A 58-year old obese man complains of pain in his left knee. The pain seems to be unrelenting, he says it is better when he rests, but gets stiff when he rests too long.

A 58-year old obese man complains of pain in his left knee. The pain seems to be unrelenting, he says it is better when he rests, but gets stiff when he rests too long.

A 58-year old obese man complains of pain in his left knee. The pain seems to be unrelenting, he says it is better when he rests, but gets stiff when he rests too long.

Week 3 680 B: Knee Pain

Subjective Data

CC: A 58-year-old male patient who is obese presents with a chief complaint of pain in his left knee. He reports the pain is unrelenting, and better when resting. His knee however stiffens when he rests for too long.

Assessment Questions:

            For further assessment of the patient’s conditions, most questions will mainly revolve around the chief complaint of left knee pain. The patient should describe the pain in terms of severity, intensity, onset, duration, and exact location. The patient should also be asked to state the exact cause of the pain, and whether he has been taking any medication to manage the pain. He also needs to specify whether he has a history of pseudogout, gout, and rheumatoid arthritis among other degenerative joint diseases (Bunt et al., 2018). It is also necessary to ask the patient about the use of alcohol or tobacco, in addition to health promotion practices like exercise.

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Objective Data

Physical Examination

            The patient’s vitals must be taken, especially BMI to evaluate the extent of his obesity. For further evaluation of the patient’s chief complaint, the clinician must inspect the affected area for bruising, redness, discoloration, or swelling (Chen et al., 2020). Palpate the left knee of the patient for warmth, tenderness, or effusion. Examine the patient’s knee movement in the short arc of motion to identify the joint lines and evaluate the range of motion.

Diagnostics

• Patellar grind test to assess the reason behind the patient’s left knee pain.
• X-ray, Arthroscopy, or MRI to determine whether anatomical deformities are the reason behind the patient’s pain (Chen et al., 2020).

Assessment

Differentia Diagnosis

1. Osteoarthritis: This condition normally occurs when the cartilage cushioning the bone ends, where down over time. Studies show that this condition commonly affects joints that bear a lot of weight such as knees and hips, hence having excessive weight can precipitate the disease (Chen et al., 2020). The patient in the provided case study is obese, and complains of knee pain, making this the most probable diagnosis.
2. Chondromalacia patellae: This is a form of anterior knee pain that is caused by physical and biochemical changes that deteriorates the cartilage. The patient is positive for knee pain which is better with rest (Bunt et al., 2018). MRI scan is however needed to confirm this diagnosis.
3. Patellar tendinitis (Jumper’s knee): It is characterized by inflammation of the patient’s patellar tendon leading to pain and tenderness around the affected area, just as displayed by the patient (Afzali et al., 2018). In addition to medical history, X-ray results are needed to confirm this diagnosis.

Working Diagnosis: Osteoarthritis

Plan

Pharmacotherapy: Analgesics such as acetaminophen or NSAIDs are considered the first choice for the management of a patient’s knee pain (Chen et al., 2020).

Non-Pharmacological: Knee braces and knee sleeves help in the management of knee pain by limiting movement (Taylor, 2018).

Diagnostics: Patellar grind test, X-ray, Arthroscopy, or MRI to determine the cause of the patient’s pain.

Health Education: The patient should be educated on the need of avoiding strenuous activities which would otherwise injure his knee further (Taylor, 2018).

Lifestyle changes: Healthy diet and physical activity will help the patient reduce his weight and limit the risks of osteoarthritis (Bunt et al., 2018).

Preventive care: Screen for type 2 diabetes and blood pressure. Counsel the patient on diet and exercise (Taylor, 2018).

Follow up: The patient should report back to the clinic after 1 week for further evaluation of his knee pain and treatment outcome.

 References

Afzali, T., Fangel, M. V., Vestergaard, A. S., Rathleff, M. S., Ehlers, L. H., & Jensen, M. B. (2018). Cost-effectiveness of treatments for non-osteoarthritic knee pain conditions: A systematic review. PLoS One, 13(12), e0209240. https://doi.org/10.1371/journal.pone.0209240

Bunt, C. W., Jonas, C. E., & Chang, J. G. (2018). Knee pain in adults and adolescents: the initial evaluation. American family physician, 98(9), 576-585. https://www.aafp.org/afp/2018/1101/p576.html

Chen, L., Zheng, J. J. Y., Li, G., Yuan, J., Ebert, J. R., Li, H., … & Zheng, M. (2020). Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading. Journal of orthopaedic translation, 24, 66-75. https://doi.org/10.1016/j.jot.2020.05.001

Taylor, N. (2018). Nonsurgical management of osteoarthritis knee pain in the older adult: an update. Rheumatic Disease Clinics, 44(3), 513-524. https://doi.org/10.1016/j.rdc.2018.03.009

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A 58-year old obese man complains of pain in his left knee. The pain seems to be unrelenting, he says it is better when he rests, but gets stiff when he rests too long.
For the case you have chosen, post to the discussion:
Some knee pain my be: Chondromalacia patellae
Patellar tendinitis (Jumper’s knee)

Baker cyst (popliteal cyst)
Medial meniscus tear
Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.
In SOAP format, list:
Pertinent positive and negative information
Differential and working diagnosis
Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.