Dull pain in both knees
A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain,
• What categories can you use to differentiate knee pain?
• What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. and justify why you selected each
• Out of the five differential diagnoses you identify, determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
Determination of Knee Pain of 15 –Year-Old Male
Knee pain is a chronic or sharp discomfort that is felt at the knee and has various causes that vary based on an individual’s physical activities, age, and other preexisting medical conditions such as arthritis and gout or infections. However, knee pain can also be caused by conditions such as damage of the knee cartilage, ligaments, tendons, or other associated tissue muscles. Additionally, common causes include but unlimited to meniscal injury, a patellofemoral pain syndrome, or a runner’s knee. This essay, therefore, determines the causes of knee pain of a 15-year-old male with a dull pain in both knees and describes a catching sensation under the patella. It highlights categories used to differentiate knee pain, physical examinations, possible conditions, including the least and most likely condition.
Knee pain can be differentiated using three main categories to assist in the determination of the cause or diagnosis. The three major categories to differentiate knee pain include acute injury, medical condition, chronic use, or overuse conditions. Notably, the acute knee category is characterized by physical damages such as bone fractures, ligament injuries – specifically the anterior cruciate ligaments, meniscus injuries, and dislocation of the knee joint (Balentine & Shiel, 2021). On the other hand, the medical conditions category of knee pain differentiation includes knee pains caused by diseases such as rheumatoid arthritis which affects joints. Additionally, other arthritis conditions associated with knee pain include gout and septic or infectious arthritis, which might infect the knee joint leading to pain and swelling (Balentine & Shiel, 2021). Besides acute injury and medical conditions, chronic use or overuse conditions include patella tendonitis, patellofemoral pain syndrome, and osteoarthritis.
A critical physical examination to be performed in a situation of dull pain in both knees with a catching sensation under the patella is the Clarkes test. This test was primarily designed to examine and identify the pathology of the patella region around the knee, including its cartilages. Additionally, it is a physical examination that helps in examining all the categories of knee pain, which ranges from acute, medical, and chronic use or overuse conditions categories of knee pain. Notably, the Clarkes test aims at assessing different anatomical structures as part of the physical exams. Based on the patient’s report and description, it is fundamental to assess anatomical structures such as the patella, ligaments, tibia, femur, and meniscus (Manske & Davies, 2016). As such, the test would assess the patella-related pains from proper diagnosis and medication.
Various knee pain conditions are associated with the patella of the knee. One of the possible conditions that may result from the examination is patellofemoral pain syndrome. The possibility of patellofemoral pain syndrome is based on the age factor – the teenager, region of attack, and a possibility of one of the physical examination result from the Clarkes test done. Another possible condition is the patellofemoral subluxation since it involves a partial slip of the patella from the trochlea, hence could be the source of pain. Additionally, patellofemoral dislocation is another possible condition since it is a traumatic injury characterized by tissue damage as the patella jumps the truck and comes back coarsely into place. Furthermore, patellofemoral arthritis is another possible condition as it involves causing knee pain from the patella region. Moreover, chondromalacia patellae is also another probable condition characterized by knee pain around the patella region.
Based on the aforementioned possible conditions, patellofemoral dislocation, which is more similar to patellofemoral subluxation, could be rejected based on the fact that the patient never reported any strenuous physical or sporty activities that could lead to dislocation. On the other hand, patellofemoral pain syndrome, which is similar to chondromalacia patellae could be the most likely condition due to its symptoms. The possibility of patellofemoral pain syndrome is based on the age factor – the teenager, region of attack, and a possibility of one of the physical examination result from the Clarkes test done.
Balentine, J., & Shiel, W. (2021). Knee Pain Treatment, Causes, Remedies, Symptoms. Retrieved 19 April 2021, from https://www.medicinenet.com/knee_pain_facts/article.htm
Manske, R. C., & Davies, G. J. (2016). Examination of the patellofemoral joint. International journal of sports physical therapy, 11(6), 831.
Stein, B., & Strickland, S. (2016). Patellofemoral Disorders: An Overview. Hospital for Special Surgery. Retrieved 21 April 2021, from https://www.hss.edu/conditions_patellofemoral-disorders-overview.asp#:~:text=Problems%20affecting%20the%20patellofemoral%20joint,in%20the%20femur)%20and%20arthritis.