A 24 year old fell hard on her knees. A knee examination was not done. Later she complains of left sided lateral knee pain as well as hip pain and left sided low back pain. Her doctor (A GP) prescribed her an analgesic and told her she needs rest. What could be the cause of her pain? Does she need further investigation?
specialist opinion is always better. there might be some internal damage to tissues
She could be a poly-trauma case and all of these complaints are due to the trauma it self!
Or even the direct trauma to the knees might cause the force to be transmitted to the hip and spine causing fracture or ligamentous injury..
Complete Hx and Ex + X ray ( knee, hip and pelvis/spine) are needed ..
Her problems could come both from the trauma itself and also from that she cannot walk and move properly due to the knee pain. It is important to examine the knee, and also the hip and low back!
Hi, clinical examination and at least x-Ray further radiological examination. Kind regards k
Interesting case.
If you fall on your knee (vertically) there may also be an impact on the sacro-iliac joints. Altered muscle activty compensating SI joint problems might explain both low back and hip problems.
Check control of the patient while standing on one leg as well as the Active Straight Leg Raise as described by Mens et al in Spine, and not to be confused with the Straight Leg Raise.
I agree with Osaid H. Alser MD. I think more impact and or shear damages resulted on a cartialge and ligament strain around knee .
Difficult to evaluate on this information i.e. what is a "hard fall" also how i.e. twisting injury or simple direct impact? etc.
Point 1: Who was at fault for the fall? Patient or external factor?
Point 2: Most Likely if genuine pain then:
Knee: Bone bruising will settle with time and avoidance of impact activities.
if twisting injury then meniscal may need intervention and MRI scan will inform.
Hip: Groin pain or lateral thigh? if thigh then radiation from LBP or muscular hence physic. if groin needs MRI scan to exclude fracture etc.
LBP: Muscular should improve with time and physiotherapy assuming no radicular symptoms. MRI if radicular symptoms otherwise straight to physic.
x-rays likely to be unhelpful in all of above with current history.
So either physic or MRI scans.
If MRI's undertaken and all MRI's normal Physic/ physic/physio and reassurance
jpm
Agree with John Paul Murphy. More detail needed to evaluate the impact (How hard and the mechanism). How much time has elapsed since the first injury? Was the rest helpful? Was there another trauma? What kind of person is she? Is she (pro-)active, or rather afraid to move? previous traumas, diseases? Was there any investigation done (any physical exam, any imaging, other diagnosis or inflammatory context etc)? Characteristics of the pain (at rest, on movement, in particular position etc.). For now, it would be difficult to suggest any MRI or other imaging modalities, more information needed
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The fall most likely caused an injury to the left knee. The hip and back pain is probably caused by awkward postures when walking to compensate for the knee pain.
A full history and clinical examination to the knees, hips and lumbar spine are very important . Radio logical examination is necessary according to the results of the clinical examination. A hard fall on the knees can affect the hips and the back, or it might have attracted the attention of something that was wrong in the related areas.
From the information provided it is impossible to make a proper diagnose. Yes, patient needs further examination, by both MD (to exclude structural damage such as fractures of the bone's (often gives nightly and progressiv pain, worsen in weight bearing), ligamentous tears etc.) and by an osteopath (for pain caused by e.g. fascial tention, blocked joints, compromised biomechanics etc). There are several
possibilities for the cause of the pain. Biomechanically the impact through the femour might have caused the ili to fixate postriorly, this may creates pain in both SI-joint, pelvis, buttocks and lumbar spine. Displaced/fixed sacrum can irritate e.g. the m. piriformis createing entrapments for vessels and nerves for lateral thigh --> pull on lateral knee (and others). The possibilities are many. Proper investigation is necessary.
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