Photo Rounds

Left knee pain

A 46-year-old woman presented to her family physician (FP) with a one-week history of left knee pain and swelling. She was an avid long-distance runner, but had begun running shorter distances because of the pain. She was afebrile and had no recent trauma to her left knee (which had a palpable effusion). Her knee wasn’t hot, but there was limited flexion at the joint. The patient had no signs of ligament instability. The McMurray test for a meniscal tear was negative.

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The FP suspected osteoarthritis (OA) was causing the knee effusion. Radiography wasn’t available and a decision was made to do a joint aspiration and steroid injection (if there were no signs of infection). The skin was anesthetized at the site of the aspiration and straw-colored fluid was removed; there were no signs of infection.

The FP injected triamcinolone acetonide 40 mg into the knee. The patient received considerable symptomatic relief from the aspiration and within days of her visit, the intra-articular steroid provided further relief.

A subsequent x-ray confirmed the FP’s suspicions and showed early signs of OA. At follow-up, the FP provided further education on the treatment of OA.

Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H, Usatine R. Arthritis overview. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:562-568.

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