TUTORIAL

MODULE: Musculoskeletal System II

CASE: Twist and Ouch!

Bea, a 25-year-old athletic woman is on her first mountain-climbing trip to Los Banos, Laguna. She has advanced
from the slopes and, during the last trip of the day, falls and twists her right leg. She cannot stand on her right leg
because of severe pain and is brought down the hill in a stretcher.

On examination, the right knee is swollen and tender. With the patient sitting on the stretcher with her knee flexed,
the lower leg seems to have several centimeters of excess anterior mobility.
 TUTORIAL

MODULE: Musculoskeletal System II

CASE: The Hazing Victim

Carlo, a 19-year-old fraternity neophyte is brought to the emergency room by the concerned citizens after being
found down on the street. He appears somnolent and lethargic. He is somewhat incoherent. In the emergency room,
he becomes uncooperative and combative. He is not oriented to self, place, or time. Security is called to help restrain
him, and he is placed in five-point leather restraints for his own and the staff’s protection. No specific complaints
can be elicited from him; he continues to yell at the staff and seems to be having auditory and visual hallucinations.
He frequently complains of severe pain in his legs.

Carlo’s temperature is 38°C, heart rate is 120/min, and blood pressure 150/100 mm Hg.

A Foley catheter is placed, and the urine is noted to be tea-colored. Urine dipstick reads 4+ for blood, but no red
blood cells (RBCs) are seen on the microscopic examination. Urine drug screen is negative.

Large confluent hematomas are found on his posterior thighs. No other external injuries are found.

A head CT scan is negative for hemorrhage or any other lesions. Complete blood count is normal while serum
creatinine level is 3.2 mg/dL.

An hour later, his systolic blood pressure is found to be 85 mmHg.

 TUTORIAL

MODULE: Musculoskeletal System II

CASE: The Limping Karate Kid

Jerome, a 13-year-old boy who is aiming to earn a black belt in his karate class, is brought to the physician’s office
with right thigh pain and a limp. His mother has noticed him limping for the past week or so. He denies any injury to
his leg but says that it hurts some when he plays basketball with his friends. He denies back pain, hip pain, or ankle
pain. He occasionally gets some pain in the right knee but does not have any swelling or bruising. He has no
significant medical history, does not take any medications regularly, and otherwise feels fine.

On examination, Jerome is an overweight adolescent. His vital signs and a general physical examination are normal.
When you have him walk, he has a prominent limp. You note that he seems to keep his weight on his left leg for a
greater proportion of his gait cycle than he does on the right leg. Examination of his back reveals a full range of
motion, no tenderness, and no muscle spasm. He gets pain in the right hip when it is passively internally rotated.
When the hip is passively flexed there is a noticeable external rotation. There is no thigh muscle atrophy. His right
knee and the remainder of his orthopedic examination are normal.