What's the diagnosis?

[GladifImakeit]

Hi ortho folks. I have a patient and I can't figure out what the next best step would be. Can you offer your insight, please?

26 y/o female with hypermobile joints presents with severe knee pain and swelling and inability to ambulate for 3 days somewhat relieved with ibuprofen and icepacks. There was no obvious trigger - the knee just "locked" when she was at her desk. What should I recommend? MRI? PT? She isn't opposed to surgery if it will help. Something is definitely abnormal though.

Thank you!

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[HopesandDreams]

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[skiz knot]

Hi ortho folks. I have a patient and I can't figure out what the next best step would be.

YOU list yourself as a medical student. YOU do not have ANY patients. Talk to your attending. Refer the patient to an orthopaedic surgeon.

 

[Green Grass]

YOU list yourself as a medical student. YOU do not have ANY patients. Talk to your attending. Refer the patient to an orthopaedic surgeon.

Boy, that was fun and helpful. SDN rocks!

 

[skiz knot]

Boy, that was fun and helpful. SDN rocks!

Your sarcasm is noted. So is your stupidity. S/He asked what the next step was. The next step is to refer the patient to an orthopaedic surgeon. The person has already indicated s/he is unsure what to do. One should obtain a history and physical exam to make a differential diagnosis. They were unable to determine a likely diagnosis. The next step is NOT to blindly order some expensive test (MRI). Xray should probably be ordered if the ordering physician is capable of interpreting it. Do not count on the radiologist to provide any meaningful information if no obvious fracture is evident. There are a variety of possible causes of this patients symptoms, not all will require advanced diagnostics. An adequate understanding of musculoskeletal medicine is grossly lacking in many physicians/NPs because it is not adequately taught in medical/NP school or residency. For the best likelihood of providing a proper diagnosis and treatment plan, refer the patient to an orthopaedic surgeon (or primary care sports medicine specialist).

 

[Green Grass]

Your sarcasm is noted. So is your stupidity. S/He asked what the next step was. The next step is to refer the patient to an orthopaedic surgeon. The person has already indicated s/he is unsure what to do. One should obtain a history and physical exam to make a differential diagnosis. They were unable to determine a likely diagnosis. The next step is NOT to blindly order some expensive test (MRI). Xray should probably be ordered if the ordering physician is capable of interpreting it. Do not count on the radiologist to provide any meaningful information if no obvious fracture is evident. There are a variety of possible causes of this patients symptoms, not all will require advanced diagnostics. An adequate understanding of musculoskeletal medicine is grossly lacking in many physicians/NPs because it is not adequately taught in medical/NP school or residency. For the best likelihood of providing a proper diagnosis and treatment plan, refer the patient to an orthopaedic surgeon (or primary care sports medicine specialist).

Why are you assuming that the student isn't on an ortho rotation? He/she posted in the ortho forum, the patient has an ortho problem, and they never mentioned referring the patient to ortho as an option. Any schmuck can tell the OP to send the patient to ortho. Why not give a meaningful response, much like you did in your second post?

 

[skiz knot]

Why are you assuming that the student isn't on an ortho rotation? He/she posted in the ortho forum, the patient has an ortho problem, and they never mentioned referring the patient to ortho as an option. Any schmuck can tell the OP to send the patient to ortho. Why not give a meaningful response, much like you did in your second post?

I am confident any attending orthopaedic surgeon would be able to determine a "next step" in diagnosis and treatment. It is more likely the OP is craftily soliciting medical advice under the guise of "having a patient" rather than a friend with a problem, as they realize that would be a SDN TOS violation.

 

[Green Grass]

I am confident any attending orthopaedic surgeon would be able to determine a "next step" in diagnosis and treatment. It is more likely the OP is craftily soliciting medical advice under the guise of "having a patient" rather than a friend with a problem, as they realize that would be a SDN TOS violation.

A troll is in our midst? I hadn't considered that. And if that is the case, please accept my apologies. Good day sir.

 

[jacobus]

 

[OrthoGod]

We shouldn't be fighting each other on these forums guys.

Anyway, most doctors would start off with an x-ray to rule out fractures or obvious breakages. Such symptoms are possible when presenting with such diagnoses.

If the x-ray comes back negative, further scans will be required (i.e. MRI).

 

[HopesandDreams]

We shouldn't be fighting each other on these forums guys.

Anyway, most doctors would start off with an x-ray to rule out fractures or obvious breakages. Such symptoms are possible when presenting with such diagnoses.

If the x-ray comes back negative, further scans will be required (i.e. MRI).

and the troll saga continues

 

[skiz knot]

and the troll saga continues

Do most attending surgeons at Harborview Medical Center use the term "breakages?"