916 - Atypical Knee Pain: A Return to the History and Physical - A Case Report

Case Diagnosis: Here we present a unique case of a 67-year-old female with reproducible severe right knee pain provoked by crossing her left leg over her right knee.

Case Description: Patient presented to the outpatient clinic with chronic progressive knee pain exacerbated by prolonged standing, back flexion, and uniquely when crossing her left leg over her right knee. Physical examination revealed tenderness over her quadriceps tendon with a firm mobile mass deep to the quadriceps tendon. A musculoskeletal ultrasound and radiographs were obtained, noting a 2.6 by 2.1 by 1.1 cm calcific loose body within the suprapatellar bursa. The definitive etiology of the loose body is unknown; however, conservative management with physical therapy was recommended with the goal of avoiding aggravation or enlargement of the loose body. A surgical referral for definitive removal of the body was also proposed.

Discussions: The diagnosis and management of knee pain is typically directed by a careful history and physical examination. Often, weight-bearing activities provoke pain; however, here, we presented a unique case where a large calcified loose body in the suprapatellar bursa provoked pain by crossing the left leg over the right knee.

Conclusions: This case illustrates the importance of physical examination, particularly in the context of post-COVID era management. Due to the precautions, many physical exams were deferred. Identifying a palpable mobile object during the physical exam led to discovering the irritant causing the patient's symptoms. Conservative measures may be appropriate initially, with surgical intervention reserved for refractory cases. Long-term monitoring and individualized treatment plans are essential for optimizing patient outcomes in such cases.