Respond  to  at least two  of your colleagues on  2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues' differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning. Main Post Purpose:  This purpose of this assignment is to review case study #3 knee pain, and use the information to evaluate, form possible diagnoses, and practice documenting in soap format. Documenting in SOAP note format allows a practitioner to assess and document that the patient was treated with a holistic approach (Ball, Dains, Flynn, Solomon, & Stewart, 2019).  Case 3:  Knee PainA 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?  Patient Information: ANW              15                     1/19/04                       M                     Caucasian                                                (CC):  “My knees hurt, sometimes I hear a clicking sound, and they get stuck.”  History of Present Illness (HPI):  Alexander (Alex) is a 15 year old Caucasian male who has come to the clinic complaining of pain in his knees. He states “sometimes it is just one knee that clicks and sometime it is both,” Alex states that his “knees get stuck or catch under the knee cap”. He rates the pain as 3/10 most days but after games the pain can be 6/10. He describes the pain as “dull and achy,” like I have done too much stuff. He states the pain started “a few weeks ago” and it was once in a while but now they hurt almost every day. He said his coach wants him to get his knees checked out before the next game. Medications: Motrin 200mg po Nightly. Allergies:  KNA  Past Medical History (PMH):  None  Past Surgical History (PSH):  None Sexual/Reproductive History:  Heterosexual. Identifies as male. Denies sexually active.  Personal/Social:   Alexander is a sophomore He plays on the basketball, baseball, soccer, football, track and wrestling team. He also loves to swim but states they do not have a team at the school. Alex states although he loves sports he wants to become a “sports doctor” and be a sports coach in his part time. Alex is proud of his 4.2 GPA and plans to graduate 1 year early and start college. He lives with his mother, adoptive father, maternal grandmother, and older sister.  Alex says he has a half-brother that is 5 that leaves in Tennessee with his biological father. He states his biological father had a baby boy that died at birth a few years ago. .

1. Respond
to
at least two
of your colleagues on
2
different days
who were assigned different case studies than you. Analyze the
possible conditions from your colleagues' differential
diagnoses. Determine which of the conditions you would reject
and why. Identify the most likely condition, and justify your
reasoning.
Main Post
Purpose:
This purpose of this assignment is to review case study #3 knee
pain, and use the information to evaluate, form possible
diagnoses, and practice documenting in soap format.
Documenting in SOAP note format allows a practitioner to
assess and document that the patient was treated with a holistic
approach (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
Case 3:
Knee PainA 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

2. you assessing as part of the physical examination? What special
maneuvers will you perform?
Patient Information:
ANW 15 1/19/04 M
Caucasian
(CC):
“My knees hurt, sometimes I hear a clicking sound, and they get
stuck.”
History of Present Illness (HPI):
Alexander (Alex) is a 15 year old Caucasian male who has come
to the clinic complaining of pain in his knees. He states
“sometimes it is just one knee that clicks and sometime it is
both,” Alex states that his “knees get stuck or catch under the
knee cap”. He rates the pain as 3/10 most days but after games
the pain can be 6/10. He describes the pain as “dull and achy,”
like I have done too much stuff. He states the pain started “a
few weeks ago” and it was once in a while but now they hurt
almost every day. He said his coach wants him to get his knees
checked out before the next game.
Medications:
Motrin 200mg po Nightly.
Allergies:
KNA
Past Medical History (PMH):
None
Past Surgical History (PSH):
None
Sexual/Reproductive History:
Heterosexual. Identifies as male. Denies sexually active.

3. Personal/Social:
Alexander is a sophomore He plays on the basketball, baseball,
soccer, football, track and wrestling team. He also loves to
swim but states they do not have a team at the school. Alex
states although he loves sports he wants to become a “sports
doctor” and be a sports coach in his part time. Alex is proud of
his 4.2 GPA and plans to graduate 1 year early and start college.
He lives with his mother, adoptive father, maternal
grandmother, and older sister. Alex says he has a half-brother
that is 5 that leaves in Tennessee with his biological father. He
states his biological father had a baby boy that died at birth a
few years ago. He reports seeing his biological father a few
times in the last few years. He states he has a girlfriend is
named Heather, is also a sophomore and that she is a
cheerleader and also plays soccer. He reports that he and
Heather are not sexual active but if they become active they will
use condoms. Alex is excited to get his license soon. He reports
he wears his sit belt in the car and wears all protective sport
gear. Denies tobacco use, drinking, illicit drug use. Reports he
tried Marijuana x1 and a beer in 2018 at a party.
Immunization History:
All immunization up to date per mother. Received flu vaccine
10/2018. Verified through Florida Immunization Registry.
Family History:
Mother:
Hx Breast Cancer. Seasonal Allergies. Anxiety.
Maternal Grandmother
: Asthma

4. Paternal Grandfather:
Died in 2009 liver Cirrhosis from etoh abuse.
Father:
MI age 30 from cocaine abuse. Bipolar disorder.
Maternal Grandmother
: None
Paternal Grandfather
: Substance Abuse
Sister:
19 Asperger’s, Anxiety, Depression.
Half-Brother-
5 Cerebral Palsy
Half Brother-
Deceased Still Born
ROS:General:
Denies fatigue, weakness, fever, chills, sweat, loss of appetite,
and weight
loss.
HEENT:
Denies any wounds, lumps, or pain. Denies vision issues.
Denies hearing issues. Reports a nose bleed once last year after
being hit during a soccer game. Reports no issues eating,
swallowing, or pain in throat. Reports he saw the dentist last
week.
Neurological:
Denies headaches, pain, and dizziness or head injuries. Denies

5. changes in memory. Denies numbness and tingling.
Skin:
Denies any wounds, rashes or moles. Reports, “I have a birth
mark on my right butt check”.
Cardiovascular:
Denies chest pain, palpitations, and racing. No hx noted.
Peripheral Vascular:
No hx noted.
Respiratory:
Denies SOB, cough, and pain.
Gastrointestinal:
Denies abdominal pain, nausea, vomiting, constipation or
diarrhea. Reports not troubles eating. Reports he eats “lots of
pasta for energy”.
Genitourinary
: Denies issues including nocturia, dribbling, incontinence,
discharge, or pain upon urination.
Musculoskeletal:
Reports knee pain bilaterally dull and achy 3/10 presently.
Denies issues, running, jumping, kicking, or bending. Reports
clicking sounds at times when knee is flexed and extended.
Hematologic:
Denies bleeding or bruising. Reports nose bled last year after
being hit in a soccer game. No other hx noted
Lymphatics:
Denies swelling and tenderness. No Hx noted.
Endocrine
: Denies heat or cold intolerance, excessive thirst or urination,
or tremors. No hx noted.
Psychiatric:
Denies depression, thought of self- harm. Reports anxiety when
taking Chemistry tests.
Allergies:
Denies.
Physical Exam:
BP 120/70 adult cuff/right arm/sitting, P 72 regular, RR 18

6. unlabored. O2 98%, T 98.6 temporal. Weight 185. Height 5 feet
11 inches. BMI 25
General:
Aox4, looks stated age, pleasant, well groomed, and
cooperative. Makes eye contact when speaking and answering
questions. No s/s of distress.
HEENT:
Head symmetrical No visual deformities noted. PER/EOMI.
Responds to questions with no requests to repeat. Breaths
through nares no s/s of congestion, or allergies. Teeth are
intact, bright white, straight, and no odor from mouth present.
Neurological:
AOX4, No s/s of neurological deficits. Adequate recall.
Neck:
No visual lesions, no enlargement, no JVD.
Skin/Lymph:
Intact. No wounds, lesions, scars or moles noted. Tan in
complex. No signs of edema or cyanosis. No nodes observed
upon palpation.
Chest/Pulmonary:
Chest is symmetrical. CTA AP&L. Respiration even and
unlabored noted at 19
.
No noted SOB, RR noted at 18, SPO2 98%. No use of accessory
muscles noted.
Heart/Vascular:
S1 and S2 noted. RRR. No murmurs, rubs, or gallops noted.
Less than 3 capillary refill. All Pulses 3+. HR slightly elevated
along with BP indicative of pain.
Abdomen:
Deferred No issues noted.
Genital/Rectal
: Deferred no issues noted.
Musculoskeletal:
Ambulates on own, full weight bearing. Mild swelling,
tenderness, warmth noted in bilateral knees. Pain with palpation

7. over the tibial tuberosity. Flinches upon flexion and extension
of both knee.
Diagnostic Results/Manipulation Test:
Negative Lachman test.
Negative Homan’s sign.
Negative McMurray test.
Differential Diagnoses
1.
Patellofemoral Pain Syndrome
2. Meniscus tear
3. Osgood Schlatter Disease
4. Osteogenic
Sarcoma
5.Stress fracture
DIAGNOSIS/CLIENT PROBLEM
The most probable diagnosis for Alex is Petellofamoral pain
syndrome. This syndrome is pain that is caused by overuse of
the knee caps (American Academy of Orthopedic Surgeons,
2015). It is prevalent in those who play sports, especially those
that involve jumping and running (Mayo Clinic, 2018). This
syndrome causes pain around the knee cap, stiffness, and may
also cause the popping and clicking sound that Alex describes
and that is present upon evaluation (American Academy of
Orthopedic Surgeons, 2015). This condition is sometimes called
runner or jumper’s knee (American Academy of Orthopedic

8. Surgeons, 2015). Alex plays multiple sports that have high
impact on the knees. It is common in women and in adolescents
(American Academy of Orthopedic Surgeons, 2015). Alex has
the signs and symptoms of this condition, including pain upon
examination. This condition would explain the pain that Alex’s
is reporting in both versus an injury that would be more likely
to shoe in just one knee. Another possible diagnosis for Alex is
bilateral torn meniscuses. A meniscus tear is when there a tear
takes place to the cartilage that is located behind the knee cap
(American Academy of Orthopedic Surgeons, 2014). It is one of
the most common knee injuries, especially in those that play
sports (American Academy of Orthopedic Surgeons, 2014). The
signs and symptoms of this condition are swelling, stiffness,
clicking or popping sound, not being able to extend the knee
fully, and a feeling that your knee is going to “give out”
(American Academy of Orthopedic Surgeons, 2014). Alex is
very active in many different sports and shows all signs and
symptoms of this condition except for negative McMurray sign.
McMurray test is a manipulative test is that performed to detect
a tear in the meniscus (Ball et al, 2019). A palpable or audible
click with this maneuver means that there is tear present in
either the lateral or medial meniscus (Ball et al, 2019). It is
very unlikely that Alex would have a torn meniscus in both
knees at the same time Osgood Schlatter Diease is yet another
possible diagnosis for Alex. This condition is a swelling and
irritation of the growth plate in the legs near the shine bone
(Kids Health Nemours, 2019).This condition usually takes place
in children who are still growing and that have active lifestyles
(Kids Health Nemours, 2019). This condition is common in
those who play sports that involving running and jumping
(American Academy of Orthopedic Surgeons, 2015). Alex is the
correct age for the condition and is very active in the sports that
cause this condition. This condition would explain the pain
Alex is experiencing but not necessarily the clicking or popping
sound. Although Osteogenic Sarcoma is a less likely diagnosis
for Alex it may still be a possible diagnosis. Osteogenic

9. Sarcoma is a type of cancer that forms at the ends of bones as
they grow (Johns Hopkins Medicine, n.d). It affects those
younger in age still growing (Johns Hopkins Medicine, n.d).
Alex does fit the age range, with the most common age being 15
(Johns Hopkins Medicine, n.d). This condition would explain
the pain being reported, however this condition is a very rare
(Johns Hopkins Medicine, n.d). An Xray , MRI and CT will be
able to establish if a tumor is present (Johns Hopkins Medicine,
n.d). It would be very unlikely that this condition will present
in both knees at the same time. Additionally this condition
would not explain the clicking and pooping sounds present in
the knees. A stress fracture or tiny break in a one is another
possible diagnosis for Alex due to his increased sports activity
(American Academy of Orthopedic Surgeons 2007). Stress
fractures are a very common injury in those that play sports
(Dains, Baumann, & Scheibel, 2019). Although the stress
fracture would cause the pain is experiencing it would not
explain the clicking in the knees. Additionally it is unlikely
unless Alex has a previous condition such as osteoporosis that
both knees would experience a fracture at the same time. An
Xray of the knees will be able to establish if a fracture exists.
Treatment Plan:
Diagnostics
Bilateral patella XRAY
Bilateral MRI of patella
CT Scan
MedicationTreatment

10. RICE treatment.
Mobic 7.5mg po daily.
Knee stretching exercise.
Education
Patient and parent on diagnosis.
RICE therapy.
Medications
usage and side effects.
Educate on stretching.
Provide stretching pamphlet.
Referral and follow-up.
Referral/Consultation
Pediatric orthopedist
Physical therapy
Follow Up Planning

11. 1 month
References
American Academy of Orthopedic Surgeons.(2014).
Meniscus Tears
.
https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-
tears/
American Academy of Orthopedic Surgeons. (2015).
Osgood-Schlatter Disease
(Knee Pain).
https://orthoinfo.aaos.org/en/diseases--conditions/osgood-
schlatter-disease-knee-pain/
American Academy of Orthopedic Surgeons. (2015).
Patellofemoral Pain Syndrome
.
https://orthoinfo.aaos.org/en/diseases--
conditions/patellofemoral-pain-syndrome/
American Academy of Orthopedic Surgeons. (2007).
Stress Fractures.
https://orthoinfo.aaos.org/en/diseases--conditions/stress-
fractures/
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. (2019).
Seidel's guide to physical examination: An interprofessional
approach (9th ed.).
St. Louis, MO: Elsevier Mosby.Dains, J. E., Baumann, L. C., &
Scheibel, P. (2019).
Advanced health assessment and clinical diagnosis in primary
care
(6th ed.). St. Louis, MO: Elsevier Mosby.Johns Hopkins
Medicine. (n.d).
Osteogenic Sarcoma.

12. https://www.hopkinsmedicine.org/kimmel_cancer_center/center
s/pediatric_oncology/becoming_our_patient/cancer_types/osteo
genic_sarcoma.html
Kids Health Nemours. (2019).
Osgood Schlatter Disease.
https://kidshealth.org/en/parents/osgood.html
Mayo Clinic. (2018).
Patellofemoral pain syndrome.
https://www.mayoclinic.org/diseases-conditions/patellofemoral-
pain-syndrome/symptoms-causes/syc-20350792