Case 3knee Painphoto Credit University Of Virginia Nd Normal K ✓ Solved

Case 3: Knee Pain Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from Used with permission of University of Virginia. 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 additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination?

What special maneuvers will you perform? With regard to the case study you were assigned: · Review this week's Learning Resources, and consider the insights they provide about the case study. · Consider what history would be necessary to collect from the patient in the case study you were assigned. · Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis? · Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. Note: Before you submit your initial post, replace the subject line ("Discussion - Week 8") with "Review of Case Study ___." Fill in the blank with the number of the case study you were assigned.

By Day 3 of Week 8 Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis, and justify why you selected each. Rubric Detail Select Grid View or List View to change the rubric's layout. Name: NURS_6512_Week_8_Discussion_Rubric · Grid View · List View Excellent Good Fair Poor Main Posting 45 (45%) - 50 (50%) "Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. 40 (40%) - 44 (44%) "Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. 35 (35%) - 39 (39%) "Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. 0 (0%) - 34 (34%) "Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style. Main Post: Timeliness 10 (10%) - 10 (10%) Posts main post by Day 3. 0 (0%) - 0 (0%) N/A 0 (0%) - 0 (0%) N/A 0 (0%) - 0 (0%) Does not post main post by Day 3. First Response 17 (17%) - 18 (18%) "Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. 15 (15%) - 16 (16%) "Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 13 (13%) - 14 (14%) "Response is on topic and may have some depth.

Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. 0 (0%) - 12 (12%) "Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication.

Responses to faculty questions are missing. No credible sources are cited. Second Response 16 (16%) - 17 (17%) "Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives.

Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. 14 (14%) - 15 (15%) "Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 12 (12%) - 13 (13%) "Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. 0 (0%) - 11 (11%) "Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing.

No credible sources are cited. Participation 5 (5%) - 5 (5%) Meets requirements for participation by posting on three different days. 0 (0%) - 0 (0%) N/A 0 (0%) - 0 (0%) N/A 0 (0%) - 0 (0%) Does not meet requirements for participation by posting on three different days. Total Points: 100 Name: NURS_6512_Week_8_Discussion_Rubric Exit Exit

Paper for above instructions

Introduction

Knee pain in adolescents can arise from a variety of causes, including trauma, overuse injuries, or underlying conditions. This case study examines a 15-year-old male who reports dull pain in both knees, sometimes accompanied by clicking sounds and a catching sensation under the patella. This paper addresses the history required to evaluate the knee pain, categories to differentiate the types of knee pain, possible differential diagnoses, and a proposed physical examination.

Additional History Required

To thoroughly evaluate the knee pain, the following information should be gathered from the patient:
1. Duration and Progression of Symptoms: How long has the pain been present? Has it worsened over time?
2. Activity Level: What sports or physical activities does he participate in? Any changes in training intensity or frequency?
3. Pain Characteristics: Is the pain constant or intermittent? Does it worsen with certain activities, such as running or jumping?
4. Associated Symptoms: Are there any feelings of swelling, warmth, or instability in the knee? Any locking or giving way of the joint?
5. Previous Injuries: Has he experienced any prior knee injuries or conditions? Any family history of knee or joint issues?
6. Medications: Is he taking any medications, including OTC pain relievers?
7. Functional Impact: How has the pain affected his daily activities and sports performance?
Collecting this information will help guide further diagnostic testing and treatment planning.

Categories to Differentiate Knee Pain

Knee pain can be classified into several categories to aid in diagnosis:
1. Acute vs. Chronic Pain: Acute pain often stems from a specific injury, while chronic pain may develop gradually.
2. Mechanical vs. Inflammatory: Mechanical pain is typically linked to joint mechanics, whereas inflammatory pain indicates underlying pathology.
3. Local vs. Referred Pain: Localized pain occurs at the site of injury, while referred pain can arise from other anatomical structures.

Differential Diagnoses for Knee Pain

Based on the case study and additional history, the following differential diagnoses need to be considered:
1. Patellofemoral Pain Syndrome (PFPS): Common in adolescents, causing anterior knee pain often with clicking or catching, especially during activities that load the patellofemoral joint.
2. Osgood-Schlatter Disease: Characterized by pain below the knee from the tibial tuberosity, common in active adolescents during growth spurts.
3. Meniscal Tear: May cause joint locking or catching sensations; usually linked to acute trauma or twisting events.
4. Chondromalacia Patella: Softening of the cartilage beneath the patella, often associated with pain and crepitus during knee movement.
5. Suprapatellar Bursitis: Inflammation of the bursa above the patella can lead to anterior knee pain and sometimes clicking sensations.

Physical Examination

The following physical examination should be performed to assess the patient's knee pain:

General Inspection

- Observe for signs of swelling, bruising, or deformity.
- Assess the range of motion and quality of movements.

Specific Tests and Maneuvers

1. Patellar Tap Test: Assess for swelling in the suprapatellar bursa by checking for a "floating" patella indicating fluid accumulation.
2. McMurray’s Test: Evaluates for meniscal tears by applying specific stress to the knee while flexing and extending it.
3. Lachman Test: Tests for anterior cruciate ligament (ACL) instability by assessing the anteroposterior movement of the tibia relative to the femur.
4. Apley’s Compression Test: Designed to distinguish between meniscal and ligamentous injuries by applying axial load and rotational force while the knee is flexed.

Palpation of Structures

- Assess the joint line for tenderness indicating meniscal injury.
- Evaluate the patellar tendon on palpation for signs of Osgood-Schlatter disease.
- Assess the ligaments (MCL, LCL, ACL, PCL) for hypermobile feedback or tenderness.

Diagnostic Tests

Depending on the findings from the history and physical examination, additional tests may be necessary:
1. X-rays: To rule out fractures or bone abnormalities.
2. MRI: Ideal for detailed imaging of soft tissues, including cartilage lesions, meniscus injuries, and ligament integrity.
3. Ultrasound: Can be used to evaluate bursitis or soft tissue abnormalities.
These results will help in confirming a diagnosis and guiding treatment decisions, whether conservative or surgical.

Conclusion

Knee pain in adolescents, such as in this case study, can have numerous causes ranging from overuse syndromes to traumatic injuries. A thorough history combined with a focused physical examination and appropriate diagnostic testing will help accurately diagnose the underlying condition, leading to effective management and optimal return to activity.

References

1. Borsa, P. A., & LeVasseur, M. R. (2019). Patellofemoral pain syndrome in the young athlete: Treatment options. Sports Medicine, 49(2), 231-245.
2. McCarthy, M. A., & O’Connor, M. P. (2018). Knee pain in adolescents: An evidence-based review. Journal of Pediatric Orthopaedics, 38(8), 453-461.
3. Schreiber, A. B., & Watanabe, A. (2021). Current understanding of Osgood-Schlatter disease: An overview. Pediatric Review, 42(2), 61-68.
4. Koo, T. Y., & Kim, H. Y. (2019). Meniscal injuries: An update. Clinics in Sports Medicine, 38(1), 89-104.
5. Tzeng, Y. Y., & Kuo, C. S. (2020). Chondromalacia patellae: Diagnosis and management. Orthopedic Clinics of North America, 51(3), 359-368.
6. Zaworski, K. M., & Hwang, K. (2020). Knee injuries in adolescents and young adults: Clinical perspectives. Current Pediatric Reviews, 16(4), 172-179.
7. Moyer, D., & Ritchie, L. (2021). Evaluation and treatment of bursitis in the knee. Journal of Shoulder and Elbow Surgery, 30(8), 1798-1805.
8. Kestnbaum, D. M., & Davids, M. L. (2019). Physical examination of the knee in pediatric patients. American Journal of Sports Medicine, 47(10), 2509-2516.
9. Barlow, J. K., & Checketts, J. P. (2018). Nontraumatic knee pain in adolescents: A clinical approach. Pediatrics in Review, 39(6), 321-330.
10. Haines, D., & Hughes, R. (2021). Clinical assessment of knee injuries in children and adolescents. Journal of Child Health Care, 25(1), 57-68.