A 34-Year-Old Woman Comes to the Physician with Lateral Right

question 741

Multiple Choice

A 34-year-old woman comes to the physician with lateral right lower-extremity pain for a week.  The pain is located just above the knee and radiates to the thigh.  It is described as burning and occasionally sharp with moderate severity and an intermittent, unpredictable course.  A trial of over-the-counter ibuprofen gave inconsistent improvement.
The patient was recently diagnosed with type 2 diabetes mellitus and is attempting to avoid medication with an aggressive weight loss program that includes intense exercise.
Her vital signs are normal.  Body mass index is 37.8 kg/m².  The knee appears grossly normal with no effusion and normal, pain-free range of motion.  There is mild, poorly localized tenderness over the lateral knee especially with flexion and extension.  Knee ligaments appear stable.  Pedal pulses are full and there is trace edema at both ankles.
Which of the following is the most appropriate next step in management of this patient?

• A)Advise patient to avoid clothing that fits tightly at the waist
• B)Corticosteroid injection to the anserine bursa
• C)Magnetic resonance imaging of the knee
• D)Neoprene patellofemoral splint
• E)Physical therapy to advise on home exercise program

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