0
ARTICLE |

A 69-Year-Old Woman With the Sudden Onset of Severe Pain in the Right Knee FREE

Robert A. Yood, MD; Murray L. Janower, MD; Edward J. Dunn, MD
[+] Author Affiliations

Reprint requests to Department of Radiology, St Vincent Hospital, Worcester, MA 01604 (Dr Janower).


JAMA. 1984;251(6):769-770. doi:10.1001/jama.1984.03340300061032
Text Size: A A A
Published online

History  A 69-year-old woman, previously in good health, awoke with the sudden onset of severe pain in the lateral aspect of her right knee. No history of trauma was obtained. On examination the right knee was cool and stable, with evidence of a small effusion. Tenderness over the lateral joint line of the knee was elicited. Roentgenograms of the knee were initially interpreted as being normal (Fig 1), and she was treated with indomethacin without receiving any benefit. One week later a 10-mL effusion in the joint was aspirated. A study of the synovial fluid showed a WBC count of 150/cu mm and an RBC count of 50/cu mm; the mucin clot was considered good. No crystals were present, and the results of the cultures were negative. Severe pain occurring both at rest and with ambulation continued. Eighteen days after the onset of pain, a technetium Tc 99m methylene diphosphonate

REFERENCES

Ahlback S, Bauer GCH, Bohne WH:  Spontaneous osteonecrosis of the knee . Arthritis Rheum 1968;;11:705-733.
Lotke PA, Ecker ML, Alvi A:  Painful knees in older patients: Radionuclide diagnosis of possible osteonecrosis with spontaneous resolution . J Bone Joint Surg Am 1977;;59:617-621.
Ahuja SC, Bullough PG:  Osteonecrosis of the knee: A clinicopathological study in 28 patients . J Bone Joint Surg Am 1978;;60:191-197.
Rozing PM, Insall J, Bohne WH:  Spontaneous osteonecrosis of the knee . J Bone Joint Surg Am 1980;;62:2-7.
Koshino T:  The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-grafting or drilling of the lesion . J Bone Joint Surg Am 1982;;64:47-58.
Williams JL, Cliff MM, Bonakdarpour A:  Spontaneous osteonecrosis of the knee . Radiology 1973;;107:15-19.
Norman A, Baker ND:  Spontaneous osteonecrosis of the knee and meniscal tears . Radiology 1978;;129:653-656.
Greyson ND, Lotem MM, Gross AE, et al:  Radionuclide evaluation of spontaneous femoral osteonecrosis . Radiology 1982;;142:729-735.
Houpt JB, Alpert B, Lotem M, et al:  Spontaneous osteonecrosis of the medial tibial plateau . J Rheumatol 1982;;9:81-90.
Burt RW, Matthews TJ:  Aseptic necrosis of the knee: Bone scintigraphy . AJR 1982;; 138:571-573.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Ahlback S, Bauer GCH, Bohne WH:  Spontaneous osteonecrosis of the knee . Arthritis Rheum 1968;;11:705-733.
Lotke PA, Ecker ML, Alvi A:  Painful knees in older patients: Radionuclide diagnosis of possible osteonecrosis with spontaneous resolution . J Bone Joint Surg Am 1977;;59:617-621.
Ahuja SC, Bullough PG:  Osteonecrosis of the knee: A clinicopathological study in 28 patients . J Bone Joint Surg Am 1978;;60:191-197.
Rozing PM, Insall J, Bohne WH:  Spontaneous osteonecrosis of the knee . J Bone Joint Surg Am 1980;;62:2-7.
Koshino T:  The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-grafting or drilling of the lesion . J Bone Joint Surg Am 1982;;64:47-58.
Williams JL, Cliff MM, Bonakdarpour A:  Spontaneous osteonecrosis of the knee . Radiology 1973;;107:15-19.
Norman A, Baker ND:  Spontaneous osteonecrosis of the knee and meniscal tears . Radiology 1978;;129:653-656.
Greyson ND, Lotem MM, Gross AE, et al:  Radionuclide evaluation of spontaneous femoral osteonecrosis . Radiology 1982;;142:729-735.
Houpt JB, Alpert B, Lotem M, et al:  Spontaneous osteonecrosis of the medial tibial plateau . J Rheumatol 1982;;9:81-90.
Burt RW, Matthews TJ:  Aseptic necrosis of the knee: Bone scintigraphy . AJR 1982;; 138:571-573.
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.