Severe bilateral tricompartmental joint space osteoarthropathy; pain is left greater than right

The patient presents today for x-ray review. She was last seen in this office earlier this month at which time plain x-rays were ordered of her knees. That was on April 1, 2013. She continues to walk with severely antalgic gait and the use of a single-point cane with complaints of severe medial compartment pain in the left knee.

DIAGNOSTIC STUDIES:
Standing weightbearing, AP and lateral views of the bilateral knees were obtained on April 6, 2013. These demonstrate bilateral tricompartmental joint space narrowing most pronounced medially. She also has what appears to be dystrophic calcification.

IMPRESSION:
1. Severe bilateral tricompartmental joint space osteoarthropathy; pain is left greater than right.
2. Chronic Plavix therapy.

PLAN:
We will start her on the protocol for viscosupplementation and regimen of physical rehabilitation. I also like her to fit for left knee brace as well. We will arrange that at her next follow-up visit. We will perform image-guided precise joint injection with the use of ultrasound at this time and we will see how she does over the new few weeks. She understands that a surgical referral may be needed depending on her response to viscosupplementation injections and regimented physical rehabilitation.

She is in agreement with this plan and we will see her for the start of her treatment hopefully next week.

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