Presentation The patient will come in limping, having suffered a whiplike sting in the calf while stepping off the foot hard or attempting a lunging shot during a game of tennis or similar activity. The patient may have actually heard or felt a “snap,” described as being like the “pop” of a champagne cork, at the time of injury or may think someone actually kicked or…

Presentation Patients seek help because of gradually increasing inferior heel pain that has progressed to the point of inhibiting their normal daily activities. This fasciitis can develop in anyone who is ambulatory but appears to be more common in athletes (especially runners), those older than 30 years of age, those who stand for prolonged periods of time, and the overweight. There is no defining episode of…

Presentation After a direct blow to the medial aspect of the patella or, more commonly, without contact and only after a sudden twisting motion to the opposite side of an outward-pointing planted foot (with a powerful contraction of the quadriceps while the thigh is turning inward), the patient’s kneecap dislocates laterally. The patient, who is usually an adolescent, is brought in with the knee guarded and…

Presentation In myofascial pain syndrome, the patient, who is generally 25 to 50 years of age, will be troubled by the gradual onset of localized or regional unilateral fibromuscular pain that at times can be immobilizing. There may be a history of either acute strain or predisposing activities such as holding a telephone receiver between the ear and shoulder to free the arms, prolonged bending, poor…

Presentation Strains are acute injuries to muscle-tendon units that result from overstretching or overexerting. Strains may occur in the trapezius or paravertebral muscles during a motor vehicle collision, with a whiplash-type injury to the neck. A strain can also occur in the anterior thigh, posterior hamstring group, groin, or gastrocnemius muscle while a person is accelerating, running, or playing in a sport such as tennis. There…

Presentation The patient complains of painful, visible, palpable muscle contractions, often affecting the gastrocnemius muscle or small muscles of the foot or hand. Ordinary cramps occur chiefly at rest during the night or after trivial movement but also can occur after forceful muscle contraction. Other muscle cramps are associated with exercise in the heat, occupations that cause overuse, pregnancy, hemodialysis, electrolyte disturbances, dehydration, and drug or…

Presentation The patient complains of one joint that has become acutely red, swollen, hot, painful, and stiff, with pain on minimal range of motion (ROM). Rapid onset with fever and local warmth suggests the possibility of septic arthritis. A prominent monarticular synovitis with comparatively little pain, but where the joint is warm with a large effusion, especially of the knee, is typical of Lyme disease. A…

Presentation Suddenly or gradually, after lifting, sneezing, bending, or other movement, the patient develops a steady pain in one or both sides of the lower back. At times, this pain can be severe and incapacitating. It is usually better when lying down, worse with movement, and will perhaps radiate around the abdomen or down the thigh but no farther. There is insufficient trauma to suspect bony…

Presentation The patient, usually with a history of a previous knee injury, and often with previous knee locking, suddenly develops a mechanical inability to extend the knee fully. The knee may flex but not extend and may be causing mild to moderate pain. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member.…

Presentation Ligament sprains occur when a joint is distorted beyond its normal anatomic limits (as when an ankle is inverted, or a shoulder is dislocated and reduced). The patient may complain of a snapping or popping noise at the time of injury, immediate swelling, and loss of function (suggestive of grade II or III sprain or a fracture). Alternatively, the patient may come to the office…

Presentation In lateral epicondylitis, the patient complains of pain in the lateral elbow that frequently radiates down the lateral aspect of the forearm. Because the lateral epicondyle is the bony origin of wrist extensors, patients are usually involved in an activity that requires repetitive wrist extension, such as tennis or mechanical work. Occasionally, the patient can recall a specific injury to the area, but more often…

Presentation After twisting the knee during a fall or sports injury, the patient complains of knee pain, possible swelling, and variable ability to bear weight. There may be a joint effusion or spasm of the quadriceps, forcing the patient to hold the knee at 10 to 20 degrees of flexion. See Fig. 113.1 for normal anatomy. With an anterior cruciate ligament (ACL) tear, there will most…

Presentation A patient rapidly develops an intensely painful monoarticular arthritis, often in the middle of the night, but sometimes a few hours following a minor trauma. The first attack of acute gouty arthritis usually occurs between the ages of 40 and 60 years in men and after the age of 60 years in women. Any joint may be affected, but the most common is the metatarsophalangeal…

Presentation The patient is concerned about a rubbery, rounded swelling most commonly emerging from the dorsal or volar aspect of the wrist or the flexor tendon sheath of the hand. It may have appeared abruptly, been present for years, or fluctuated, suddenly resolving and gradually returning in much the same place ( Fig. 111.1 ). The patient often first notices it when a minor injury brings…

Presentation The patient injures the fingertip by falling backward and striking it on the floor or hitting it in some other way, causing sudden and forceful hyperextension at the distal interphalangeal (DIP) joint against resistance. Alternatively, this injury can befall a football player trying to tackle the ball carrier but only catching the jersey or belt with the distal phalanx of one finger ( Fig. 110.1…

Presentation The patient seeks help after a crushing injury to the fingertip, such as closing it in a car door. The fingertip will be swollen and painful, with ecchymosis. There may or may not be a subungual hematoma, open nail bed injury, or finger pad laceration. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you…

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Presentation The patient will have jammed a finger, causing a hyperextension injury that forces the middle phalanx dorsally and proximally out of articulation with the distal end of the proximal phalanx. A swollen, painful deformity of the proximal interphalangeal (PIP) joint will be present, unless the patient or a bystander has reduced the dislocation prior to presentation. There should be no sensory or vascular compromise. You’re…

Presentation A patient arrives with a tender fingertip injury with a noticeable deformity. There is a history of a sudden resisted flexion of the distal interphalangeal (DIP) joint, such as when the fingertip is struck by a ball or jammed against a stationary object, resulting in pain and tenderness over the dorsum of the base of the distal phalanx. This injury can occur with relatively minor…

Presentation The patient experiences an insidious onset of difficulty with tasks such as opening jars because of pain localized to the dorsoradial aspect of the wrist that is exacerbated with thumb and wrist motion, and which may also be present on awakening. On examination, the first dorsal compartment over the radial styloid is thickened and tender to palpation. Crepitus of the tendon may be felt on…