D: How may I help you?

P: I'm I'm here because my right knee is very painful. It looks kind of swollen and it's it's also a little bit warm so I'm just worried, I'm worried about it and I was wondering if you could look at it.

D: Yeah, certainly, um. So where are you feeling the the pain exactly?

P: So it's where, so right in the middle of my knee. So just below the bone that, the big knee bone.

D: OK, so like underneath the kneecap, like below that?

P: Yeah just just a little bit below.

D: OK, so slightly below the Patella. Sounds like somewhere in the region of the tibial through tuberosity. 

P: Right.

D: OK, and when did this pain start?

P: It started about two weeks ago.

D: OK, two weeks ago when the pain started, was there any trauma or could you remember any movement that that caused the pain? 

P: Nothing like that, but I recently found out that I had some osteoarthritis on my left knee, so I was trying to put more pressure on my right knee one whenever I was doing like gardening work um and I think something something may have happened when I was doing that, something maybe, maybe I put too much strain on it.

D: OK, I see an. Alright, like are you doing a lot of kneeling on on or during the gardening work?

P: I am. 

D: OK. Um, and. How long has the pain been going on for, has it been constant over these two weeks?

P: Yes, it has been.

D: OK, and how would you describe the pain, is it sharp, burning, achy?

P: I would say mostly achy, but it can be sharp.

D: OK, and do you feel the pain radiate anywhere else?

P: No, just it's pretty local.

D: OK, have you tried anything to make the pain better?

P: I tried some topical like what are those like ice and fire gels. Those seem to help temporarily, but the pain comes back.

D: OK. And. Have you tried, has anything made the pain worse?

P: I guess like when I kneel down on it, it gets painful or If I touch it or palpate it, I guess painful if I'm I'm flexing my knee too much that hurts as well. Kind of keeping it straight and not touching it makes it feel better.

D: OK, and. What would you say the severity of the pain is with 10 being the worst pain you've ever felt and one being the least pain? 

P: I give it about a 6.

D: OK, and have you had a pain like this in your right knee before?

P: No, nothing like this and I have osteoarthritis in my left knee but it feels different.

D: OK, and um. OK, and have you had any fevers or chills?

P: Uhm, no.

D: OK, and how about any night sweats?

P: No. 

D: OK, and have you had any unexpected weight loss over the last several months?

P: No.

D: Have you had any headaches?

P: No.

D: Have you had any changes to your senses like vision or hearing?

P: No 

D: Any changes to your sense of smell or taste?

P: No.

D: OK, have you had any sore throat or cough?

P: No. 

D: Alright, have you had any shortness of breath? 

P: No.

D: Have you had any wheezing?

P: No.

D: Have you had any chest pain? 

P: No.

D: Had any lightheadedness or dizziness?

P: Um no.

D: Have you had any heart palpitations? 

P: No.

D: OK um an have you had any nausea or vomiting?

P: No.

D: Have you had any abdominal pain?

P: No. 

D: Have you had any diarrhea or constipation, or blood in the stool? 

P: No.

D: Have you had any pain with urination or frequency with urination? 

P: No.

D: OK, and have you had any like muscle aches or joint pains anywhere else?

P: No.

D: OK, and have you had any neurological symptoms such as numbness or or tingling or reduced sensation?

P: No.

D: OK, and how is your energy been recently have you had any fatigue?

P: No, not really. It's been the same.

D: OK, and in the past have you been diagnosed with any medical conditions?

P: Uhm I have Class 2 obesity. And then also arthritis in my left knee. As well as high blood pressure.

D: I see and. Do you take any medications?

P: Currently I'm on Ramipril and I take some ibuprofen sometimes for the osteoarthritis in my left knee.

D: OK and, do you have any allergies to medications?

P: No.

D: Have you had any surgeries before?

P: Nope.

D: Or have you had any hospitalizations for any reason?

P: No. 

D: OK. And. Have you been pregnant in the past? 

P: Um I I have one, one child, she was born through c-section.

D: And are you currently sexually active?

P: I am. 

D: OK, could you tell me about your partner or partners?

P: Yeah, so just with my husband of 10 years.

D: OK, any concerns for a sexually transmitted infection like vaginal discharge or or pain or itchiness?

P: No.

D: OK. And could you tell me a little bit about your living situation currently, like who you're living with an whereabouts?

P: Um I live in downtown London I live in a house with my husband and my daughter.

D: OK. And have you been around anybody who's been sick recently?

P: No.

D: And have you traveled anywhere recently? 

P: No.

D: OK, are you currently working right now?

P: I yes I am.

D: OK, well then what what do you do?

P: I work as a full time gardener for a landscaping company. 

D: OK, I see. So you're spending a lot of time doing kind of like repetitive kneeling type movements to do your job?

P: Yes, that's right.

D: OK And do you smoke cigarettes? 

P: I don't.

D: Alright, and do you drink alcohol?

P: I'll have a glass of wine every other night.

D: OK, and do you use any recreational drugs?

P: No, I don't.

D: Have you used anything like that in the in the past.

P: No

D: like IV drugs, no, OK. And in the family or is there a history of any musculoskeletal or neurological conditions? 

P: No. 

D: OK. So next I just wanted to do the physical exam portion and ask you to have a look at the knee first and let me know if the if you're having any swelling, redness or warmth to the knee compared to the other side.

P: Sure.

D: Sorry so you are having, having swelling, warmth and redness to the right knee?

P: Yes.

D: OK and are you having pain to like palpation is there a specific spot you can press on that causes a sharp pain?

P: Um so just below that kneecap area there is some swelling there and when I press down on that swollen area, it causes a bit of pain.

D: OK. And are you able to fully bend, bend and straighten the knee?

P: I can do that, but when I bend my knee it really hurts.

D: OK. And are you able to walk normally or do you have a limp?

P: Um I can walk normally, it just hurts.

D: OK. So that was a everything that I wanted to ask today on the history and and physical. Was there anything? That you maybe I forgot about you wanted to add? 

P: No, I don't think so.

D: OK, so right now it's sounding like this could possibly be a knee Bursitis. Or Prepatellar, or sorry, infra patellar bursitis or a prepatellar bursistis which are the kind of the more common types. One thing to make sure that we rule out would be a septic Bursitis. Although you're not having any fevers or chills so that makes it a little bit less likely.

P: Mmmm

D: But if your symptoms are getting worse and you're developing a fever, it's becoming even more painful then certainly will have to rule out infection. And as well if things are not improving, potentially a structural disease and any, such as a meniscal injury, or like a ligamental injury from all of the like kneeling and and repetitive movements. But right now I think it's mostly sounding like a knee bursitis.

P: OK.

D: OK, and treatment for that will be activity modification as well as using things like as um NSAIDS and icing to help with um the inflammation. 

P: OK, that sounds good, thank you.