case of knee joint sweeling and pain

case of an 82-year-old female who presented to the hospital with chief complaints of 

- Pain in the lower limbs since 2 days, bilaterally 

- Fever since 2 days

- Swelling in the lower limb, bilaterally since 2 days 



History of Presenting Illness 

The patient was apparently asymptomatic 6 months ago. 

6 months ago, the patient experienced a pricking type of joint pain while climbing the stairs, it was pricking in nature, and the patient could carry out her daily activities without hindrance. 

On 25th May 2023, After waking up at 5 AM, the patient could not lift her legs from the bed.  

After three days, the patient developed a sudden onset of pain. The pain was pricking in character, and continuous.  present bilaterally in the lower limbs at and below the level of the knee. It aggravated on walking and relieved at rest. 

The pain was associated with swelling of the lower limb at and below the level of the knee joint, bilaterally. It was associated with redness over the limbs up to the ankle. 

The patient also experienced high-grade fever, which was continuous, and generalised body pain and malaise. And relieved on taking medication.

One week later, there was a sudden increase in pain and swelling similar to the last episode. There was also a rise in fever up to 104 °F. She was given NSAIDS and paracetamol which reduced fever and pain.

2 Days later, the patient developed the same constitution of symptoms again and came to our hospital.  


Past History and treatment history

K/C/O  hypertension since 10 years and is  on Telmisartan and Amlodipine .  

8 Months ago, the patient had a syncopal attack and was started on low-dose aspirin as a prophylactic measure. 

N/K/C/O Diabetes Mellitus, Tuberculosis, CAD, or Epilepsy. 


Family History 

No significant family history


Personal History 

Appetite: reduced since yesterday 

Diet: Vegetarian 

Sleep: The patient consumes alprazolam (on prescription) as she has difficulty falling asleep. 

Bladder: 9 months ago, the patient had oliguria, since the onset of fever, she has increased the frequency and urgency of micturition. 

Bowel Movements: Normal 

Addictions: None 

Allergies: none. 


General Examination

The patient is conscious, coherent, and oriented to time, place and person. 

The patient is moderately built and moderately nourished. 

Vitals : 

- Pulse - 94 beats per minute 

- RR- 16 cycles per minute

- Temperature: Afebrile 

-Blood Pressure- 120/70 mmHg

Pallor - Present 

Icterus - absent 


Cyanosis - Absent 



Clubbing - Absent 


Koilonychia - absent 

Lymphadenopathy - Absent 

Oedema -present



Examination of the Musculoskeletal System 

Inspection findings - 

Bilateral swelling of the lower limbs, at and below the level of the knee joint. More prominent on the right than the left. 

Right, Limb Fixed flexion deformity seen at the knee joint. 

Left lower limb, ability to flex knee present. 

No scars, sinus, erythema or rashes




Palpatory Findings 

Local rise of temperature present bilaterally at the knee joint

Palpable swelling is present on the right and left knee, and ankle with mild oedema in her lower limbs , associated with tenderness, in the suprapatellar bursa

Patellar tap is positive bilaterally.

Join Line tenderness observed.

absence of lower limb shortening. 

Range Of Motion 

Inability to flex the right lower limb. 


Investigations 


Provisional Diagnosis 

? Bursitis 

? Osteoarthritis 

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