Physician Shirley Ryan AbilityLab Chicago, Illinois, United States
Case Diagnosis: Patella Stress Fracture
Case Description: 31 year-old female with a history of Arthrogryposis Multiplex Congenita presented with insidious onset left knee pain for several months without preceding trauma. The searing-type pain was present with weight bearing. She has a history of right knee injury and was becoming more reliant on her left knee. She had an overall decrease in activity level the last few years due to the pandemic. On examination, there was tenderness to palpation at the anterior knee, and the pain was exacerbated by active and passive knee extension. X-ray was remarkable for cortical lucency within the patella demonstrating a nondisplaced stress fracture of the inferior pole. She was treated non-operatively consisting of rest and avoidance of pain provoking activities, with plan for physical therapy to focus on quadriceps and hip abductor strengthening, balance, and endurance, and to follow up in six weeks given the high risk of non-union.
Discussions: Arthrogryposis is a rare disorder that causes non-progressive contractures present at birth. This patient presented with an uncommon diagnosis of patella stress fracture. Her risk factors were low level of physical fitness, female gender, altered biomechanics given deformities in the distal femur and proximal tibia due to her underlying Arthrogryposis, and overuse of the left knee due to previous injury of her right knee. Physiatrists are in a unique position and hold an important role in addressing musculoskeletal complaints, especially in patients with Arthrogryposis, given our specialized training in the musculoskeletal system, orthopedics, orthotics, rehabilitation, and neuromuscular medicine.
Conclusions: Patients with Arthogryposis Multiplex Congenita could undergo early comprehensive Physiatric evaluation to optimize gait mechanics, avoid injuries including stress fractures, and enhance function. Physiatrists are an integral resource for the early identification of gait abnormalities and coordinating the rehabilitation needs to prevent these long-term musculoskeletal sequelae associated with the disease.
