Case 4

Jesse is a fifteen-year-old who presents with a six-month history of right knee swelling, restriction of motion and pain. He does not recall any specific injury, although he is generally very active in sports (hockey, volleyball, basketball) and has had many bangs and bruises over the last several years. His problem has been slowly progressive over the last few months and has caused him to drop out of gym and not participate in hockey this year. He is otherwise healthy and has no allergies. His only medications are occasional over-the-counter analgesics (acetaminophen and ibuprofen) which he takes rarely (once or twice a week) if his knee is particularly sore.

Image credit: L. Davidson

1. What anatomic structure(s) may be the source of this patient's pain?
2. What features of the physical exam will help you make a diagnosis?
3. What imaging would be helpful and what would you expect to see?

 

 

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