[doctor] hey sophia how are you doing today
[patient] i've been better my primary care doctor wanted me to see you because of this knee pain that i've been having for about six months now
[doctor] okay do you remember what caused the pain initially
[patient] you know i really ca n't recall any specific event that caused the pain
[doctor] alright well can can you describe the pain for me
[patient] yeah so it's it's like a deep achy pain that it i feel like it's behind my kneecaps and sometimes i can even hear like what seems like like some creaking in my knees
[doctor] hmmm alright now tell me what what type of activities makes that pain worse
[patient] so i feel like the pain gets worse anytime i'm like getting from like a seated position to standing so i i work from home so i'm at my desk a lot so anytime i get up i have some pain or after watching tv or even like going up and down stairs it's really painful
[doctor] hmmm okay and does anything make the pain feel better
[patient] usually after i rest it for some time it does help with the pain
[doctor] okay now you did mention earlier that you have tried some things in the past can you tell me what they were
[patient] yeah so when it first started hurting i was putting ice on it and i even got like some ace bandage like wrapping from the pharmacy i do take ibuprofen or aleve sometimes but i try to avoid really taking any medications
[doctor] okay and and tell me what is your day like
[patient] well i try to be as active as i can i actually love to run and i would run like five to six miles a day but now i i mean honestly i ca n't even get to half a mile and my leg will start hurting my knee will start hurting
[doctor] okay that's definitely a decrease in your mileage there where have you been running lately like do you run outside or on a treadmill or
[patient] yeah i i you know i will do the treadmill during the winter but i just love being outdoors and running
[doctor] yeah yeah there are some really nice senior routes here in boston is n't there like
[patient] there are
[doctor] so many knee places there's some right by the harbor that i've i've done some runs there before too it's pretty nice well i mean the boston marathon what can you say right
[patient] right exactly exactly no it's very nice
[doctor] well okay well hopefully that we get you feeling better so you can start running again more than . five miles but tell me though have you noticed any swelling or redness in your knees
[patient] no not really
[doctor] okay and have you ever injured your knees before
[patient] no i've been pretty good i actually have never broken a bone actually no i'm gon na change that actually i did break my arm when i was in sixth grade but nothing since then
[doctor] okay
[patient] i
[doctor] okay and it's just your arm right not not your knee
[patient] right
[doctor] okay well alright well let's go ahead and do a quick physical exam on you here let me look at your vital signs okay i reviewed your vitals they they overall they look good take a listen to your heart real quick alright and your heart exam i hear regular rate and rhythm with no murmurs and on your musculoskeletal exam i have seen you and walk around here and you do have normal gait alright now i'm gon na have you do some movements on your legs here okay
[patient] okay
[doctor] alright good your strength is three out of five for abduction of legs bilaterally and the remainder of muscle strength for your lower extremities are five out of five so that's good let me take a look at your knee now on your knee exam there is no overlying erythema that's redness or ecchymosis and that's bruising or any warmth of the skin appreciated there is no effusion let me go ahead and feel around here does that hurt right here how does that feel
[patient] it does
[doctor] sorry so there is tenderness to palpation of the bilateral retinacular retinaculum and there is positive patellar grind test alright and can you are you able to squat for me
[patient] i can but that hurts
[doctor] okay alright so you're definitely having some knee pain with squatting and i'm just gon na maneuver your leg just a little bit here real quick okay so lachman anterior and posterior drawer and mcmurray tests are all negative bilaterally so that's good there okay now your neuro exam patella and achilles reflexes are symmetrical alright so now i did review the results of your x-ray and both of your knees which shows no fractures or osteoarthritis so let me go ahead and tell you about my assessment and plan so for your problem of bilateral knee pain based on what you told me your exam and reviewing your mri your symptoms are consistent with patellofemoral pain syndrome and this is a very common condition that we see that causes knee pain especially in active young people so this condition has to do with the way your kneecap which is your patella how that moves along the groove of your thigh your thigh bone which is the femur now for the pain you may continue taking ibuprofen or anti-inflammatory as needed to help with the pain but i'm also going to recommend physical therapy where where they will show you a number of lower extremity exercises and this will help increase your lower extremity strength your mobility and correct any incorrect running mechanics that you may have so do you have any questions for me about that
[patient] will i be able to run anytime soon
[doctor] well that is a goal of treatment and to get you back in running again now you will have to take an take it easy from running for now but we will continue to assess your progress with each visit okay
[patient] okay
[doctor] alright anything else
[patient] no i think that's it
[doctor] okay well very good well i will be following up with you soon and again just take it easy for now from the running okay
[patient] okay thank you
[doctor] bye
[patient] bye
CHIEF COMPLAINT

Bilateral knee pain.

HISTORY OF PRESENT ILLNESS

Sophia Jackson is a pleasant 30-year-old female who presents to the clinic today for the evaluation of bilateral knee pain. She was referred by her primary care provider. The onset of her pain began 6 months ago. She denies any specific injury. The patient describes her pain as a deep, achy pain. She locates her pain to the posterior aspect of her patellae. The patient also reports “creaking” in her knees. She denies any swelling or redness in her knees. Her pain is aggravated by transitioning from a seated position to standing as well as ascending and descending stairs. Her pain is alleviated by rest. The patient has been icing her knees and wrapping her knees with an ACE bandage. She also takes ibuprofen or Aleve occasionally for pain. She states she tries to be as active as she can. She enjoys running outdoors. The patient adds that she would run 5 to 6 miles per day; however, she is unable to go 0.5 miles secondary to the pain. She denies any previous injuries to her knees.

She works from home.

MEDICAL HISTORY

Patient reports history of an upper extremity fracture when she was in 6th grade.

REVIEW OF SYSTEMS

Musculoskeletal: Reports bilateral knee pain and crepitus. Denies swelling or redness in the bilateral knees.

VITALS

All vital signs are within the normal limits.

PHYSICAL EXAM

GAIT: Normal, no deformity present.
CV: Auscultation of Heart: Regular rate and rhythm. No murmurs.
No edema
NEURO: Patella and Achilles reflexes are symmetrical.
MSK: Examination of the bilateral lower extremities: Abduction strength is 3/5. Remainder of muscle strength is 5/5. Examination of the bilateral knees: No overlying erythema, ecchymosis, or warmth of the skin appreciated. No effusion. Tenderness to palpation of the bilateral retinaculum. Positive patellar grind test. Knee pain with squatting. Negative Lachman test bilaterally. Negative anterior and posterior drawer tests bilaterally. Negative McMurray test bilaterally.

RESULTS

X-rays of the bilateral knees were reviewed today. These demonstrate no evidence of any fractures or osteoarthritis.

ASSESSMENT

Bilateral knee patellofemoral pain syndrome.

PLAN

After reviewing the patient's examination and radiographic findings today, I have had a lengthy discussion with the patient regarding her current symptoms. I have explained to her that her symptoms are consistent with patellofemoral pain syndrome. We discussed treatment options and I have recommended that we begin with conservative treatment in the form of formal physical therapy to increase her lower extremity strength, mobility, and correct any incorrect running mechanics. I encouraged her to take running easy for now. She can continue taking ibuprofen or anti-inflammatories as needed for pain. All questions were answered.

INSTRUCTIONS

The patient will follow up with me soon.