KNEE EXAMINATION
NAME: Mrs. Eleanor Vance
DATE: 01 November 2024
FILE: EV-00789-2024
TITLE: Mrs.
SIDE: Both
REFERRING PRACTITIONER: Dr. Thomas Kelly
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History:
Medical diseases:
Mrs. Vance has a history of well-controlled hypertension, diagnosed 5 years ago, managed with medication. She also has osteoarthritis, diagnosed 2 years ago, affecting both knees, which she manages with over-the-counter pain relievers.
Medication used:
She is currently taking Ramipril 5mg once daily for hypertension and occasionally uses Ibuprofen 400mg as needed for knee pain. She also takes a daily multivitamin.
Allergies:
Mrs. Vance reports no known drug allergies. She has a seasonal allergy to pollen, which causes mild rhinitis.
Other operations:
She underwent an appendectomy at age 25 with no reported complications. No other previous surgical procedures are noted.
Operative adverse reactions:
No adverse reactions or complications were noted during or after her appendectomy.
Complaint Right Knee:
Patient complains of chronic dull ache in her right knee, exacerbated by walking stairs and prolonged standing. The pain has been present for approximately 2 years, gradually worsening. It is relieved by rest and applying a heat pack. She reports occasional clicking but no locking or instability.
Pain Right Knee:
The pain is located diffusely across the anterior aspect of the right knee, described as a dull ache. On a scale of 0-10, her pain is typically 4/10, increasing to 7/10 with activity. There is no radiation of the pain.
Previous Treatment Right Knee:
Previously, Mrs. Vance has tried physiotherapy for 6 months, which provided temporary relief. She also received a corticosteroid injection 8 months ago, which offered relief for approximately 3 months. She currently uses topical anti-inflammatory creams.
Complaint Left Knee:
Patient complains of intermittent sharp pain in her left knee, particularly with twisting movements and kneeling. The pain started approximately 18 months ago, also gradually worsening. It is relieved by rest. She reports occasional stiffness, especially in the mornings, lasting about 15-20 minutes.
Pain Left Knee:
The pain is localised to the medial joint line of the left knee, described as sharp. On a scale of 0-10, her pain is typically 3/10, increasing to 6/10 with specific movements. There is no radiation of the pain.
Previous Treatment Left Knee:
She has not undergone any specific treatment for her left knee pain, apart from using over-the-counter pain relief when symptoms are severe.
Other orthopaedic complaints not related to the knees:
Mrs. Vance occasionally experiences lower back stiffness, particularly after prolonged sitting, but states it is manageable and not her primary concern today.
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Examination:
Weight: 75 kg
Height: 165 cm
BMI: 27.5 kg/m^2
Right knee examination – Tibio-femoral joint:
* Mild valgus alignment noted.
* Minimal effusion present.
* Tenderness to palpation along the medial joint line.
* Range of motion: Full extension (0 degrees), Flexion to 120 degrees with mild pain at end range.
* Meniscal assessment: McMurray's test negative. Apley's grind test negative.
* Ligament assessment: Lachman's test negative, Anterior/Posterior drawer tests negative, Varus/Valgus stress tests negative at 0 and 30 degrees.
* Special tests: Nil significant.
Right knee examination – Patella:
* Good patellar tracking, no apprehension.
* Mild retropatellar crepitus on movement.
* No significant tenderness.
Left knee examination – Tibio-femoral joint:
* Normal alignment.
* No effusion.
* Tenderness to palpation along the medial joint line.
* Range of motion: Full extension (0 degrees), Flexion to 115 degrees with moderate pain at end range.
* Meniscal assessment: Medial McMurray's test elicits pain with a subtle click. Apley's grind test positive for medial meniscus.
* Ligament assessment: Lachman's test negative, Anterior/Posterior drawer tests negative, Varus/Valgus stress tests negative at 0 and 30 degrees.
* Special tests: Nil significant.
Left knee examination – Patella:
* Patellar tracking appears normal.
* No apprehension or crepitus.
* No significant tenderness.
Other orthopaedic examination findings:
Spine examination revealed mild tenderness in the lumbar paraspinal muscles with full range of motion. No neurological deficits were noted in the lower extremities.
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Special investigations:
Right knee X-rays:
Anteroposterior (AP) and lateral views demonstrate mild to moderate joint space narrowing in the medial compartment, with osteophyte formation. Patellofemoral joint space appears preserved.
Right knee MRI:
MRI shows full-thickness cartilage loss in the medial tibiofemoral compartment with subchondral bone oedema. No significant meniscal tears or ligamentous injuries are observed.
Right knee other investigations:
Nil other investigations performed.
Left knee X-rays:
AP and lateral views show mild joint space narrowing in the medial compartment. No significant osteophytes or subchondral changes are noted.
Left knee MRI:
MRI reveals a horizontal tear of the posterior horn of the medial meniscus, extending to the inferior articular surface. Mild chondromalacia of the medial femoral condyle. Ligaments are intact.
Left knee other investigations:
Nil other investigations performed.
---
Diagnosis:
Right knee:
Osteoarthritis, right knee, Kellgren-Lawrence Grade 2-3.
Left knee:
Medial meniscal tear, left knee, and early osteoarthritis, left knee.
Other orthopaedic diagnosis:
Lumbar spondylosis (mild).
Other general diagnosis:
Essential hypertension, controlled.
---
Treatment plan:
Right knee – Further investigations:
Consider bone scan if conservative measures fail to assess for ongoing inflammatory activity.
Right knee – Conservative:
Continue with regular low-impact exercise (e.g., swimming, cycling). Initiate a structured physiotherapy programme focusing on quadriceps strengthening and gait training. Consider viscosupplementation if oral pain relief is insufficient.
Right knee – Theatre:
Discuss options for unicompartmental knee arthroplasty if conservative management fails and symptoms significantly impact quality of life.
Left knee – Further investigations:
No further investigations are immediately planned.
Left knee – Conservative:
Referral to physiotherapy for targeted rehabilitation, including strengthening exercises and activity modification. Advise on R.I.C.E. (Rest, Ice, Compression, Elevation) for acute exacerbations. Consider a trial of a knee brace for support during activity.
Left knee – Theatre:
Discuss possibility of arthroscopic meniscectomy if symptoms persist despite conservative management and pain significantly impacts daily activities.
General measures:
Patient advised on weight management and healthy lifestyle choices. Follow-up appointment scheduled in 6 weeks to review progress and discuss treatment options.
Medication prescribed:
N/A (patient to continue current medications; Ibuprofen use as needed for breakthrough pain).
Other orthopaedic conditions:
Advised to continue with core strengthening exercises for lumbar stiffness and consider referral to a chiropractor if back pain worsens.
KNEE EXAMINATION
NAME: [Insert patient’s full name] (Only include if explicitly mentioned in the attachment, transcript, contextual notes or clinical note; otherwise omit completely. Write in a single line.)
DATE: [Insert date of consultation] (Only include if explicitly mentioned in the attachment, transcript, contextual notes or clinical note; otherwise omit completely. Write in a single line.)
FILE: [Insert patient file number or ID] (Only include if explicitly mentioned in the attachment, transcript, contextual notes or clinical note; otherwise omit completely. Write in a single line.)
TITLE: [Insert patient title] (Only include if explicitly mentioned in the attachment, transcript, contextual notes or clinical note; otherwise omit completely. Write in a single line.)
SIDE: [Insert side giving symptoms: Right, Left, or Both] (Only include if explicitly mentioned in the attachment, transcript, contextual notes or clinical note; otherwise omit completely.)
REFERRING PRACTITIONER: [Insert referring doctor or specialist] (Only include if explicitly mentioned in the attachment, transcript, contextual notes or clinical note; otherwise omit completely. Write in a single line.)
---
History:
Medical diseases:
[Insert past and current medical diseases] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Medication used:
[Insert current and past medications, including over-the-counter medications and supplements] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Allergies:
[Insert known allergies and reactions] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Other operations:
[Insert details of previous surgical procedures] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Operative adverse reactions:
[Insert adverse reactions or complications related to previous operations or procedures] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Complaint Right Knee:
[Insert right knee complaint including onset, duration, character, aggravating and relieving factors, and associated symptoms] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Pain Right Knee:
[Insert description of right knee pain including location, quality, severity, pain score, and radiation if applicable] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Previous Treatment Right Knee:
[Insert previous conservative or surgical treatments for the right knee and outcomes] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Complaint Left Knee:
[Insert left knee complaint including onset, duration, character, aggravating and relieving factors, and associated symptoms] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Pain Left Knee:
[Insert description of left knee pain including location, quality, severity, pain score, and radiation if applicable] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Previous Treatment Left Knee:
[Insert previous conservative or surgical treatments for the left knee and outcomes] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Other orthopaedic complaints not related to the knees:
[Insert description of other orthopaedic complaints] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
---
Examination:
Weight: [Insert patient weight] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in a single line.)
Height: [Insert patient height] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in a single line.)
BMI: [Insert BMI] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in a single line.)
Right knee examination – Tibio-femoral joint:
[Insert right tibio-femoral joint findings including alignment, swelling, tenderness, range of motion, meniscal and ligament assessment, and special tests] (Only include if explicitly mentioned in the clinical examination; otherwise omit completely. Use a concise bulleted format.)
Right knee examination – Patella:
[Insert patello-femoral findings including tracking, tenderness, apprehension, crepitus, and retinacular tightness] (Only include if explicitly mentioned in the clinical examination; otherwise omit completely. Use a concise bulleted format.)
Left knee examination – Tibio-femoral joint:
[Insert left tibio-femoral joint findings including alignment, swelling, tenderness, range of motion, meniscal and ligament assessment, and special tests] (Only include if explicitly mentioned in the clinical examination; otherwise omit completely. Use a concise bulleted format.)
Left knee examination – Patella:
[Insert patello-femoral findings including tracking, tenderness, apprehension, crepitus, and retinacular tightness] (Only include if explicitly mentioned in the clinical examination; otherwise omit completely. Use a concise bulleted format.)
Other orthopaedic examination findings:
[Insert findings from examination of other orthopaedic areas] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
---
Special investigations:
Right knee X-rays:
[Insert right knee X-ray findings] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Right knee MRI:
[Insert right knee MRI findings] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Right knee other investigations:
[Insert other right knee investigations and findings] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Left knee X-rays:
[Insert left knee X-ray findings] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Left knee MRI:
[Insert left knee MRI findings] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Left knee other investigations:
[Insert other left knee investigations and findings] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
---
Diagnosis:
Right knee:
[Insert right knee diagnosis] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Left knee:
[Insert left knee diagnosis] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Other orthopaedic diagnosis:
[Insert other orthopaedic diagnoses] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Other general diagnosis:
[Insert other general medical diagnoses] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
---
Treatment plan:
Right knee – Further investigations:
[Insert further investigations planned] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Right knee – Conservative:
[Insert conservative management plan] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Right knee – Theatre:
[Insert surgical plan] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Left knee – Further investigations:
[Insert further investigations planned] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Left knee – Conservative:
[Insert conservative management plan] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Left knee – Theatre:
[Insert surgical plan] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
General measures:
[Insert general advice and follow-up details] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Medication prescribed:
[Insert medications prescribed with dosing instructions] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
Other orthopaedic conditions:
[Insert treatment plans for other orthopaedic conditions] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in full sentences.)
(For each section, only include if explicitly mentioned in the transcript, contextual notes, attachment, or clinical note; otherwise omit the section entirely. Never come up with your own patient details, examination findings, diagnoses, investigations, or management plans. Use only the transcript, contextual notes, or clinical note as the source of truth. If any information related to a placeholder has not been explicitly mentioned, do not state that it is missing—simply omit the placeholder or section entirely.)
