Your 66-year-old Chinese American patient with a history ofdiabetes mellitus presents today with complaints of left knee pain.She reports that it started hurting a couple days ago after workingin the garden. She states that the knee is swollen and red andseems hot to touch. She comments that it is hard getting old andbelieves the pain is due to osteoarthritis. She also reports thatshe has had a fever since last night with associated chills. Hergranddaughter has been sick, so she figured she was catching hercold. On the assessment the first thing you note is that she has asmall scrape on the knee. When asked about it, she reports that shescraped her knee one week ago but that it has not been botheringher. In fact, she states she has not even needed a bandage. Furtherexamination finds that the knee is swollen, red, and hot to touch.She has pain with passive and active range of motion and reportsthe knee is more comfortable fully extended. Given the sudden onsetof symptoms, the monoarticular presentation, and the presence offever and chills you are very concerned and recognize the need toconsult orthopedics emergently.
What would you report to orthopedics? What is your main concern?What in the history and physical makes you think this? What riskfactors did this patient have for developing this condition? Whatdiagnostic testing would you like them to perform?
