KNEE PAIN - WEIGHT LIFTER

Abstract

HISTORY 35 year old male presented with right anteromedial knee pain that began following his routine weight training workout 8 days prior to presentation. Pain fairly constant. No alleviating factors. Symptoms worsened over past 8 days. He denied any trauma. He denied any previous history of knee pain. He denied swelling, instability, locking, or other mechanical symptoms. He denied constitutional symptoms. No history of crystalline-induced arthropathy. Alcohol intake <2 drinks per week. Denied use of anabolic-androgenic steroids. Works as a customs engineer which requires being on his feet most of the day. No family history of rheumatologic disease. PHYSICAL EXAMINATION Afebrile, Right knee with trace effusion. No erythema or warmth. Full extension; Flexion to 125 degrees; Maximal area of tenderness over the medial femoral condyle. No joint line tenderness. No ligamentous instability. Negative McMurray's. Negative patellar apprehension test. Normal gross neurologic and vascular exam. DIFFERENTIAL DIAGNOSIS Medial meniscal tear. Osteochondral or chondral defect. Avascular necrosis. Femoral stress fracture. Crystalline-induced arthropathy. Medial plica syndrome. Pes anserine bursitis. Saphenous neuritis. Loose body. Quadriceps tendon tear (partial). TEST AND RESULTS AP/LAT, notch and sunrise radiographs — small suprapatellar joint effusion; otherwise normal. - MRI — abnormal increased signal within the distal vastus lateralis; — intrameniscal abnormality within the posterior horns of the medial and lateral menisci, without tear, — small joint effusion - Patient declined arthrocentesis - Positive Tinel's test over the saphenous nerve - Diagnostic local lidocaine injection of the saphenous nerve near its exit from the adductor canal - complete resolution of symptoms. FINAL/WORKING DIAGNOSIS Saphenous neuritis (right medial knee). TREATMENT and OUTCOMES Patient with complete resolution of symptoms upon leaving the office. Failed to keep follow-up appointment. Patient was called 1 and 3 months after presentation and has been completely pain free. No nerologic complaints. Returned to all previous activities (work and weight lifting) without problems.