Transcript

Doctor: Okay, so it's more the left knee that is painful than the right. Okay. Patient: So yeah, we were doing some exercises. We're doing the leg curls. Both of them gave me some problems. I was only doing like 40 pounds, which I was really surprised at because it just it hurt when I was extending my leg out this way. Like my leg even with that 40 pounds was like more with the extension move. Doctor: Okay. Patient: Yeah, it was like really jittery. Doctor: Yeah, right. Patient: Yeah, so when I was done like I could felt like even sitting right now. Yeah, I could feel like a little any of the knee so left leg pain is worse after like prolonged walking and with leg extension movements. Doctor: Okay, and then is there any giving out of the knee for it? Patient: Okay so far. Doctor: Yeah, yeah any locking where it locks it and you can't get it to move? Patient: Okay, how long has this been going on for? Doctor: I've noticed it probably about just after I saw you the last time so two months. Doctor: Okay, and when you're resting the pain is better. It's more those specific movements for the most part. Where specifically is the pain on the knee? Patient: Like right at the very top here. Doctor: Okay, so sometimes like down there. So right in this like this region. Patient: Okay, so patients pointing to the front part over the patella. Doctor: All right, so let's have you sitting here. So make it go make it extend. So go fully straight. Okay, leave it there. Does that cause pain? Patient: No, just hold it up. Doctor: Full range of motion was extension and then fully flex for me go all the way down. Okay, I hear the grinding. What does that cause any pain right now? Patient: I could feel a little something right there. Doctor: Okay again, it's not like I don't want to say it's like extreme pain or anything like that. Patient: Yeah, I do feel like yeah pain to the front part of the knee with flexion. Doctor: Okay, and we're feeling any pain here? Here? Here? Patient: It's like a little soreness like right here. Doctor: Okay. Yeah, like that whole region that you just went here. Patient: Okay. Doctor: Okay, so noted pain over the MCL. And I'm gonna have you just raise it again, okay. Does that cause pain? Does that cause pain? Patient: Okay, varus and valgus maneuvers are negative. Turn inwards for me. Doctor: Okay, and then bend bend your knee bend bend bend bend bend. Does that cause pain? Patient: Just a little bit. Doctor: Okay, bend again. Does that cause pain? Patient: I guess just a little bit. Doctor: Okay, so pain with the McMurray's test and then go outwards. Rotate externally and then bend again. Does that cause pain? Patient: But on the medial area there. Doctor: Okay, so pain over the MCL with Murray's test. Okay, so what we'll do is it's been two months. Have you done any treatment for it? Patient: Okay, tried any physio? Doctor: Okay, any Tylenol? Patient: Just like ointments. Doctor: Yeah, which ointments have you tried? Patient: So I use Tiger Balm. Doctor: Yeah. Like Voltaren or anything? Patient: I have tried Voltaren, but there's another one. It's a it's like a gel and it has like a little Salon pass? Doctor: It's not a salon pass, I can't remember the name of it. It's a clear bottle. Patient: Okay, but is it an anti-inflammatory or is it a cooling agent? Doctor: It's like a cooling agent. Patient: Okay. Doctor: It cools down then it heats up. Okay, and it okay, so if you find it helpful you can use it. Can also be helpful don't use these things all at once because sometimes it can cause like if you do a cooling agent then with like an anti-inflammatory you can cause like a burning. So just use one or the other. Patient: Yeah, exactly I don't use any of them together just one at a time. Doctor: Okay. And then the other thing is you can take Tylenol for the pain if you need to. We will let's image it. We'll do an x-ray and an ultrasound. I'll order that. Patient: Okay. Doctor: And the rec is good for six months and you can do it at whatever places close to home convenient for you. And then I'll keep an eye out for them. If it shows anything, I'll call and follow up. It may also be beneficial to look into some physio. But no, do you any insurance? Patient: Okay. Doctor: We do have Steve who's our physiotherapist here in office. So I could do a referral to you, but I want to see the imaging first. So I'll make a note to myself to wait for the imaging and then when we know what's going on we can do a referral. I can I can refer you to Steve and then it's covered like he's part of our staff here. So same as seeing Jean-Anne is covered. He's covered as well. Patient: Okay, if you're interested I could do that referral that yeah, that's perfect. Doctor: Yeah. Yeah, but let's do the imaging first. We know what we can tell Steve and he also works with Joey who's the kinesiologist who you'll be seeing as part of the change program too. So if you still have the pain when you start the change program mentioned that to Joey the kinesiologist. Patient: Okay. Doctor: Because he can give exercises specific for that as well. Um, he works with Steve. So but let's do imaging and then I'll make a note to myself that next steps will be review the imaging and probably do a referral with Steve. Patient: So just as I'm sitting here and I'm just like I'm not like bending it or anything I'm just sitting here and I'm just lifting like my leg a little bit here. The extension. Doctor: Yeah. Patient: Right on a kneecap right here. That's where I feel like the most pain and that's where and so the only thing is because like the some of the tests and where the pain was when I was examining was slightly over and with extension I always think that sometimes something called the MCL which is your medial collateral ligament sometimes can be effective. That's why sometimes it's worse with those extension movements or straightening movements. The MCL tends to be affected with that one. And then on exam, that's what was kind of bothering you and the specific test I did at the end those are tests for that. So it may be a bit inflamed or even a small tear. Doctor: Okay, so that's why the x-ray will show us if there's arthritis because with like the grinding and the clicks we think arthritis. But it but the ultrasound will help us show if there's any kind of ligament or tendon or meniscus kind of issue going on. Okay, so we'll we'll do that. Patient: Okay. Doctor: Yeah the other issue that I have that I've been having so recently so is whenever I sit like I'm sitting here on this on this chair it has a little bit of padding, which is not bad. But the longer periods I sit in especially like this position I tend to get like this really. I don't know if it's called soreness or pain, but in my butt muscles. Patient: So, I'm not sure like why is it doing that? I don't know if it's because I lost all that weight before and now I'm gaining back it probably like it's it's I mean it's it's about 60 pounds, right? Doctor: Yeah, it is quite a lot 60 pounds is a lot of weight. Patient: Yeah, and I don't know if maybe that's also the results of yeah, I know that when I did lose the weight I was showing some more muscle mass coming back in I had stopped losing weight, but the muscle mass. Doctor: Your weights not moving anymore, but you are showing signs of like size difference. Patient: Exactly, right? Cuz you have to remember muscle is more than like then then like then adipose tissue, right? So the scale numbers we aren't chasing so much. It's how clothes are fitting. How do you feel like that? Doctor: And I guess I like even this sweater I went down from I used to wear like or I used to buy like three four excels and I went down to a 2x all my pants I used to wear a 44 waist pants, and I went down to a 40 these pants here. It's still 40 It's a little tighter for me now, but I mean and it's only been I want to say