Assessing Musculoskeletal Pain Week 8 | Assessment
Min of 3 reference dated within 5 years
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?
Patient Information:
Intials: AB Age: 15 Sex: Male Race: White
S.
CC (chief complaint): dull ache in both knees
HPI: Patient is a 15 year old white male who complains of dull pain in both knees. He states at
time one or both knees click, and there is a catching sensation under the patella. The patient
states it has been about 2 months since the aching began. He denies any other signs and
symptoms other than the pain he voices. He denies that it makes him nauseated. Exertion does
worsen the pain such as when he is squatting or running. He has taken Aleve and other NSAIDS
but denies any real relief. At worse, he complain of a 7/10 pain scale.
, Current Medications: Aleve 220mg x 2 tablets PO q 4hr PRN, Motrin 200mg x 2 tablets PO q
4hr PRN (alternating as needed for swelling & pain), Tylenol 225mg x 1-2 tablets PO for fever
when needed
Allergies: Medication – NKDA; Food – okra – patient’s throat begins to swell and he breaks out
in hives; Seasonal – none noted
PMHx: all childhood immunization are up to date (MMR, Polio, DTaP/DT/Td, Hib, Hep B); AB
did have chicken pox as a younger child; no surgical history; procedures – tonsillectomy and
adenoidectomy when 5 years old, tubes in ears when 5 years old.
Soc Hx: AB is a student is middle school who has a passion for sports. He plays baseball and
runs track for the school. He also participates in summer league baseball. He lives with his
parents in a nice subdivision in a 2 story home where his bedroom is upstairs. AB denies use of
any alcohol or tobacco at this time. He does have a younger sister who is 9 years old.
Fam Hx: Sister – 9 years old with no illnesses or health issues; Dad – 37 years old with no
health issues but had partial knee replacement last year. Takes NSAIDs as need for pain and
swelling around joints; Mother – 36 years old with hypertension, well controlled with Atenolol
10mg PO QD; Maternal Grandmother – 62 years old HTN, GERD, THR at age 55; Maternal
Grandfather – 66 years old, skin cancer, hx of prostate cancer (urologist removed prostate);
Paternal Grandmother – 70 years old, hospitalized with recent fall and broken hip, hx of breast
cancer, beginning stages of dementia, hx of UTI; Paternal Grandfather – deceased last year at age
73 from aneurysm, hx of HTN, cardiac stent placement 4 years prior, TKR bilaterally.
ROS:
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes - No visual loss, blurred vision, double vision or yellow sclerae; Ears – no
hearing loss, no build up; Nose & Throat – Denies sneezing, congestion, runny nose or sore
throat.
SKIN: No rash or itching. Intact, cool, dry, normal turgor, non-pale, no burning or pain,
CARDIOVASCULAR: No chest pain voiced. No palpitations or edema noted. No murmurs
noted. Normal heart sounds.
RESPIRATORY: No dyspnea or orthopnea, denies cough, lungs clear bilaterally, no rhonchi or
wheezing.
GASTROINTESTINAL: Denies nausea, vomiting or diarrhea. No abdominal pain or blood in
stool. No acid reflux voiced. Bowel sounds heard in all 4 quadrants, no tenderness noted.
GENITOURINARY: No burning on urination. No delayed urination. Denies blood in urine.
States bright yellow color. No issues with bladder control.
Min of 3 reference dated within 5 years
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?
Patient Information:
Intials: AB Age: 15 Sex: Male Race: White
S.
CC (chief complaint): dull ache in both knees
HPI: Patient is a 15 year old white male who complains of dull pain in both knees. He states at
time one or both knees click, and there is a catching sensation under the patella. The patient
states it has been about 2 months since the aching began. He denies any other signs and
symptoms other than the pain he voices. He denies that it makes him nauseated. Exertion does
worsen the pain such as when he is squatting or running. He has taken Aleve and other NSAIDS
but denies any real relief. At worse, he complain of a 7/10 pain scale.
, Current Medications: Aleve 220mg x 2 tablets PO q 4hr PRN, Motrin 200mg x 2 tablets PO q
4hr PRN (alternating as needed for swelling & pain), Tylenol 225mg x 1-2 tablets PO for fever
when needed
Allergies: Medication – NKDA; Food – okra – patient’s throat begins to swell and he breaks out
in hives; Seasonal – none noted
PMHx: all childhood immunization are up to date (MMR, Polio, DTaP/DT/Td, Hib, Hep B); AB
did have chicken pox as a younger child; no surgical history; procedures – tonsillectomy and
adenoidectomy when 5 years old, tubes in ears when 5 years old.
Soc Hx: AB is a student is middle school who has a passion for sports. He plays baseball and
runs track for the school. He also participates in summer league baseball. He lives with his
parents in a nice subdivision in a 2 story home where his bedroom is upstairs. AB denies use of
any alcohol or tobacco at this time. He does have a younger sister who is 9 years old.
Fam Hx: Sister – 9 years old with no illnesses or health issues; Dad – 37 years old with no
health issues but had partial knee replacement last year. Takes NSAIDs as need for pain and
swelling around joints; Mother – 36 years old with hypertension, well controlled with Atenolol
10mg PO QD; Maternal Grandmother – 62 years old HTN, GERD, THR at age 55; Maternal
Grandfather – 66 years old, skin cancer, hx of prostate cancer (urologist removed prostate);
Paternal Grandmother – 70 years old, hospitalized with recent fall and broken hip, hx of breast
cancer, beginning stages of dementia, hx of UTI; Paternal Grandfather – deceased last year at age
73 from aneurysm, hx of HTN, cardiac stent placement 4 years prior, TKR bilaterally.
ROS:
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes - No visual loss, blurred vision, double vision or yellow sclerae; Ears – no
hearing loss, no build up; Nose & Throat – Denies sneezing, congestion, runny nose or sore
throat.
SKIN: No rash or itching. Intact, cool, dry, normal turgor, non-pale, no burning or pain,
CARDIOVASCULAR: No chest pain voiced. No palpitations or edema noted. No murmurs
noted. Normal heart sounds.
RESPIRATORY: No dyspnea or orthopnea, denies cough, lungs clear bilaterally, no rhonchi or
wheezing.
GASTROINTESTINAL: Denies nausea, vomiting or diarrhea. No abdominal pain or blood in
stool. No acid reflux voiced. Bowel sounds heard in all 4 quadrants, no tenderness noted.
GENITOURINARY: No burning on urination. No delayed urination. Denies blood in urine.
States bright yellow color. No issues with bladder control.
