Musculoskeletal Physiotherapy, Refine Health Ltd, Auckland, New Zealand.
Musculoskeletal Physiotherapy, University of Wisconsin- Madison, Madison, WI, USA.
J Man Manip Ther. 2023 Aug;31(4):297-303. doi: 10.1080/10669817.2023.2183338. Epub 2023 Mar 3.
Physical therapists (PTs) working in primary care settings commonly encounter mechanical causes of knee pain. Non-mechanical causes of knee pain, such as bone tumors, are rare, and therefore, PTs often have a low index of suspicion regarding sinister pathology. The purpose of this case report is to describe the physical therapist's clinical reasoning process for a 33-year-old female presenting with medial knee pain and a subsequent history of metastatic melanoma. Initially, subjective and objective testing pointed to a mechanical internal derangement of the knee. However, symptom progression and poor treatment responses between physical therapy visits 2 and 3 raised suspicions as to the cause of the knee pain. This prompted an orthopedic referral and medical imaging, revealing a large bone tumor invading the medial femoral condyle, which was further characterized as metastatic melanoma by a specialty oncology team. Further imaging revealed several metastatic subcutaneous, intramuscular and cerebral lesions. This case highlights the importance of the ongoing medical screening process, including the monitoring of symptoms and treatment responses.
物理治疗师（PT）在初级保健环境中经常遇到膝关节疼痛的机械原因。膝关节疼痛的非机械原因，如骨肿瘤，很少见，因此，PT 通常对恶性病理学的怀疑指数较低。本病例报告的目的是描述一名 33 岁女性出现内侧膝关节疼痛和随后的转移性黑色素瘤病史时，物理治疗师的临床推理过程。最初，主观和客观检查指向膝关节的机械内部紊乱。然而，症状的进展和第 2 次和第 3 次物理治疗就诊之间的治疗反应不佳引起了对膝关节疼痛原因的怀疑。这促使进行了骨科转诊和医学影像学检查，发现了一个大的骨肿瘤侵犯了内侧股骨髁，并进一步由肿瘤学专业团队确定为转移性黑色素瘤。进一步的影像学检查显示了几个转移性皮下、肌肉内和脑内病变。本病例强调了持续医疗筛查过程的重要性，包括症状和治疗反应的监测。
