A 48yr old male patient with lower left knee pain


This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of  " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.


A 48 year old male resident of cooch Bihar, came to the hospital on 17th July 2021 with the chief complaints of 
Left knee pain since two years
History of presenting illness:
Patient was apparently assymptomatic two years back then he developed left lower knee joint pain which was insidious in onset, gradually progressive, aggravated on sitting and walking with restriction of movements 
Associated with tingling and numbness of upper limb and lower limb with deep pain, crepitations 
Past history
Similar complaints of backache was present 7years ago for which he took local medication and got cured
k/c/o asthma since 17years 
Not a k/c/o HTN, DM

Family history
Not significant

Personal history
Diet -mixed
Appetite -normal
Bowel and bladder regular
Sleep -adequate
No addictions 
General examination
Patient is conscious, coherent, co operative
Oriented to time, place and person
Moderately built well nourished
Temperature afebrile
Bp 120/90mm hg 
Pulse rate 68bpm 
Respiratory rate 16cpm 
On examination of left knee
ROM 0-110°
Valgus stress test POSITIVE
Medial joint line tenderness PRESENT 
ADT NEGATIVE 
PDT NEGATIVE 
CVS 
S1 S2 heard
Respiratory examination
Normal VBS
BAE present
Per abdomen
Soft, non tender 

INVESTIGATIONS
HEMOGRAM
.      CUE


LFT


RFT


HBsAG RAPID












        
2D ECHO


ECG

GASTRIC ENDOSCOPY


treatment provided till now 
TAB TRYPTOMER 25mg OD 
Physiotherapy of QUADRICEPS TENDON 
KNEE CAP
TAP JOINTACE C2
TAB TENDOFIRM 
TAB ETOS 60mg 

Course in hospital-

Patient is planned for arthroscopy for definitive findings,
In view of elevated HbA1C and RBS patient is being started on glimeperide 0.5mg once daily.
Arthroscopy done on 26th July 2021
 FINDINGS


-Chondrocalcinosis observed on arthroscopy

-Denuded cartilage observed over medial femoral condyle and tibia(medial side)

-Central part of menisci eroded

-Multiple micro fractures done over medial femoral condyle to promote cartilage growth
DIAGNOSIS
? CARTILAGINOUS DEGENERATION SECONDARY TO ARTHRITIS

BY HARSHINI BEECHUPALLY


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