Background

This case looks at chronic knee pain without an obvious cause. It focuses on designing an effective management approach without clear objective findings.

Minimum Level

New graduate Physiotherapist

Case study

David, a 48 year old male, presents with chronic knee pain on his Right side. He is active and surfs regularly as well as doing weekly boot camp classes (group fitness classes). He has an average build and is not overweight.

Does David’s regular exercise and build alter your clinical reasoning on the possible causes of the pain?

Mentor’s reasoning:

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What are the diagnostic considerations of unilateral vs bilateral symptoms?

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The chronic knee pain has been around for over 5 years but has become more consistent and functionally limiting in the last 3 months.

Does the duration of symptoms indicate a greater likelihood of any particular conditions or injuries?

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David’s chronic knee pain is diffuse and vague with most pain is located on the medial aspect of the knee. It can shift around to posteromedial or anteromedial pain at times.

Does the vague or shifting nature of the pain impact your diagnostic reasoning?

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There is occasional swelling noted but it’s not consistent or associated with any specific activity.

Discuss the presence of occasional but inconsistent swelling related to your diagnosis and management

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David’s local doctor ordered an X-ray two months ago but it came back without any significant findings.

What are the limitations of X-ray imaging in this case and related to your diagnostic hypotheses?

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Further questioning

What further questions would you ask David?

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What information are you hoping to gain?

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How would that impact your diagnostic or management reasoning?

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Physical examination planning

Which tests are most important for diagnostic info?

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Which tests will help inform your management approach?

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Which tests may help to benchmark or monitor David’s progress?

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Management approach

Design a management plan with the information above

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Is there any research support for your chosen approach?

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Expected timeframes for response to treatment

How long until David should expect to notice an improvement?

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How long will the symptoms take to subside completely?

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