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Question: MSK

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A 14yo female soccer player comes to the ED complaining of bilateral knee pain x 1 month, right greater than left. She does not recall a specific traumatic injury or fall, nor of any knee swelling, popping, or locking. The pain is worse after soccer practice or a game, and after getting up from sitting for a prolonged period such as her 2-hour block classes. The pain is described as behind the knee cap. There is no knee effusion, and there is full active range of motion. She has been afebrile throughout the course.

What is the next appropriate step in caring for this patient?
10 votes

pemsou5_wp • July 11, 2017

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  1. llking85 July 11, 2017 - 8:45 am Reply

    Sounds like patellofemoral syndrome to me. Would likely discuss appropriate footwear for exercise, stretching and minimizing movements/positions that strain the patella before sending for MRI or physical therapy. If I had to choose I think I’d go with physical therapy.

  2. Kelly July 14, 2017 - 4:04 pm Reply

    E. Physical therapy referral

    The patient’s presentation is consistent with patellofemoral pain syndrome, common in adolescent females. Possible pathophysiology involves malalignment and abnormal tracking of the patella. Pain with activities that require quadriceps contraction (e.g. squats, going up and down stairs), and after having the knee in a flexed position (e.g. sitting) for a prolonged period is typical. If a classic presentation and no reason to suspect ligamentous, meniscus, or bony injury, no imaging is needed. Treatment is physical therapy to stretch and strengthen quadriceps.

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