Dull Pain in Both Knees With an Occasional Clicking Sound Essay

HPI: The patient is a 15-year-old Caucasian male with complaint of dull knee pain in both knees with an occasional clicking in one or both knees. Patient states “there is a catching sensation under the patella”. Patient reports dull pain with occasional clicking started 2 weeks ago while participating in baseball practice at school. Patient reports dull pain without clicking to both knees during clinic visit. Patient rates pain 4/10. Patient states pain is brought on upon exertion such as baseball practice. Patient denies any other associated symptoms. Patient reports taking ibuprofen and applying OTC icy hot patch with little relief. Dull Pain in Both Knees With an Occasional Clicking Sound Essay

Location: Knees bilaterally.

Onset: 2 weeks ago.

Character: Dull bilaterally with occasional clicking paired with a catching sensation under patella.

Associated signs and symptoms: Patient denies.

Timing: Upon exertion in baseball practice.

Exacerbating/ relieving factors: Baseball practice, Ibuprofen with little relief.

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Severity: 4/10 pain scale.

Current Medications: Ibuprofen 200 mg 2 tabs po every 8 hours as needed, for 2 weeks for dull pain after practice. OTC Icy Hot patch applied after practice for 1 week used x 3 days as needed after practice. Dull Pain in Both Knees With an Occasional Clicking Sound Essay

Allergies: PCN (rash). Denies food allergies. Seasonal allergies to pollen (watery eyes, sneezing). Environmental allergies to dust and cats (watery eyes, sneezing).

PMHx: Childhood immunizations are up to date. Tdap 08/02/2019. Flu vaccine 10/20/2021. Hx Tonsillectomy on 07/10/2015. Hx Chicken Pox 2013.

Soc Hx: NC is a high school freshman and plays on the jr. varsity baseball team. NC lives at home with both parents in a house with his grandmother as the designated caretaker to drops him off and picks him up from school and baseball practice while his parents are working. NC denies tobacco use including nontobacco vaping. NC states he loves “playing GTA” on his PS4 with his friends to relax on weekends. NC reports that he always wears his seatbelt when riding in a vehicle with his parents, grandmother and or friends. NC reports he has a nice family and a good friend group that he can talk to if needed. Dull Pain in Both Knees With an Occasional Clicking Sound Essay

Fam Hx: Mother 45 yrs old – HTN, overweight. Father 48 yrs old- hx cigarette smoking, nonsmoker currently. Sister 19 yrs old- asthma controlled. Maternal Grandmother 65 yrs old HTN, HLP. Maternal Grandfather deceased at 70 yrs old from CVA, Paternal Grandfather 68- COPD, HTN. Paternal Grandmother 69 yrs old- DM2, HLP. Dull Pain in Both Knees With an Occasional Clicking Sound Essay

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT

Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae.

Ears: Denies hearing loss or tinnitus.

Nose: Denies congestion, sneezing, or loss of smell.

Throat: Denies sore throat. Denies issues swallowing. Dull Pain in Both Knees With an Occasional Clicking Sound Essay

SKIN: Denies rash or itching.

CARDIO/PERIPHERALVASCULAR: Denies chest pain, chest pressure or chest discomfort. Denies palpitations or edema.

RESPIRATORY: Denies shortness of breath, cough, or sputum.

GASTROINTESTINAL: Denies nausea, vomiting or diarrhea. No abdominal

NEUROLOGICAL: Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: C/o dull knee pain bilaterally with clicking on occasion under patella, reports a catching sensation with click.

HEMATOLOGIC: Denies anemia, bleeding, or bruising Dull Pain in Both Knees With an Occasional Clicking Sound Essay

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: Denies history of depression or anxiety.

ENDOCRINOLOGIC: Denies cold sweats, increased thirst.

ALLERGIES: PCN (rash), Dust (watery eyes, sneezing), Cats (watery eyes, sneezing).

O.

Physical exam

General: Pt A&O x4. Sitting upright on exam table with grandmother at side. Pt has a pleasant affect and eager to participate in health interview and exam. Pt is well groomed and dressed appropriate for season. Pt is ambulatory without assistance. Pt smiles often when speaking about hobbies. Pt has clear speech and goal oriented. Dull Pain in Both Knees With an Occasional Clicking Sound Essay

VS: BP 110/60, P 74, R 18, T 37.6 C, 02 100% RA, HT 5’7, WT 136, BMI 21.3

RESPIRATORY: Breath sounds clear bilaterally up and lower lobes. No respiratory distress noted. 02 sats 100% RA.

CARDIO/PERIPHERALVASCULAR: S1 and S2 noted without rub. Gallops present. Regular rate and rhythm. No murmur detected. No edema present to extremities.

MUSKULOSKELETAL: Swelling noted to Left knee. No swelling to R knee. Pt states pain 4/10 bilaterally. Patellar reflexes intact. Knees misaligned. Able to bear weight. Gait steady without need of assistance. L knee flexion 5/5 with pain. R knee flexion 5/5 with pain. Dull Pain in Both Knees With an Occasional Clicking Sound Essay

Diagnostics:

Bilateral Knee X-Ray: To view the orthopedic alignment and degree of arthropathy. X-ray view is used to assess the joint space loss and osteoarthritis or bone fracture (radiopadia.org, 2021).

CT Scan: Computed Tomography scan (CT scan) is used to assess knee ligament injury. The CT scan is noninvasive imaging combining both X-Ray and compute technology into slices or cross-sectional images for a sophisticated detailed view of the soft tissue (2022).

MRI: Magnetic Resonance Imaging (MRI) is used in producing detailed images of the structures within the knee and the joint. MRI is typically used in diagnosing knee pain, swelling or bleeding around the joint and can help to determine if surgery is required for treatment (radiologyinfo.org, 2022).

CBC: Complete Blood Count (CBC) is a serum lab that is used in screening for red blood cells, white blood cells and platelets in which can determine infection and inflammation (questdiagnostics.com, 2018). Dull Pain in Both Knees With an Occasional Clicking Sound Essay

A.

Primary Diagnosis:

Medial Meniscus Tear- Meniscus tears are common in sports that present with pain upon injury, and repeated activity and can break off and leave frayed edges. Tears can develop slowly as the meniscus loses resiliency in repeated injuries (cedars-sinai.org, 2021). Dull Pain in Both Knees With an Occasional Clicking Sound Essay

Differential Diagnoses:

Osteoarthritis- The most common form of osteoarthritis is in the knee. Osteoarthritis presents with cartilage in the knee deteriorating and can be exacerbated by repeated strenuous activities (orthoinfo.org, 2021).

Patellar Dislocation- Common among children, patellar dislocation occurs when the patellar slips out of place due to injury such as fall. Dislocation can be partial or full and presents with pain and swelling (orthoinfo.org, 2021). Dull Pain in Both Knees With an Occasional Clicking Sound Essay

Ewing’s Sarcoma- A malignant tumor that begins with bone growth. Usually affects children and young adults and symptoms present in teen years. Typically, the femur is affected (orthoinfo.org, 2021).
please use the above sources as referecnce Dull Pain in Both Knees With an Occasional Clicking Sound Essay