Name
Purdue University Globle
NU605 Transition to Practice
Prof. Name
Date
A focused SOAP note for acute right knee pain should connect the mechanism of injury, subjective symptoms, objective examination findings, differential diagnoses, diagnostic testing, and treatment plan. In this case, the patient’s twisting soccer injury, persistent pain, swelling, and limited range of motion make a meniscal injury an important diagnostic consideration. However, the presence of low-grade fever, warmth, erythema, and joint effusion means that septic arthritis and other inflammatory or infectious causes should also be evaluated promptly.
Sarah is a 25-year-old female presenting with acute right knee pain that began approximately two weeks ago after a twisting injury while playing soccer. Despite rest, her symptoms have persisted and interfere with activities such as climbing stairs and bending the knee.
The history and physical examination suggest an internal knee injury, but the inflammatory findings require careful evaluation to determine whether infection or another serious condition is contributing to her symptoms.
The patient reports:
“Sharp, stabbing pain in the right knee that becomes worse when using stairs or bending the knee.”
Sarah reports that her right knee pain began immediately after twisting her knee during a soccer game approximately two weeks ago. The pain has remained persistent and becomes worse with physical activity, particularly bending the knee and climbing stairs. Rest and ice provide some relief.
The reported symptoms include sharp, stabbing knee pain accompanied by swelling and reduced mobility. The persistence of symptoms despite rest raises concern for an underlying structural injury.
The patient reports no significant past medical history. She denies previous knee injuries and does not report chronic medical conditions.
The review of systems is generally within normal limits except for findings relevant to the current knee problem.
Musculoskeletal findings include right knee pain, tenderness, swelling, and decreased range of motion. General findings include mild fatigue and a low-grade temperature of 100.1°F.
The patient’s vital signs are:
Temperature: 100.1°F
Heart rate: 80 beats/minute
Blood pressure: 128/76 mmHg
Respiratory rate: 12 breaths/minute
Oxygen saturation: 99% on room air
Sarah appears generally well but demonstrates mild discomfort associated with her right knee pain.
Examination of the right knee demonstrates erythema, increased warmth, tenderness to palpation, joint effusion, and limited flexion and extension.
These findings are consistent with significant joint inflammation and may occur with traumatic internal derangement. However, warmth, erythema, effusion, and fever also warrant evaluation for an infectious joint process.
Neurological examination of both lower extremities is normal. Sensation and reflexes are intact bilaterally.
The patient’s history and examination support several possible diagnoses. The mechanism of injury is particularly relevant because twisting injuries can damage the menisci and knee ligaments.
A meniscal tear is an important consideration because the patient developed symptoms following a twisting injury. Persistent pain, swelling, tenderness, and restricted range of motion can occur with meniscal injuries.
A detailed knee examination, including appropriate provocative maneuvers, can help identify internal derangement. MRI may be considered when imaging is needed to evaluate suspected meniscal or other soft-tissue injuries.
An MCL or ACL injury should also be considered following a sports-related twisting injury. Ligament injuries may cause pain, swelling, and functional limitations. Findings such as instability or abnormal ligament-specific examination tests would provide additional evidence for a ligament injury.
Patellar tendinopathy can produce activity-related anterior knee pain, particularly in athletes. However, the acute twisting mechanism and presence of joint effusion make an isolated patellar tendon problem less consistent with the overall presentation.
Osteoarthritis is less likely in this 25-year-old patient because it generally develops gradually and is more common with increasing age. The acute onset after a traumatic twisting event also favors an injury-related cause.
Septic arthritis must remain in the differential diagnosis because the patient has a low-grade fever along with warmth, erythema, swelling, and joint inflammation. Although the history of trauma makes an internal knee injury plausible, infection can cause rapid joint destruction and requires timely evaluation.
If septic arthritis is clinically suspected, synovial fluid analysis obtained through arthrocentesis is particularly important for determining whether infection is present.
Initial management of an uncomplicated acute musculoskeletal knee injury may include activity modification, rest, ice, compression, and elevation. The patient should avoid activities that significantly increase pain or swelling.
Gentle range-of-motion and rehabilitation exercises may be introduced according to the clinical diagnosis and the patient’s tolerance. Physical therapy can be considered when appropriate to restore mobility, strength, and function.
Because this patient has fever and inflammatory joint findings, conservative treatment should not replace evaluation for a potentially infectious joint process.
Additional diagnostic testing should be guided by the clinical examination and level of concern for structural injury or infection.
A right knee radiograph may be appropriate when evaluating for fracture or other bony abnormalities. MRI can provide more detailed assessment of soft tissues and may help identify meniscal, ligamentous, or other internal knee injuries when clinically indicated.
Because the patient has fever and signs of joint inflammation, inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be obtained as part of the evaluation.
If septic arthritis remains a clinical concern, arthrocentesis with synovial fluid analysis and culture is an important diagnostic step. Laboratory results should be interpreted together with the patient’s history and physical examination rather than used in isolation.
An NSAID such as ibuprofen may be considered for pain and inflammation when appropriate and when the patient has no contraindications to NSAID therapy. Medication selection and dosing should account for factors such as allergies, gastrointestinal disease, kidney function, pregnancy status, and other medications.
Orthopedic referral may be appropriate when a significant meniscal or ligament injury is identified, symptoms persist despite appropriate conservative management, or additional specialist evaluation is needed.
If septic arthritis is suspected, the patient requires prompt medical evaluation rather than routine orthopedic follow-up, because an infected joint can require urgent treatment.
Follow-up should be based on the severity of symptoms and the results of the diagnostic evaluation. At follow-up, the clinician should reassess:
Pain severity and functional limitations
Knee swelling and range of motion
Results of imaging and laboratory testing
Evidence of infection or worsening inflammation
Need for physical therapy or specialist referral
The patient should also be instructed to seek prompt medical attention if she develops worsening pain, increasing swelling or redness, higher fever, inability to bear weight, or other signs of systemic illness.
A structured SOAP note helps clinicians organize the evaluation and management of acute knee pain while ensuring that important differential diagnoses are not overlooked. Sarah’s twisting soccer injury, persistent pain, swelling, and restricted range of motion are compatible with an internal knee injury such as a meniscal tear. At the same time, the low-grade fever, warmth, erythema, and effusion require careful assessment for septic arthritis.
A thorough history and physical examination, appropriate imaging, and targeted laboratory or synovial fluid testing can help distinguish traumatic knee injuries from infectious or inflammatory conditions. Early identification of the underlying cause supports appropriate treatment and helps reduce the risk of complications.
American Academy of Orthopaedic Surgeons. (n.d.). Meniscus tears. OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/meniscus-tears/
American College of Radiology. (2024). ACR Appropriateness Criteria® acute trauma to the knee. https://acsearch.acr.org/docs/69419/narrative/
Bickley, L. S. (2024). Bates’ guide to physical examination and history taking (14th ed.). Wolters Kluwer. https://shop.lww.com/Bates–Guide-to-Physical-Examination-and-History-Taking/p/9781975180597
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2024). Knee problems. National Institutes of Health. https://www.niams.nih.gov/health-topics/knee-problems
Merck Manual Professional Edition. (n.d.). Septic arthritis. Merck & Co., Inc. https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/infectious-arthritis/septic-arthritis
