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Pain with descending stairs

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Pain with descending stairs - January 23, 2006 10:42:00 PM   
Alex Brenner PT MPT OCS

 

Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline 		25 year old female complains of right anterior knee pain only when descending stairs. She reports that she had an old injury 1 year ago skiing but was never evaluated for it. She denies any locking, swelling, or giving out episodes. Radiographs were ordered by the referring physician but were never read. What are the findings?

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< Message edited by David Adamczyk -- July 12, 2007 9:04:45 PM >

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Alex Brenner, PT, MPT, OCS
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Re: Pain with descending stairs - January 24, 2006 3:38:00 AM   
Synergy


Posts: 589
Joined: March 11, 2004
From: Forney, TX
Status: offline 		It appears to me to be an osteochondroma or an exostosis of some kind on the posterior distal femur just proximal to the condyles.

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Chris Adams, PT, MPT

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Re: Pain with descending stairs - January 24, 2006 4:29:00 AM   
ehanso

 

Posts: 353
Joined: September 14, 2004
From: Minnesota
Status: offline 		On the sunrise view there is a divot in the articular surface of the medial condyle.

(in reply to Alex Brenner PT MPT OCS)
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Re: Pain with descending stairs - January 24, 2006 7:18:00 AM   
Shill

 

Posts: 1044
Joined: February 13, 2003
From: Madison WI USA
Status: offline 		Big problem. No sense guessing when it could be a nasty tumor. Refer to orthopod who deals with musculoskeletal tumors immediately. Rehab can wait.

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Steve Hill PT

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Re: Pain with descending stairs - January 24, 2006 9:23:00 AM   
ehanso

 

Posts: 353
Joined: September 14, 2004
From: Minnesota
Status: offline 		I agree with the tumor but I think the cause of the pain descending the stairs is the condylar defect.

(in reply to Alex Brenner PT MPT OCS)
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Re: Pain with descending stairs - January 24, 2006 10:19:00 AM   
Sean Weatherston

 

Posts: 102
Joined: August 3, 2005
From: Idaho
Status: offline 		Sure looks like a tumor to me...

Looks like there's quite a bit of um...soft tissue... in the thigh area....anyone think this thing would be palpable?

Not that I do deep popliteal palpation on all of my anterior knee pain patients :) , but just curious.....

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Sean Weatherston, PT, OCS, CSCS

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Re: Pain with descending stairs - January 24, 2006 1:08:00 PM   
jma

 

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Joined: August 24, 2000
From: NY
Status: offline 		This may be a tumor of some kind. Will there be any other radiologic imaging done to narrow down the choices? CT, bone scan, etc?

(in reply to Alex Brenner PT MPT OCS)
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Re: Pain with descending stairs - January 26, 2006 9:37:00 AM   
Jeffre

 

Posts: 130
Joined: August 18, 2005
From: Lafayette, LA
Status: offline 		This may be one of those cases where you're looking for something simple and find something big on accident. That is, if it is a tumor. Would a tumor on the post aspect cause her pain? And would descending stairs trigger her pain? Maybe the condylar defect explains her symptoms.

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"You are as well as your insurance company is willing to allow."
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(in reply to Alex Brenner PT MPT OCS)
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Re: Pain with descending stairs - February 22, 2006 4:57:00 PM   
jma

 

Posts: 2301
Joined: August 24, 2000
From: NY
Status: offline 		Hello, its been a while. What were the findings from the radiographs Alex?

(in reply to Alex Brenner PT MPT OCS)
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Re: Pain with descending stairs - February 25, 2006 11:04:00 PM   
Alex Brenner PT MPT OCS

 

Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline 		JMA, keeping me honest. I love it! :)

FINDINGS: Convexity along the posterior aspect distal femur measuring approximate 6.2 x 2.4 x 2 cm consistent with an osteochondroma. There is no evidence of bony destruction, periosteal reaction or soft tissue mass. No evidence of fracture, dislocation or significant arthritic change.

IMPRESSION: Osteochondroma posterior aspect distal femur.

In my current physical therapy situation I am able to order radiographs and I am the first provider to view them. Even with several years of looking at these I personally always make a quick call to the radiologist on call when I see these just to be sure. We can't miss an osteosarcoma.

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< Message edited by David Adamczyk -- July 12, 2007 9:10:38 PM >

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Alex Brenner, PT, MPT, OCS

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Re: Pain with descending stairs - February 26, 2006 10:55:00 AM   
jma

 

Posts: 2301
Joined: August 24, 2000
From: NY
Status: offline 		What has been the plan of care, if any, to address the pain with descending stairs?

(in reply to Alex Brenner PT MPT OCS)
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Re: Pain with descending stairs - February 26, 2006 11:35:00 AM   
Synergy


Posts: 589
Joined: March 11, 2004
From: Forney, TX
Status: offline 		From my limited experience dealing with this type of pathology, surgeons usually do not operate unless the lesion is constantly interfering with daily life/functional activities, levels of pain have increased, or if malignancy has occurred. I believe the literature suggests malignancy occurs very infrequently...something like 1-3% of the population with an osteochondroma. My numbers may be a little skewed as I cannot recall the specifics, but it's close.

Here's a  of an excised osteochondroma I found at http://www.emedicine.com . Pretty interesting looking. :)

< Message edited by David Adamczyk -- July 12, 2007 9:19:34 PM >

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Chris Adams, PT, MPT

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Re: Pain with descending stairs - February 26, 2006 8:45:00 PM   
Alex Brenner PT MPT OCS

 

Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline 		Thanks for sharing Chris. I had a patient a few years ago that had a large osteochondroma on the lateral side of the knee that was interfering with the IT band. It was excised and the patient did great.

JMA, this patient went through some patellofemoral rehab and is doing quite well. The osteochondroma was an incidental finding.

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Alex Brenner, PT, MPT, OCS

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Post #: 13
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