Author: Rajiv Verma, DO
Co Author #1: Joshua A. Blomgren, D.O. [Faculty, Departments of Family Medicine and Orthopaedics, Midwest Orthopaedics at RUSH/Rush University Medical Center, Chicago, IL]

Patient Presentation:
60 year-old Caucasian female presenting with chief complaint of "floating objects" in her left knee.

History:
The patient is a 60 year-old Caucasian female with past medical history of hypertension and osteoarthritis who presented with chief complaint of numerous "floating objects" within her left knee causing extreme pain. The problem had been present for the past four to five years and notably began after the patient received a series of hyaluronic acid injections six years ago. She reported 6/10 pain when she felt the "floating objects" move within her knee. Exacerbating factors included walking, standing, lifting, carrying, bending, and sleeping. She noted that these activities did not regularly cause pain, but did cause pain when the "floating objects" moved. The patient denied locking, buckling, and giving way. She further denied radiation, numbness, and tingling. The frequency of the episodes was increasing. The patient had been taking indomethacin as-needed basis for pain, which provided minimal relief.

Physical Exam:
VS: BP = 122/76 | HR = 59 | Ht = 68" | Wt = 170 lbs.
General: A&Ox3, NAD
Skin: No erythema, edema, or ecchymosis
Gait: Grossly non-antalgic gait in normal heel-toe fashion

Right Knee: Trace effusion with crepitation of patellofemoral joint. Tenderness at patellar facet. ROM was 140 degrees. No tenderness at medial or lateral joint line. Valgus/varus, Lachmann, posterior drawer tests negative. Rotational testing negative.

Left Knee: +2 effusion with palpable Baker's cyst. Multiple nodular masses with one superolateral to the patella. The mass was freely movable with some crepitus and translated medially under the patella. With flexion, the mass became prominent. There were areas of nodularity that were freely movable palpated within the popliteal fossa with a Baker's Cyst. They were slightly tender to palpation. Range of Motion:120 degrees with pain at terminal flexion. There was medial greater than lateral joint line tenderness. Valgus/varus, Lachmann, and posterior drawer tests negative. Rotational testing positive for pain.

Pulses: Popliteal pulses +2
Neuro: Sensation to lower extremities grossly intact

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