Henry Ford Studies

MEDICATIONS:

1.  Cartia XT.

2.  Fosamax 70 mg a week.

3.  Hydrochlorothiazide 25 mg daily.

4.  Lisinopril 5 mg daily.

5.  Zocor 40 mg a day.

CHIEF COMPLAINT:  Knee pain.

HISTORY OF PRESENT ILLNESS:  Patient is a 78-year-old white female complaining of knee pain for years.  Pain is getting worse.  Now she is unable to work in her garden.  She cannot bend or kneel.  She has difficulty getting out of a chair.  No relief with the use of naproxen sodium or with ibuprofen.  The pain is localized.  Does not radiate.  No numbness or tingling.

REVIEW OF SYSTEMS:  No abdominal pain.  No chest pain.  Occasional swelling in the legs.

PAST MEDICAL HISTORY:

1.  Hemicolectomy for colon cancer 2001.

2.  Hypertension.

3.  Arthropathy of the right hip in 2006 for which the patient received an intraarticular corticosteroid injection.

EXAMINATION:

VITAL SIGNS:  Weight is 157 pounds, blood pressure 136/75, with a pulse of 63, temperature 97.1.

MUSCULOSKELETAL:  No swelling in the joints of the hands, the wrists, the elbows.

EXTREMITIES:  Knees lack hyperextension.  They were cool to touch.  There were no anterior knee effusions.  There is valgus deformity bilaterally.  Joint line is not tender.  No pain with range of motion of the hips.  Fatty tissue about the legs, but no overt edema.

IMAGING STUDIES:  Weightbearing radiographs of both knees were obtained today and reviewed with the patient and her husband.  There is obliteration of the lateral tibiofemoral compartments bilaterally.

IMPRESSION:  Arthrosis, both knees.

MEDICAL DECISION MAKING:  Treat symptomatically.  Prescriptions provided for Celebrex 100 mg daily and Vicodin p.r.n.  Consider arthroplasty.