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  • Title: An unusual cause of knee pain discovered at a nurse practitioner clinic.
    Author: Heins JK, Heins A.
    Journal: J Am Acad Nurse Pract; 2008 Nov; 20(11):563-6. PubMed ID: 19128340.
    Abstract:
    PURPOSE: To describe an interesting and instructive case of knee pain from nurse practitioner (NP) practice and discuss the epidemiology, pathophysiology, clinical evaluation, and treatment of osteosarcoma. DATA SOURCES: Findings from the history, physical examination, diagnostic testing, and follow-up of the case of an 18-year-old male who first presented with nontraumatic, diffuse left knee pain of 2.5-month duration. CONCLUSIONS: At follow-up, after a trial of conservative treatment, a lesion suspicious for osteosarcoma was seen in the proximal tibia. Osteosarcoma is a rare but dangerous cause of chronic extremity pain, especially in children and adolescents. IMPLICATIONS FOR PRACTICE: NPs must consider malignant bone tumors in the differential diagnosis of traumatic and nontraumatic extremity pain of extended duration, especially in children and adolescents. Thorough, persistent follow-up on recommended tests and referrals is necessary to ensure that important findings are not missed. The care of uninsured patients requires particular attention to cost concerns and access issues.
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