HPI 48 yo F comes to the clinic complaining of left knee pain What questions would you like to ask?
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Transcript of HPI 48 yo F comes to the clinic complaining of left knee pain What questions would you like to ask?
HPI• 48 yo F comes to the clinic complaining
of left knee pain
What questions would you like to ask?
HPI• 2 month history of L knee pain, worse with ROM
• Reports noticeable L knee “stiffness”
• Recently noticed a “bump” behind the left knee
• - history of recent falls or trauma to the knee
• Denies other joint pain/discomfort
PMH: HTN, DM
PSH: cholecystectomy
Family Hx: colon cancer
Social: social drinker, ½ pack/day smoker, denies illicits
Meds: HCTZ, lisinopril
Allergies: none
Differential Diagnosis?
Differential Diagnosis
• Osteoarthritis• Baker’s cyst• Rheumatoid arthritis• Ligamentous, meniscal injury• Soft tissue/ bone tumor
PE
• Vitals: AVSS• CV, Pulm, Abd: WNL• Musc: Left knee exam: • Fixed solid mass palpated over the posterior knee.
No warmth, erythema appreciated. No joint line tenderness. Tender to palpation over posterior aspect of the knee. Decreased ROM (0-90 degrees). Negative anterior/posterior drawer. Negative Mcmurray’s. Neurovascularly intact distal to R knee.
Labs:WNL
Giant Cell Tumor• benign but aggressive tumor primarily found in the epiphysis
of long bones • Epidemiology• Predominance in females • ages 30-50 years• 50% occur around the knee (distal femur or proximal tibia)• 10% in sacrum and vertebrae (sacrum is most common site in
axial skeleton) • distal radius is third most common location• Presentation: pain, decreased range of motion at the affected
joint• Malignant Potential: Metastatic to the lung in 2-5% • Hand lesions have greater chance of metastasis
1. Orthobullets.com/pathology2. Miller’s review of orthopaedics
Characteristic Features
• Xray• eccentric lytic epiphyseal/metaphyseal lesion that often extends
into the distal epiphysis and borders subchondral bone