A 63 yrs old male with bilateral knee pains since 2 yrs and lower back pain since 1 year

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Chief complaints:-

Bilateral knee pains since 2 years

Lower back pain since 1 year

History of presenting illness:-

Patient is apparently asymptomatic 2 years ago and then he developed bilateral knee pains which are insidious in onset gradually progressive,dull aching type of pain aggrevates on walking he is not able stand up from sitting position,walking with the knees flexed and with help of a stick.Pain is associated with early morning stiffness.

Patient complaints of dragging type of pain in hamstring muscles and calf muscles while walking since 1 yr

No c/o any other joint pains.

C/o lower back ache and right flank pain which is insidious in onset gradually progressive,dragging type of pain,non radiating with no aggrevating and relieving factors.

C/o sob on walking since 1 week

H/o buring micturation on and off since 1 yr,

H/o nocturia(3 to 4 times) and terminal dribbling of urine on and off since 1 yr.

No h/o hematuria ,decreased or incresed urine output

No h/o cough,chest pain and palpitaions.

No h/o fever,headache,nausea and vomiting.

Past history:-

C/o loin pain 3 years ago daignosed with kidney stones and treated with medication and got cured

N/k/c/o dm,htn,tb,asthma,epilepsy,thyroid disorders,cva and cad.

No h/o any surgeries and blood transfusions.

Personal history:-

Diet:mixed

Apetite: normal

Sleep:adequate

Bowel:regular

Bladder: burning micturition occasionally.

Addiction: smoker(2 beedis/day)for 20 years stopped since 3 years.

Drinks alcohol occasionally for 35 years.

Family history:-

Insignificant

General Examination:-

Patient  is conscious, coherent, cooperative.

Gait:walking with the stickp with knee flexed.

Well built and well nourished

No signs of pallor,icterus,

cyanosis,clubbing,generalised lymphadenopathy and bilateral pedal edema.

Vitals:-

Bp:140/100

Pr:72bpm

Rr:20 cpm

Temp:afebrile

Spo2:99%

Grbs:110mg/dl

Local Examination:-knee joint(b/l) 

-On Inspection:-

there is swelling around both the knees,and there is a flexon deformity of both the knees. No redness.No scars,sinus and discharge.

-On Palpation:-

No local rise of temperature.

Joint line tenderness is present in both the kness.

Fluctuation is present in both the kness.

Movements:not able to flex and extend the knees completely.Tenderness is present on movement.

All other joints are normal.

Clinical Images:-

Systemic Examination:-

RS:-NVBS heard,BAE+

CVS:-S1, S2 heard, No murmurs

P/A:-obese, soft and non tender

CNS:-NAD

Investigations:-

Hemogram

LFT

RFT

Serology

RBS

ECG

2D Echo

X rays:-

Provisional Diagnosis:-

Osteoarthritis of b/l knee

Treatment:-

TAB.PAN 40 MG PO/OD

TAB.ULTRACET PO/BD