Knee Pain-Recreational Athlete

Abstract

1267 HISTORY: A 24-year old male presented to the office with progressive wax/waning severe knee pain associated with effusions for 4 weeks. He denied any acute injury or increase of his usual activities of jogging and weight training. He had a past medical history significant for a torn medial meniscus in the same knee 2 years ago confirmed by MRI, which subsided without invasive intervention. He felt that his symptoms at present were reminiscent of those associated with his prior injury. He denied locking or buckling, but admitted to difficulty pivoting in certain directions, and also admitted to pain with full weight-bearing. He denied systemic symptoms. PHYSICAL EXAMINATION: Patient walked in with a noticeable limp, but was able to fully bear weight. Patient's knee was warm and swollen, with a significant joint effusion. The skin is slightly wam, without erythema. range of motion severely limited in both flexion and extension, with knee held at 45 degrees. There was no obvious deformity. The knee was globally tender without definitive joint line tenderness. There was no patellar apprehension or associated tenderness upon gentle manipulation. Lachman, McMurray's, anterior and posterior drawer tests were limited secondary to patient discomfort, with no positive findings. Likewise, there was no appreciable laxity with valgus and varus stress (also limited). Under sterile conditions the knee joint was aspirated, yielding 37 cc. of cloudy serous fluid, with partial resolution of the patient's symptoms. DIFFERENTIAL DIAGNOSIS: Reexacerbation of medial meniscus tear Other internal derangement Septic arthritis TEST AND RESULTS: Joint aspiration-cloudy serous synovial fluid. CBC- Largely WNL Comprehensive metabolic panel, including uric acid- WNL Synovial Fluid Cell Count: WBC 13900 cells/mm-3 RBC 2200 cells/mm-3 Polys 50% Lymph 14% No crystals Glucose 51 mg/dl Protein 4.2 g/dl Fluid culture- No aerobic or anaerobic growth Lyme Western Blot of Fluid: Positive for IgM and IgG FINAL WORKING DIAGNOSIS: Lyme disease TREATMENT AND OUTCOMES: Patient was placed on Doxycycline 100 mg BID for a thirty day course, along with Ibuprofen 800 mg TID, and sent to orthopaedics for further evaluation. Patient was initially with assisted weight bearing, progress as tolerated. The patient subsequently had complete resolution of his symptoms after his course of antibiotics. Complete follow-up pending.