Right knee pain

The patient is a very pleasant 68-year-old gentleman with insulin-dependent diabetes. He has complaints of severe right knee pain which he states is the result of osteoarthritis in the right knee. He had a recent XR of the knee and also had an MRI which he states demonstrated a torn meniscus. He has been under the care of orthopedic surgeon .He states that he underwent 12 sessions of physical therapy which did not help as well as a non-fluoroscopically guided cortisone injection in the right knee, which appears to have had no local anesthetic phase relief. He presents today to inquire about viscosupplementation injections.

ASSESSMENT:
This is a 68-year-old insulin-dependent diabetic with severe and progressive worsening right knee pain which has been evaluated by Dr. The patient states that he has osteoarthritis of the right knee in addition to a meniscal tear, but I have no access to imaging studies today.

IMPRESSION:
1. Right knee pain; most likely a combination of degenerative osteoarthropathy with meniscal tear (per patient as there are no imaging studies available).
2. Insulin-dependent diabetes.

PLAN:
The patient appears to have maximized his physical therapy visits this year. He is interested in viscosupplementation and from his history I do feel that he is an appropriate candidate. I have placed a request for his radiological interpretations for his x-rays and his MRI as well as the physical therapy notes from the medical center where he was treated. Unless there is some severe abnormality noted on imaging studies, we can move forward with regimented viscosupplementation injections of a series of 3 to 5. We will forgo physical therapy at this point as he has already had extensive physical therapy. He has significant bony enlargement as well as bony tenderness with crepitus and has significant morning stiffness. He has failed conservative therapy at this point including a non-image guided glucocorticoid injection as well as physical therapy.

We will see how well he does from regimented viscosupplementation injections and we may have to consider PRP therapy for his meniscal tear in the future. This was discussed but I would not to pursue treatment for the meniscal tear until we have maximized treatment of the osteoarthropathy.

He is in agreement with this plan. He is very happy with this visit today. I will see him back when I return in four weeks’ time at which time we can reassess his progress. I would also like to have him fitted for an unloading brace as he does have significant difficulty with ambulation at this time and it does place him at a risk for falls. We will have him fitted at follow-up.

He seemed very happy with this visit. I look forward to see him in follow-up.

Advertisements

Leave a Reply