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Knee Pain

Solve the Medical Riddle: Her 14-year-old Daughter Had Knee Pain and Difficulty Climbing Stairs, Third Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient and her mother reported the patient’s symptoms to her PCP. The doctor proceeded with the examination using the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor ordered an X-ray of Julia’s knee and an MRI, and referred Julia to a physiatrist and a sports medicine doctor. The second week, we learned the results of Julia’s X-ray and MRI, and the  specialists did exams and conferred with the PCP. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“I’m betting that the diagnosis is not the kind of tumor mentioned during the First Week of this Riddle! Wow! I hope I’m right. Anyway, here’s my guess: Maybe Julia has a chronic injury of her anterior cruciate ligament or ACL, or maybe a partial tear with some involvement of meniscus or cartilage tears. I studied ballet until I was 16 years old, and I kept quiet about my knee pain that started when I was 15 and landed really hard out of a jump on a stage that wasn’t “spring” or “floating.” When I finally gave in and told my teacher about the pain, it turned out that the meniscus was causing the pain and that the ACL issue could be serious down the road if the whole thing did tear. Ligaments don’t have any blood flow so you can’t feel pain if they tear but the ‘joint mice’ – little bits of meniscus cartilage that were trying to regrow – were jamming my knee and that really hurt. End of story, I have an arthroscopy to get the joint mice vacuumed out and I went to physical therapy to strengthen my quadriceps in order to prevent a full ACL tear. The quads are the four groups of muscles on the front, back, and sides of your thigh. I quit dancing when I went to college and took up swimming, which was safer for me. I wasn’t all that good at dancing anyway! So now I’m in my 50s and the ACL has never torn. Best of all, I’m pain free!”

— Lillian G.

“Could Julia have an infection such as chronic Lyme disease or maybe autoimmune arthritis? My cousin had knee pain from Lyme disease after she went camping with her family in Connecticut, and my sister has knee pain from rheumatoid or autoimmune arthritis. We have no idea what caused it! The doctor says it’s ‘idiopathic’, meaning no known cause.” But Julia’s kind of young for that, I think.”

— Jean R.


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