VCOM Research Day Program Book 2023

Medical Student Research Case Reports

21 An Unusual Case of Medial Knee Pain in Softball Player

Jason Canestrano; Thomas Grove, DO; Kaitlyn Mahoney, DO Corresponding author: Edward Via College of Osteopathic Medicine-Virginia Campus OrthoVirginia Case history: Athlete is an 18 year old female presenting with sharp medial right knee pain after diving during softball game. Her pain was associated with numbness, swelling, and bruising. Physical exam: Patient has ecchymosis over VMO with associated tenderness to palpation extending to medial joint line. She had full passive and active range of motion with 5/5 muscle strength to knee flexion and extension and ankle dorsiflexion and plantarflexion. She had decreased sensation to light touch over the superior aspect of the patella. DTRs 2/4 to patellar and Achilles tendon. Capillary refill is less than 3 seconds. For special testing Lachman’s, pivot shift, anterior drawer, posterior drawer, McMurray’s, valgus and varus stress tests are negative. Functionally patient is able to perform quad set. Differential diagnosis: Medial collateral ligament tear, medial meniscal tear, knee contusion,

pes anserine bursitis, saphenous nerve entrapment, Morel Lavallee lesion. Tests ordered/performed: Diagnostic ultrasound revealed an anechoic well circumscribed lesion measuring approximately 2.3 cm in length and 2 mm deep superficial to the VMO distally which is fluctuant with no increased PDI uptake which was tender on sonographic palpation. Final working diagnosis: Morel Lavallee lesion. Treatment: Ultrasound guided aspiration of the lesion was performed with 1 cc of blood aspirated to decompress lesion and athlete was discharged from clinic with ACE bandage for compression. Outcome/follow up: Patient was adherent to rest and ACE bandage and had complete resolution of symptoms in 2 days. Return to activity: After 2 days of rest athlete was able to return to competition without restriction.

Figure 1: Diagnostic Right Knee Ultrasound


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