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Challenge of the Unknowns

Unknown #5

HISTORY:

An 85 year-old female presented to orthopedic surgeon in April of 1997 with knee pain over the medial aspect which is worse with weight bearing and has been slowly progressing since October of 1996. She initially twisted her knee coming down from the bleachers after her grandson's high-school football game. After an initial brief evaluation and x-rays at her family practice doctor, she decided to "let it heal" and manage her pain with ibuprofen. Over a six month period of she finally decided that she couldn't bear the pain. She consulted an othopedic surgeon, and an injection was performed and she reported approximately 50% improvement. Two months later, June of 1997, she again twisted her knee which resulted in increased pain, swelling, and tenderness over the medial joint margin.

CLINICAL \ ORTHOPEDIC FINDINGS:

Examination at the orthopedic surgeon's office revealed a joint effusion at the suprapatellar and popliteal region with medial joint margin tenderness. There is no report of mechanical locking sensation and orthopedic stress tests revealed normal ligamentous stability. There was decreased, painful range of motion both actively and passively.

"A clinical/radiological viewpoint"

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April of 1997


"Read carefully"

The above images are the films you will examine.
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Introduction to Unknown Cases

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