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A 25-year-old male with right knee pain following trauma: Case presentation
Clinical Chiropractic (2008) 11, 2—3
intl.elsevierhealth.com/journals/clch
CASE CHALLENGE
A 25-year-old male with right knee pain following trauma: Case presentation Martin D. Timchur a,*, Samantha R. Cornell a, Michelle A. Wessely b, Peter W. McCarthy a a
Welsh Institute of Chiropractic, University of Glamorgan, Treforest, Pontypridd CF37 1DL, UK ´en de Chiropratique), Department of Radiology, IFEC (Institut Franco-Europe 24 Boulevard Paul Vaillant Couturier, 94200 Ivry-Sur-Seine, France b
Received 2 July 2007; accepted 20 July 2007
Clinical findings and presentation A 25-year-old male patient presented to the Welsh Institute of Chiropractic (WIOC), complaining of a
1-week history of right knee pain after being struck by a car travelling at approximately 50 km/h. At the time of the injury, the patient was taken to hospital where digital radiographic imaging of the
Figure 1 Anteroposterior (a) and lateral (extension) (b) digital radiographs of the right knee demonstrate no evidence of fracture. No other abnormality is observed. DOI of original article: 10.1016/j.clch.2007.08.002. * Corresponding author. Tel.: +44 1443 483 735. E-mail address: [email protected] (M.D. Timchur). 1479-2354/$32.00 # 2007 Published by Elsevier Ltd on behalf of The College of Chiropractors. doi:10.1016/j.clch.2007.08.004
A 25-year-old male with right knee pain following trauma
3
Figure 2 Coronal T1 weighted spin-echo (a) and Short Tau Inversion Recovery (STIR) (b), parasagittal STIR (lateral compartment) (c) and axial STIR (d) MR imaging sequences of the right knee.
right knee was performed and the films were reported as normal (Fig. 1). The patient was subsequently discharged and encouraged to weight bear and return to normal activities. Due to lack of diminution of symptoms the patient presented to the WIOC 7 days later for management of his pain. Physical examination revealed that the patient was able to bear weight on the affected limb in a static posture. Obvious, generalised swelling was noted around the knee with exquisite palpable tenderness over the superior attachment of the medial collateral ligament. Palpation of the medial tibio-
femoral joint line was less painful. Active and passive ranges of motion were significantly reduced in both planes due to pain, with flexion demonstrating the greatest loss of motion at 308. Positive valgus stress test at 308 of flexion and negative at 08 was recorded. All intra-articular ligamentous orthopaedic testing was negative for instability. Magnetic resonance (MR) imaging of the knee was subsequently requested (Fig. 2). What are your imaging findings? What is the most likely diagnosis? How will you manage the patient?
Available online at www.sciencedirect.com
intl.elsevierhealth.com/journals/clch
CASE CHALLENGE
A 25-year-old male with right knee pain following trauma: Case presentation Martin D. Timchur a,*, Samantha R. Cornell a, Michelle A. Wessely b, Peter W. McCarthy a a
Welsh Institute of Chiropractic, University of Glamorgan, Treforest, Pontypridd CF37 1DL, UK ´en de Chiropratique), Department of Radiology, IFEC (Institut Franco-Europe 24 Boulevard Paul Vaillant Couturier, 94200 Ivry-Sur-Seine, France b
Received 2 July 2007; accepted 20 July 2007
Clinical findings and presentation A 25-year-old male patient presented to the Welsh Institute of Chiropractic (WIOC), complaining of a
1-week history of right knee pain after being struck by a car travelling at approximately 50 km/h. At the time of the injury, the patient was taken to hospital where digital radiographic imaging of the
Figure 1 Anteroposterior (a) and lateral (extension) (b) digital radiographs of the right knee demonstrate no evidence of fracture. No other abnormality is observed. DOI of original article: 10.1016/j.clch.2007.08.002. * Corresponding author. Tel.: +44 1443 483 735. E-mail address: [email protected] (M.D. Timchur). 1479-2354/$32.00 # 2007 Published by Elsevier Ltd on behalf of The College of Chiropractors. doi:10.1016/j.clch.2007.08.004
A 25-year-old male with right knee pain following trauma
3
Figure 2 Coronal T1 weighted spin-echo (a) and Short Tau Inversion Recovery (STIR) (b), parasagittal STIR (lateral compartment) (c) and axial STIR (d) MR imaging sequences of the right knee.
right knee was performed and the films were reported as normal (Fig. 1). The patient was subsequently discharged and encouraged to weight bear and return to normal activities. Due to lack of diminution of symptoms the patient presented to the WIOC 7 days later for management of his pain. Physical examination revealed that the patient was able to bear weight on the affected limb in a static posture. Obvious, generalised swelling was noted around the knee with exquisite palpable tenderness over the superior attachment of the medial collateral ligament. Palpation of the medial tibio-
femoral joint line was less painful. Active and passive ranges of motion were significantly reduced in both planes due to pain, with flexion demonstrating the greatest loss of motion at 308. Positive valgus stress test at 308 of flexion and negative at 08 was recorded. All intra-articular ligamentous orthopaedic testing was negative for instability. Magnetic resonance (MR) imaging of the knee was subsequently requested (Fig. 2). What are your imaging findings? What is the most likely diagnosis? How will you manage the patient?
Available online at www.sciencedirect.com