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1. Right knee joint pain

2. CHIEF COMPLAINT
• Ms N, 52 years old lady, with underlying lumbar spondylosis
• admitted to the ward since 2 days ago
• with a complain of right knee joint pain for 3 years
• associated with swelling of the right leg

3. HOPI
• S : R knee joint
• O : after long walking, everyday worsen in the evening
• C : generalized, continuous dull aching pain
• R : pain sometimes radiates to the lateral part of the leg and calf, She
mentioned that she could feel the crack at her R knee whenever she
walked.
• A : swelling at the right leg especially at the calf area
• T :persistent for 3 years
• E : exaggerated upon movement especially walking / pain relieved
temporarily after taking paracetamol
• S : 7/10 upon movement and 5/10 at rest

4. Swelling
• also persistent for 3 years
• complained that the swelling would become worse when she stood
for a long time
• There was no discharge or redness noticed by her
Effect her daily activities
• severe attack of the pain would cause her to get up of her bed and
disrupted her sleep

5. Job
• machine operator in A4 paper factory
• affected her job performance as the job required her to stand for a
long time
• Took frequent MCs last year
• her monthly salary had been cut off
Tx regarding joint pain
• Intraarticular injection was performed on June last year but the pain
recur and worsen

6. Otherwise,
• the pain and swelling were not due to any triggers from food such as
seafood or meat
• no complain of fever, no underlying gout, no history of significant fall
or trauma, no urinary or bowel symptoms

7. Systems Findings
General No fever with chills and rigor
No loss of appetite, no loss of weight
Respiratory System No runny nose, no cough, no shortness of breath
Cardiovascular System No profusely sweating, no cyanosis, no shortness of breath, no
pallor, no chest pain
Central Nervous System No loss of consciousness, no malaise, no visual disturbance or
headache.
Genitourinary System No dysuria, no urinary incontinence, no nocturia, no hematuria,
no urgency.
Gastrointestinal System No abdominal pain, no nausea & vomiting, no change in bowel
habit, no heartburn, no change in stool colour.
H & L System No bleeding tendency, no easily bruising.
Musculoskeletal System No myalgia, no muscle weakness

8. PAST MEDICAL & SURGICAL HISTORY
• On 2017, she was diagnosed with lumbar spondylosis with a chief complain of
back pain. She is still having her follow-up with orthopedics department for
further management.
• No other underlying diseases or significant past surgical history.
DRUG HISTORY
• Tablet Paracetamol 1g PRN, Tablet Celebrex 200mg PRN
ALLERGIC HISTORY - Nil
FAMILY HISTORY
• She is the 3/3 siblings. Others hv no known illness such as DM, bone malignancy
and skin disease.
• Her mother has underlying hypertension for 13 years & under medication

9. SOCIAL HISTORY
• She is married for 5 years already and currently living with her
husband who works as a chauffeur from the same company.
• live Batu Caves, in a rented single-storey terrace house.
• Her house has squatting toilet with commode chair.
• The household income is about RM1100 and she is under SOCSO for
her treatment expenses.
• She is a non-smoker, non-alcoholic, and she did not take any
recreational drugs.
.

10. PHYSICAL EXAMINATION
• Ms N, was lying comfortably in supine position supported with one
pillow. She looked slightly overweight. There was no walking aid near
her bed. There was a presence of branula attached to the right cubital
fossa. There was no deformity at the hand
• Body weight : 64 kg
• Body height : 1.55 m
• Body Mass Index : 26.6 kg/m2
Interpretation : She was overweight.

11. Vital signs
• Blood pressure: 110/80 mmHg
• Pulse rate: 65 beats/min
• Respiratory rate: 20 breaths/min
• Temperature: 36.9
• Pain score : 4/10

12. LOWER LIMB EXAMINATION
• Inspection upon standing position
Patient had a right valgus knee deformity. There were no quadriceps muscle
wasting, no genu recurvatum, no calf muscle wasting, no swelling, no visible scars,
no ulcer and no skin changes on bilateral lower limb.
• Gait assessment
Patient had antalgic gait.
• Inspection upon sitting position and assess for crepitus
Patellar tracking were normal for both knees. Crepitus was felt on the right knee.
• Upon supine position
Look - There were presence of right knee valgus deformity. Presence of parapatellar
gutter, but no shortening in a limb, no obvious swelling bilaterally. No posterior
sagging of the tibia from lateral view upon flexion of the knees at 90 degrees.

13. Range of motion during : Right knee Left knee
Active Flexion : 0- 90 degrees (due
to pain)
Extension : 0 degree
Flexion : 0-140 degrees
Extension : 0 degree
Passive Flexion :0-120 degrees (due
to pain)
Extension: 0 degree
Flexion : 0-140 degrees
Extension: 0 degree
• Feel
• Move
Right limb Left limb
Temperature Warm and dry Warm and dry
Fluid shift test Negative Negative
Patellar grinding test Positive Negative
Palpate for landmarks of the
knee (at 90 degrees)
Patient felt tender over the
medial and lateral joint line
No tenderness

14. CLINICAL SUMMARY
• Ms N, 52 years old lady, with underlying lumbar spondylosis,
admitted to the ward since 2 days ago with a complain of right knee
joint pain for 3 years associated with swelling of the right leg. On
physical examination, noted right knee valgus upon inspection,
antalgic gait, presence of crepitus on the right knee and limited active
and passive range of motion of the right knee due to mechanical pain.