Doctor: Good morning, Miss X Y Z, correct? 
Patient: Yes, that's me, good morning doctor. 
Doctor: Before we begin, I just need a few pieces of information. How old are you? 
Patient: I'm forty four years young, doctor. 
Doctor: Good, thank you. Next, which hand do you write with? 
Patient: I write with my right hand. 
Doctor: Finally, what do you do for a living? 
Patient: I'm an aircraft mechanic. 
Doctor: Very nice, so, how did you get hurt?
Patient: Um, I was working on repairing an airplane at work when I fell between the plane and one of the stands.
Doctor: How big was the gap that you stepped in?
Patient: Um, it was about a foot and a half. 
Doctor: Which knee did you hurt?
Patient: It was my left knee.
Doctor: Did you have surgery after the accident?
Patient: Yes I did, I had two arthroscopies, and an, um, patellar replacement after those. 
Doctor: Okay, yes, I see.
Patient: Then, I had a left knee replacement on Month D D, Y Y Y Y.
Doctor: Do you have any imaging of this knee? 
Patient: I didn't have any x rays done, but I have an MRI report and notes from Doctor A B C D. 
Doctor: Can I see that report?
Patient: Yes absolutely, here. 
Doctor: Okay, so this M R I from September two thousand six shows some nonspecific edema anterior to the patellar tendon, but thankfully there's no evidence of fracture of ligamentous avulsion or abnormality. 
Patient: What does that mean?
Doctor: There's some bleeding in the bone there, but nothing is broken or out of alignment. 
Patient: Oh, thank you, that's good. 
Doctor: Oh certainly, yes, it is. What treatments have you had for this knee, aside from surgery? 
Patient: I've done a full course of PT for this. 
Doctor: Where is your knee pain? 
Patient: Mostly, it's here in the front of the knee, and then on both sides, like the inside and outside.
Doctor: Does the pain go down your leg at all? 
Patient: Yes, it goes down my, is this the femur? 
Doctor: Yes, that's the femur. 
Patient: Then this must be my tibia, it goes down the front of that too. 
Doctor: Does it go into your thigh at all?
Patient: Yes, it goes into the back of my thigh. I feel numbness and tingling back there. 
Doctor: Do you feel anything in the feet?
Patient: Nope, my feet are completely normal, thankfully.
Doctor: Are you having any back pain? 
Patient: A little, I feel something in my lower back, I'm not sure if it's related.
Doctor: Does anything make your knee pain worse? 
Patient: Yeah, I can hardly walk anymore, it hurts so bad. 
Doctor: What kind of symptoms do you see when you walk on this?
Patient: I feel popping and grinding, and my knee swells up.
Doctor: That numbness and tingling you feel in the thigh, do you feel that in the knee at all?
Patient: Actually yes, it feels like pins and needles there.
Doctor: What about this, when I touch the knee do you feel any abnormal discomfort or pain over the rest of the knee?
Patient: No, nothing out of the ordinary there. 
Doctor: What about this, this is the fibular head, which is where you feel the pins and needles. I'm applying pretty heavy pressure here, how would you describe what you're feeling?
Patient: Um, numbness, tingling, and then that same pins and needles feeling.  
Doctor: Is there any instability? 
Patient: Yes, and there's pain with it too. 
Doctor: Are you working right now?
Patient: No, I'm not right now. 
Doctor: Any allergies I should know about? 
Patient: Yes, actually, I'm allergic to a lot of pain medications. 
Doctor: Okay, have there been any changes in how you're walking?
Patient: Yes, I had to change my walking pattern to take weight off my knee, and I think that has to do with my back pain. 
Doctor: That's certainly a possibility. How would you describe your pain? 
Patient: I'd say its constant, shooting, cramping, aching, throbbing, feels like it's being pulled, sharp, and , um, stabbing. All of those words seem fitting. 
Doctor: Okay, does the pain wake you up at night? 
Patient: Yeah, it does occasionally. 
Doctor: Does anything make this feel better?
Patient: Yeah, it gets a little better if I lay down or if I keep my leg elevated. 
Doctor: Out of ten, with ten being the worst pain ever, how would you describe your pain on average? 
Patient: Um, I'd say six out of ten. That's how it is right now, too. 
Doctor: What about at its worst?
Patient: Easily, its ten out of ten. 
Doctor: Finally, what about when the pain is at its least?
Patient: Um, when it's not too bad, I'd say it's a three out of ten. I also have this other M R I report from September of O six, here. 
Doctor: Thanks. I see. They said that there is nonspecific edema anterior to the patellar tendon, but there is no acute fracture or any ligament abnormalities. That's good.

Clinical note:
Symptoms: pain in the anterior aspect of the left knee, primarily over the medial and lateral tibial components, pain extending proximally to the distal femur and distally down into the anterior tibial plateau area, intermittent numbness and tingling in the posterolateral thigh, axial low back pain, pain worse with walking, associated with swelling, popping, and grinding, pins and needles sensation over the area of the common peroneal nerve overlying the fibular head, constant, shooting, cramping, aching, throbbing, pulling, sharp, and stabbing pain, occasionally awakens her at night, better in recumbency with her leg elevated, pain exacerbated by standing, walking, pushing, pulling.
Diagnosis: N/A
History of Patient: Fell between an airplane and a stand, injuring her left knee, underwent two arthroscopic procedures followed by patellar replacement and subsequently a left total knee arthroplasty, MRI report from September 2006 showing nonspecific edema anterior to the patellar tendon with no evidence of fracture or ligament abnormalities, persistent instability and pain, not working, allergies to pain medications, gait disturbances relating to her knee.
Plan of Action: N/A