Note Callum Fairbrother
Today 09:15 · Initial Assessment, 45 min · Derby (Friar Gate) · by Ellie Brennan
Note as sent
Subjective
- Right knee pain, medial aspect, 3/52 duration.
- Mechanism: non-contact twisting injury, foot planted while turning during 5-a-side football on artificial turf.
- Swelling onset the same evening; able to weight bear with a limp.
- Intermittent locking (unable to fully straighten, releases with a click after the patient moves the knee) and episodes of giving way; last locking episode on the stairs on Saturday.
- Pain 6/10 when catching, 2-3/10 otherwise. Night pain only when rolling onto the knee.
- No previous injury to the right knee.
- No scans or imaging. No previous treatment; ibuprofen for a few days.
- Works as a warehouse supervisor: prolonged standing and stairs aggravate.
Objective
- Observation: mild effusion R knee, sweep test 1+.
- AROM flexion R 115°, L 145°. Extension R -5°.
- Quads lag 5° on SLR.
- Palpation: tender medial joint line.
- Special tests: McMurray positive medial with palpable click; Thessaly positive at 20°; Lachman negative, firm end-feel; valgus stress stable at 0° and 30°.
- Gait: antalgic.
Treatment
- Education on suspected diagnosis and the significance of locking.
- Exercises: static quads (5 s holds), static bike without resistance.
- Advice: no football and no twisting until specialist review.
- Safety-netting: if the knee locks and does not release, return to clinic or attend A&E.
- Referral to orthopaedic knee clinic and MRI discussed with patient.
Analysis
- Working diagnosis: suspected medial meniscal tear, right knee, with mechanical locking; bucket-handle tear to be ruled out.
- ACL and MCL clinically intact.
Plan
Edited by you- Refer to orthopaedic knee clinic (Mr Bhattacharya) for opinion and MRI.
- Home exercises as above.
- No return to football until reviewed.
- Review in 1 week, booked for next Thursday 09:15.
Review transcript 24:12 session · 1:48 dictation
Session recording · 24:12
so callum come in grab a seat how's the knee been since you rang us last week yeah not great to be honest it's been about three weeks now i was playing five a side on the astro at the leisure centre went to turn and my foot just stayed planted and i felt something go on the inside of the knee right knee yeah right knee it swelled up that night like a balloon i could still walk on it though limping a bit has it locked at all or given way yeah a couple of times it gives way and it gets stuck like i can't straighten it and i have to sort of wiggle it and then it clicks and goes back last time was saturday on the stairs okay and pain out of ten when it catches about a six otherwise two or three any pain at night only if i roll onto it have you hurt this knee before no never have you seen anyone about it had any scans no just took ibuprofen for a few days what do you do for work i'm a warehouse supervisor so i'm on my feet all day and the stairs up to the office are a killer right let's have a look then pop up on the bed for me there's a bit of swelling there bend it up as far as it'll go that's about one fifteen and the left was one forty five and it's not quite getting straight is it no i'll just twist the knee now tell me if that ow yeah that's the spot and there's the click okay ligaments feel nice and firm the acl's intact so what i think is going on is you've probably torn the cartilage the meniscus on the inside and because it's locking i want a knee surgeon to have a look and get an mri so i'll write to mr bhattacharya's knee clinic in the meantime no football no twisting i'll show you some exercises tighten the thigh push the knee into the bed hold for five and the bike's fine with no resistance if it locks and doesn't unlock come straight back or go to a and e otherwise i'll see you in a week ...
Dictation · 1:48
dictation for callum fairbrother initial assessment right knee effusion sweep test one plus flexion one hundred and fifteen degrees right one hundred and forty five left extension minus five on the right quads lag five degrees on straight leg raise tender medial joint line mcmurray positive medial with palpable click thessaly positive at twenty degrees lachman negative firm end feel valgus stress stable at nought and thirty antalgic gait query medial meniscal tear rule out bucket handle refer orthopaedic knee clinic for opinion and mri review one week
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Session details
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- 24:12 session · 1:48 dictation
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- Tomorrow 09:58, 24 hours after it was written