Bilateral Knee Pain Research Articles

A Case Study of Baker Cysts With Intramuscular Extension into the Medial Head of the Gastrocnemius

Baker cysts are common pathological findings during sonography of the popliteal fossa. Although they can present as a typical, mild variant or have an atypical sonographic appearance, a common feature of them is that their expansion is usually limited in the intermuscular planes or spaces between muscles and knee capsule. Baker cysts extending into muscles are rare. Two cases of a Baker cyst with extension into the medial head of the gastrocnemius (MHG) are reported with sonographic findings. Both of the cases were discovered in females, who had anterior or bilateral knee pain and radiographic features of osteoarthritis. Knee effusion was identified sonographically in both of the patient cases. In the popliteal fossa, Baker cysts were found in both patients with intramuscular extension into the MHG. In the first case, a cystic penetration was noted into the MHG, near the neck of the cyst, having a cone shape and oriented toward the inferior aspect of the muscle. The second case had a cystic penetration into the MHG near the base of the cyst with a tube shape, along its long axis. The possible pathogenesis is discussed.

Bilateral Knee Pain—Soccer

Bilateral Knee Pain—Soccer

Course and predictors of pain and physical functioning in patients with hip osteoarthritis: Systematic review and meta-analysis

To systematically summarize the literature on: (i) the course of pain and physical functioning; and (ii) predictors of deterioration of pain and physical functioning in patients with osteoarthritis of the hip. A literature search was conducted in PubMed, CINAHL, Embase, PsychINFO and SPORTDiscus up to July 2015. Meta-analyses and qualitative data syntheses were performed. Eleven of the 15 included studies were of high quality. With regard to the course of pain and physical functioning, high heterogeneity was found across studies (I² > 71%) and within study populations (reflected by large standard deviations (SDs) of change scores). Therefore, the course of pain and physical functioning was interpreted to be indistinct. Clinical characteristics (higher comorbidity count and presence of knee osteoarthritis), health behaviour factors (no supervised exercise and physical inactivity) and socio-demographics (lower education) were found to predict deterioration of pain (weak evidence). Higher comorbidity count and lower vitality were found to predict deterioration of physical functioning (strong evidence). For several other predictive factors weak evidence was found (e.g. bilateral hip pain, increase in hip pain (change), bilateral knee pain, presence of knee osteoarthritis). Because of high heterogeneity across studies and within study populations, no conclusions can be drawn with regard to the course of pain and physical functioning. Several clinical characteristics, health behaviours and psychosocial factors prognosticate deterioration of pain and physical functioning. These findings may guide future research aimed at the identification of subgroups of patients with hip osteoarthritis.

Bilateral generalised synovial chondromatosis of the knee: Bone scintigraphic demonstration with radiologic correlation.

A 67-year-old woman with a history of bilateral progressive knee pain and swelling was referred for 99mTc-methyl diphosphonate bone scintigraphy. Flow and blood pool images showed bilateral heterogeneous increased uptake and delayed phase revealed mass-looking lobulated heterogeneous increased activity in both of knees extending distal part of the femoral shaft, but no other pathologic uptake was found in rest of the body. A diagnosis of synovial chondromatosis was made when correlated with X-ray and computed tomography.(CT) images. This is a rare presentation of generalized synovial chondromatosis involving both knees which demonstrated on bone scintigraphy with X-ray and CT correlation.

Bilateral Simultaneous Quadriceps Tendon Rupture in a 24-Year-Old Obese Patient: A Case Report and Review of the Literature.

Introduction. Simultaneous bilateral quadriceps tendon ruptures (SBQTR) are uncommon knee injuries and most frequently occur in male patients, over 50 years of age. It can be associated with one or more predisposing risk factors like obesity, steroids use, and hyperparathyroidism. The main focus of this paper is to review SBQTR in obese patients. Case Report. We are reporting the youngest patient in the literature to date, a 24-year-old obese male patient, who presented to the emergency department complaining of bilateral knee pain and inability to walk after a fall during a basketball game. His clinical examination revealed the presence of a palpable suprapatellar gap and loss of knee extension bilaterally. Magnetic resonance imaging (MRI) confirmed that both of his quadriceps tendons were ruptured. A day after his diagnosis, the patient underwent successful operative repair followed by rehabilitation. At the two-year follow-up, the patient had full strength of both quadriceps muscles with no extension lag. Conclusion. The diagnosis of SBQTR can be challenging. Early diagnosis and treatment are associated with better functional outcome compared to delayed treatment. Physicians should have a high index of clinical suspicion in order not to miss such an injury and achieve favourable outcomes.

A MISSED DIAGNOSIS OF ASYMPTOMATIC SIMULTANEOUS BILATERAL FRACTURE NECK FEMUR DUE TO VITAMIN D DEFICIENCY TREATED AS SEVERE BILATERAL OSTEOARTHRITIS KNEE: HOW TO PREVENT IT?

Simultaneous bilateral neck of femur fracture is a rare injury and poses a diagnostic challenge. This uncommon pattern of injury has been associated with high-energy trauma and seizure disorders. Proper clinical examination of both hip and knee joint should be performed in patients presenting with bilateral knee pain. Clinical suspicion and detailed radiologic evaluation of both hip and knee joint is essential for diagnosis of uncommon injury around hip joint. A battery of metabolic tests to assess vitamin D deficiency and histology study of the specimen should be performed. Patients with simultaneous bilateral fracture neck femur can be treated well and perform activities of daily living with good outcomes with prompt surgical intervention and medical treatment. We report the case of asymptomatic simultaneous bilateral neck of femur fracture following vitamin D deficiency which was missed and was misdiagnosed and treated for severe bilateral osteoarthritis knee.

Health-related quality of life in older adults with bilateral knee pain and back pain: data from the Osteoarthritis Initiative.

This study's objective was to examine the association of self-reported bilateral knee pain (KP) and back pain (BP) with health-related quality of life (HRQoL) among older adults. In this cross-sectional study, data for 1252 older adults (≥65years) were included from the Osteoarthritis Initiative project. Self-reported bilateral KP and BP were used to classify participants into four groups: (1) neither bilateral KP nor BP; (2) no bilateral KP with BP; (3) bilateral KP without BP; and (4) both bilateral KP and BP. Health-related quality of life was measured using the health survey short form (SF)-12. We used multiple linear regression analyses to examine the associations of bilateral KP and/or BP with the HRQoL. After controlling for covariates, bilateral KP and BP were associated with poorer HRQoL [physical composite scale (PCS): estimated average (β)=-13.1, SE=1.15, p<0.0001; mental composite scale: β=-2.71, SE=1.09, p=0.013, respectively] compared with the group with neither bilateral KP nor BP. In conclusion, older adults with coexisting bilateral KP and BP had significantly poorer physical and mental HRQoL when compared to peers without these conditions.

Bilateral Crush Injury of the Proximal Tibial Physis in an Adolescent Gymnast: A Case Report.

A thirteen-year-old female gymnast experienced bilateral knee pain after landing from a jump off a vault during a competition. Initial radiographs revealed negative findings, but magnetic resonance imaging demonstrated periphyseal osseous edema of the proximal parts of the tibiae. The patient later developed an anterior physeal bar on the right side, with recurvatum deformity. Despite similar initial imaging findings bilaterally and identical mechanisms of injury, only the injury on the right side met the strict criteria for classification as a Salter-Harris type-V injury. This case illustrates the difficulty encountered with current diagnostic criteria for type-V injuries.

Differences in health-related quality of life among subjects with frequent bilateral or unilateral knee pain: data from the Osteoarthritis Initiative study.

Cross-sectional study. To examine associations between frequent bilateral knee pain (BKP) and unilateral knee pain (UKP) and health-related quality of life (QoL). We hypothesized that frequent BKP would be associated with poorer health-related QoL than would frequent UKP and no knee pain. Knee pain is one of the most frequently reported types of joint pain among adults in the United States. It is the most frequent cause of limited physical function, disability, and reduced QoL. Data were collected from the Osteoarthritis Initiative public-use data sets. Health-related QoL was assessed in 2481 participants (aged 45-79 years at baseline). The Knee injury and Osteoarthritis Outcome Score QoL subscale (knee-specific measure) and the physical component summary and mental component summary (MCS) scores of the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) (generic measure) were used to assess health-related QoL. Multiple regression analyses were used to examine the relationships between frequent knee pain and health-related QoL, adjusted for sociodemographic and health covariates. Compared with subjects with no knee pain, subjects with frequent BKP and UKP had significantly lower scores on the Knee injury and Osteoarthritis Outcome Score QoL subscale (mean difference, -35.2; standard error [SE], 0.86; P<.001 and mean difference, -29.2; SE, 0.93; P<.001; respectively) and the SF-12 physical component summary score (mean difference, -6.25; SE, 0.41; P<.001 and mean difference, -4.10; SE, 0.43; P<.001; respectively), after controlling for sociodemographic and health covariates. The SF-12 MCS score was lower among those with BKP (-1.29; SE, 0.42; P<.001). Frequent UKP was not associated with the SF-12 MCS. Subjects with frequent BKP had lower health-related QoL than those with frequent unilateral or no knee pain, as reflected in lower Knee injury and Osteoarthritis Outcome Score QoL subscale and SF-12 physical component summary and MCS scores.

Synovial lipomatosis: A rare cause of knee pain in an adolescent female

Synovial lipomatosis is a benign proliferative disease of the subsynovial adipose which can lead to a variety of presentations. Cases of synovial lipomatosis in children or adolescents are rare. This case report describes an adolescent patient with a rare bilateral presentation of synovial lipomatosis. She had been treated for years prior to her presentation for juvenile idiopathic arthritis. She presented with chronic bilateral knee pain, swelling, and mechanical symptoms. Bilateral MR imaging demonstrated effusions, hypertrophy of the synovium, and polyp-like projections of tissue with the same signal intensity as fat which is pathognomonic for synovial lipomatosis. Arthroscopic synovectomy and extensive debridement of polyp like fat projections of the right knee was performed. Histopathology was consistent with the synovial lipomatosis diagnosis. Postoperatively, the patient was satisfied with her outcome with improved pain relief and function in her right knee.

Resisted exercise and outcomes using disease-specific Urdu version of osteoarthritis outcome score questionnaire in knee osteoarthritis

The purpose of this study was to evaluate the efficacy of resisted exercises on quality of life (QOL) in knee osteoarthritis (OA) patient using disease-specific Urdu version of the knee injury and osteoarthritis outcome score (KOOS) questionnaire. A 60-year-old male patient with bilateral grade-2 primary knee OA was referred by an Orthopedist, with a complaint of bilateral knee pain with poor QOL. He experienced pain severity as seven on visual analog scale, difficulty climbing stairs and on observation patient had left and right swaying, while walking. Pain and QOL were assessed using self-rated questionnaire such as KOOS. On functional assessment prior to the intervention using KOOS questionnaire, the pain subscale was 27% means severe pain and QOL subscale was 13% means poor QOL. The patient was given bilateral resisted exercises using quadriceps table twice daily for 4 weeks along with initial short wave diathermy for pain relief. At the end of 6 th week pain was nearly normal 2 on the numeric scale and KOOS subscales pain and QOL were 84%, 82.25% indicating substantial pain relief and good QOL along with improved gait. It is concluded that bilateral resisted exercises for both hamstring and quadriceps can be used as a prime intervention for relief of pain and improved QOL and to prevent knee flexion deformity.

Tumor-Induced Rickets Presenting in an Adolescent: A Case Report and Review of the Literature.

Rickets of any etiology is rarely encountered in modern clinical practice, and a primary presentation in an adolescent is even less common. Most cases of rickets are due to abnormalities in vitamin D intake, absorption, activity, or metabolism; others are related to phosphate deficiency from excessive renal excretion (e.g., X-linked dominant hypophosphatemic rickets). When a patient presents with no evidence of hereditary rickets and a standard workup fails to reveal the cause, unusual etiologies must be considered. Tumor-induced hypophosphatemia is a paraneoplastic condition that typically presents with osteomalacia in adults in their fifth decade of life1. We present a case of tumor-induced rickets in a previously healthy adolescent. The patient and his family were informed that data concerning the case would be submitted for publication, and they provided consent. A fourteen-year-old black adolescent presented to the pediatrician with the vague symptoms of bilateral knee and ankle pain, as well as generalized weakness. His mother was concerned that he “walked like a 70-year-old man.” He had no history of trauma or related family history. At the time of presentation, his height was at the 70th percentile and his weight was above the 90th percentile for age. He had no overt skeletal deformities. The pain was initially attributed to “growing pains.” He was prescribed nonsteroidal anti-inflammatory drugs, physical therapy, and shoe insoles. When the pain did not remit over the subsequent seven months, he was referred to a primary care sports medicine clinic where he was diagnosed with bilateral patellofemoral syndrome and bilateral pes planus. Radiographs of the knees obtained at that time demonstrated notable physeal widening and generalized demineralization of the cortices bilaterally (Fig. 1). Laboratory assessment was initiated (Table I). He was diagnosed with vitamin D deficiency and hypophosphatemic rickets and was prescribed calcitriol as well as sodium …

Bilateral Knee and Intermittent Elbow Pain in a Competitive Archer/Hunter

A 59-year-old white hunter and archer presented to the sports medicine clinic with bilateral knee and left elbow pain. Various treatments for presumed musculoskeletal diagnoses did not help. When reviewing his medications, the patient concluded that the only new one before the appearance of his symptoms was tadalafil. He stopped taking it, and his pain resolved immediately thereafter. On review, it was noted that the patient was also on pravastatin. There have been a few previous reports of myopathy and rhabdomyolysis with the concomitant use of a phosphodiesterase-5 inhibitor (PDE5I), such as tadalafil and a statin. We report a case where such processes may have been occurring and may have resolved shortly after discontinuing concomitant use, in turn resulting in decreased pain. Clinicians may need to be aware of the possibility of such symptoms and processes occurring in patients taking both a statin and a PDE5I.

Poster 463 Novel Use of Genicular Nerve Block as an Alternative Treatment Option in a Patient with Chronic Bilateral Knee Pain after Left Total Knee Arthroplasty. A Case Report

Poster 463 Novel Use of Genicular Nerve Block as an Alternative Treatment Option in a Patient with Chronic Bilateral Knee Pain after Left Total Knee Arthroplasty. A Case Report

Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed.

(247) Successful interdisciplinary pain management in the treatment of chronic joint pain in a patient with Noonan Syndrome: a case report

Noonan Syndrome is a rare genetic disorder that results in the abnormal development of various body parts that can present as short stature, unusual facial features and is most commonly associated with cardiac defects. Chronic joint pain is a clinical finding that is associated with Noonan Syndrome (54% prevalence).1 We present a case of a 51 year-old male with a history of scoliosis status post correction who presented with back, neck and bilateral knee pain. The back and neck pain were described as dull in nature and the knee pain was sharp. The neck and back pain improved with lying down, however, there were no clear alleviating factors for the knee pain. Prior to being evaluated by the chronic pain program, he had been taking hydrocodone/acetaminophen 10/325mg, one to two tablets, four times a day. Without pain medications, the patient’s pain was rated a 90/100 on a visual analog scale (VAS), and decreased to 40/100 on the VAS with opioid medication usage. Prior to participating in an interdisciplinary pain management program, the patient tried land based physical therapy with limited success. Through participation in an interdisciplinary pain management program, which included occupational therapy, physical therapy, biofeedback, pool therapy, feldenkrais, twice weekly medication monitoring and pain psychology, the patient was able to improve his functionality and tolerance to pain. He also learned coping strategies which helped him manage his pain on a more productive basis. This case highlights the importance of using an interdisciplinary approach in the treatment of complex disorders when other treatments have been unsuccessful. (1. Smpokou, P, American Journal Medical Genetics, 2012.) Noonan Syndrome is a rare genetic disorder that results in the abnormal development of various body parts that can present as short stature, unusual facial features and is most commonly associated with cardiac defects. Chronic joint pain is a clinical finding that is associated with Noonan Syndrome (54% prevalence).1 We present a case of a 51 year-old male with a history of scoliosis status post correction who presented with back, neck and bilateral knee pain. The back and neck pain were described as dull in nature and the knee pain was sharp. The neck and back pain improved with lying down, however, there were no clear alleviating factors for the knee pain. Prior to being evaluated by the chronic pain program, he had been taking hydrocodone/acetaminophen 10/325mg, one to two tablets, four times a day. Without pain medications, the patient’s pain was rated a 90/100 on a visual analog scale (VAS), and decreased to 40/100 on the VAS with opioid medication usage. Prior to participating in an interdisciplinary pain management program, the patient tried land based physical therapy with limited success. Through participation in an interdisciplinary pain management program, which included occupational therapy, physical therapy, biofeedback, pool therapy, feldenkrais, twice weekly medication monitoring and pain psychology, the patient was able to improve his functionality and tolerance to pain. He also learned coping strategies which helped him manage his pain on a more productive basis. This case highlights the importance of using an interdisciplinary approach in the treatment of complex disorders when other treatments have been unsuccessful. (1. Smpokou, P, American Journal Medical Genetics, 2012.)

Erdheim–Chester disease with an 18F-fluorodeoxyglucose-avid breast mass and BRAF V600E mutation

Erdheim-Chester disease (ECD) is a non-Langerhans cell histiocytosis. Herein we report a case of a 49-year-old woman who developed bilateral knee pain. Imaging procedures revealed multiple long bone lesions and a well-defined 18F-fluorodeoxyglucose-avid mass in the left breast. The breast mass was resected, and an open biopsy was performed on the right femoral lesion. Both specimens revealed involvement by histiocytic infiltrates with features suggestive of ECD. The BRAF V600E mutation was detected by DNA sequencing and immunohistochemistry.

Effects of Mild and Severe Knee Joint Pain on the Frequency of Falls and Fall Risk in Elderly Females

This study aimed to examine differences in the frequency of falls during the past year and fall risk among 392 elderly females was categorized into five groups on the basis of the knee pain expe-rienced: no knee pain, mild unilateral knee pain, mild bilateral knee pain, severe unilateral knee pain, and severe bilateral knee pain. The subjects participated in a fall risk survey comprising 50 items representing five risk factors: “symptoms of falling”, “disease and physical symptoms”, “en-vironment”, “behavior and character”, and “physical function”. The frequency of falls during the past year, score for each risk factor, and the total fall risk score were not significantly different between the mild unilateral and mild bilateral knee pain groups, and between the severe unilateral and severe bilateral knee pain groups. Therefore, these groups were pooled to form a mild knee pain group and a severe knee pain group and analyzed. The severe knee pain group had experienced a significantly greater number of falls during the past year compared with the no knee pain group. Furthermore, the symptom of falling score was significantly higher in the severe knee pain group than in the no knee pain group, while the disease and physical symptoms score was significantly higher in the mild and severe knee pain groups than in the no knee pain group. The physical function score and total fall risk score were significantly higher in the following order: the severe knee pain group, the mild knee pain group, and the no knee pain group. Our results indicate that for elderly females who can achieve ADL independently, the degree of knee pain (mild or severe) has a marked effect on fall risk, irrespective of laterality of the pain (unilateral or bilateral). Factors such as symptoms of falling, disease and physical symptoms, and physical function are also related to fall risk in this population. Furthermore, elderly individuals with severe knee pain experience frequent falls.

Anterior knee pain in patients with cerebral palsy.

BackgroundThe aim of this study was to identify the risk factors for anterior knee pain in patients with cerebral palsy.MethodsThis prospective study investigated the risk factors for anterior knee pain in 127 ambulatory patients with spastic cerebral palsy in terms of walking pain, resting pain, and provocative pain. Demographic data analysis and physical examination for measuring the knee flexion contracture and unilateral and bilateral popliteal angles were performed. Patellar height was measured on radiographs, and patella alta was identified. The risk factors for anterior knee pain were analyzed using multivariate analysis with a generalized estimating equation.ResultsSeventy-seven patients were found to have patella alta based on the radiographic measurements (60.6%). Overall, sixteen patients (12.6%) had either unilateral or bilateral anterior knee pain. Of these, 6 patients showed a visual analogue scale (VAS) ≤ 3, 9 patients showed 3 < VAS ≤ 7, and one patient showed a VAS > 7. Age was found to be a significant risk factor for walking pain and resting pain with odds ratios (ORs) of 1.08 (95% confidence interval [CI], 1.02 to 1.14) and 1.09 (95% CI, 1.03 to 1.15), respectively. In the multivariate analysis, knee flexion contracture was a significant protective factor with an OR of 0.92 (95% CI, 0.85 to 0.98).ConclusionsApproximately 12.6% of ambulatory patients with spastic cerebral palsy were found to have anterior knee pain in our hospital-based cohort study. Age was found to be a significant risk factor for anterior knee pain while walking and resting.

A case of bilateral stress fractures in an old woman: three years of pain

In elderly patients frequent episodes of joint pain of lower limbs exacerbated by stress and resistant to treatment occur frequently. This paper reports a case of a long lasting bilateral atraumatic knee pain with a final diagnosis of bilateral stress fractures of proximal tibia in osteoporotic postmenopausal woman. The distinctive trait of this case is that the fracture has set in bilaterally and associated with an isthmic L4-L5 spondylolisthesis in a patient afflicted by a decline in mood. This particular clinical picture has delayed the diagnosis and the suitable treatment for 3 years. Therapy for this type of patients must aim in the acute phase at pain relief and only after must be settled in a long term antiosteoporotic therapy. We choose clodronate acyd for pain relief and after strontium ranelate for osteoporosis prevention.