Just another knee sprain?

Diagnostic Challenge

James Webley, MD

From the Genesys Regional Medical Center, Grand Blanc, Mich., Michigan State University College of Osteopathic Medicine, East Lansing, Mich., Michigan State University College of Human Medicine, Grand Rapids, Mich.

CJEM 2010;12(1):62

CASE HISTORY

A 62 year old man presented to the emergency department with right knee pain and an inability to bear weight on the affected limb after stumbling down a set of stairs. The patient did not fall, nor did he twist his knee. He complained of pain around his knee, but only on extension. His medical history included hypertension and type 2 diabetes mellitus. There was no history of recent immunosuppressive therapy or treatment with a fluoroquinolone antibiotic.

The key features of the physical examination are evident in the photographs of the patient’s knee (Fig. 1).

Figure 1 A Figure 1 B

Fig. 1. Emergency department wait time and length of stay before and after intervention. Mean wait time (from registration to physician encounter) and length of stay (from registration to exiting department) for discharged patients and for all patients are displayed on a month-by-month basis.