limitations.

General Health Status:

Overall, John was in good health with no other significant medical concerns.

Vitals:

Blood Pressure: 120/80 mmHg

Heart Rate: 75 bpm

Respiratory Rate: 16 breaths/min

Temperature: 98.6°F (37°C)

Aggravating Factors:

Running or engaging in high-impact activities

Climbing stairs

Prolonged sitting with knees bent

Easing Factors:

Rest

Straightening the knees

Application of ice

Examination:

Palpation of the patella revealed tenderness around the medial and lateral borders.

Mild swelling and crepitus were noted during knee flexion and extension.

Active and passive range of motion was within normal limits, but squatting caused discomfort.

No signs of significant joint instability.

Sleep and 24-hour Pattern:

John reported that the pain did not significantly affect his sleep. However, he mentioned that the pain was typically worse after prolonged periods of inactivity, such as sitting at his desk for work.

Duration of Current Symptoms:

Symptoms have been present and gradually worsening over the past three months.

Mechanism of Injury/Current Symptoms:

There was no specific traumatic event that triggered the symptoms. The pain seemed to develop gradually, likely due to repetitive stress on the patellofemoral joint during running and other activities.

Progression Since the Current Episode:

The symptoms initially began as mild discomfort during runs and have progressively worsened to the point where the pain is now affecting daily activities and lifestyle.

Significant Prior History:

No significant prior history of knee injuries or chronic pain.

Previous Treatment:

John attempted to self-treat with rest, over-the-counter pain medications, and modification of his running routine, but these interventions provided only temporary relief.

Diagnostic Test/Imaging:

X-ray imaging of the knees revealed no structural abnormalities or signs of osteoarthritis. MRI was not conducted due to the absence of red flags for more serious conditions.

Differential Diagnosis:

Patellofemoral Pain Syndrome (Runner’s Knee)

Iliotibial Band Syndrome

Patellar Tendinopathy

Meniscus Injury

Postural Observation:

John demonstrated a slightly valgus knee alignment (knock-knee), which can contribute to patellofemoral pain.

Precaution and Contraindications:

Avoid high-impact activities that exacerbate the pain.

Temporary reduction in running intensity and duration.

Avoid prolonged sitting with knees bent.

Functional Movement Analysis (Sign):

Squatting or descending stairs caused discomfort and crepitus around the patella.

Quick Screening Tests/Clearing of Additional Joint Structures:

No signs of ligament instability or meniscal abnormalities during knee stability testing.

No neurological deficits observed.

Range of Motion (ROM):

Active and passive range of motion within normal limits.

Special Tests:

Patellar Compression Test: Positive for tenderness around the patella.

McConnell Test: Positive for pain during resisted knee extension.

Assessment:

Diagnosis: Patellofemoral Pain Syndrome (Runner’s Knee)

Contributing Factors: Repetitive stress on the patellofemoral joint, slight valgus knee alignment, overuse.

Problem List/Complaints:

Bilateral knee pain, worse on the right side.

Pain during running, climbing stairs, and prolonged sitting.

Decreased ability to engage in regular running routine.

Treatment:

Pain Management:

Rest and activity modification.

Ice application after activities.

Over-the-counter pain relievers as needed.

Physical Therapy:

Quadriceps and hip strengthening exercises to improve patellar tracking.

Hamstring and calf stretches.

Patellar taping or bracing for temporary support.

Prognosis:

With appropriate management, John’s symptoms are likely to improve over time. However, compliance with the treatment plan and gradual return to running are crucial to prevent recurrence.

Goals:

Alleviate pain and discomfort.

Improve patellar tracking and muscle imbalances.

Gradually resume running without exacerbating symptoms.

Interventions:

Regular physical therapy sessions focusing on strengthening, flexibility, and biomechanical correction.

Education on proper warm-up, cool-down, and gradual return to running.

Patient Education:

Explanation of the condition and contributing factors.

Importance of adherence to the treatment plan.

Emphasis on proper running technique and footwear.

Self-management techniques for pain relief.

Patient/Family Education:

Family involvement in providing support and encouragement.

Understanding the need for gradual progression in activities.

Discharge Plan:

Continued physical therapy sessions as needed.

Regular follow-up appointments to monitor progress.

Gradual return to running and other activities under the guidance of a physical therapist.

Emphasis on long-term preventive strategies and maintaining a balanced exercise routine.