Solve the Medical Riddle: Her 14-year-old Daughter Had Knee Pain and Difficulty Climbing Stairs, Second Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

Last week, the patient and her mother reported the patient’s symptoms. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor ordered and X-ray and MRI, and referred Julia to a physiatrist and a sports medicine physician. This week, we’ll learn the results of the X-ray and MRI, and find out what what happened during Julia’s appointments with the specialists.

The X-ray of Julia’s knee was normal, as the doctor had suspected it would be. Yet the MRI, which allows for grading or scoring of the cartilage, showed a high signal and evidence of small joint effusion or fluid.

Both the physiatrist, an MD with training in physical medicine, and the sports medicine specialist performed the same tests and physical exam that Julia’s PCP had done. The three doctors then consulted with one another and felt they agreed on a diagnosis. The sports medicine specialist, who often treated ballet students as well as the professional dancers in the city near where Julia lived, was particularly sure he knew what was wrong with Julia’s knee.

To be continued . . .

Come back to ThirdAge.com next Thursday to find out what some people have guessed the diagnosis might be.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.