What is the best management plan for a 28-year-old male patient with a history of left knee pain, bilateral foot dryness, and a diagnosed lipoma, who declined physical therapy (PT) and nonsteroidal anti-inflammatory drugs (NSAIDs) and is currently prescribed Minerin (urea) cream?

From the Guidelines

The best management plan for this 28-year-old male with left knee pain, bilateral foot dryness, and a diagnosed lipoma would involve a multi-faceted approach despite his refusal of PT and NSAIDs. I recommend continuing the Minerin (urea) cream for his foot dryness, applying it twice daily to affected areas after bathing when skin is slightly damp to maximize absorption, as per the current treatment plan. For his knee pain, since he declined NSAIDs and PT, alternative pain management strategies should be explored, including topical analgesics like diclofenac gel 1% applied to the knee 3-4 times daily, or capsaicin cream 0.025-0.075% applied 3-4 times daily with careful handwashing after application, as supported by evidence from studies such as 1. Cold therapy (15-20 minutes several times daily) and activity modification to avoid aggravating movements would also be beneficial. For the lipoma, which is typically benign, observation is appropriate unless it's growing, painful, or cosmetically concerning to the patient, in which case surgical excision could be considered. The patient should be educated about the importance of maintaining a healthy weight to reduce knee stress, and gentle strengthening exercises he can perform independently at home should be suggested as an alternative to formal PT, as recommended by guidelines such as 1. Regular follow-up in 4-6 weeks would be prudent to assess treatment response and potentially reconsider PT and oral pain management options if symptoms persist. Key considerations in managing knee pain include the use of paracetamol as an initial oral analgesic, as suggested by 1, and the potential benefits of topical NSAIDs and capsaicin, as supported by studies such as 1. However, the patient's refusal of NSAIDs and PT requires careful consideration of alternative management strategies to optimize outcomes and minimize morbidity, mortality, and impact on quality of life. Some key points to consider in the management of knee pain include:

• The importance of patient education and self-management strategies, as emphasized by 1
• The potential benefits of alternative pain management strategies, such as topical analgesics and cold therapy, as supported by studies such as 1
• The need for regular follow-up and reassessment of treatment response, as recommended by guidelines such as 1
• The importance of considering the patient's individual needs and preferences in developing a management plan, as emphasized by 1.

From the Research

Management Plan for Knee Pain

• The patient's left knee pain could be due to various causes such as osteoarthritis (OA), patellofemoral pain, or meniscal tears, as approximately 5% of all primary care visits in adults are related to knee pain 2.
• Given the patient's age (28 years) and the fact that the knee injury happened last month, patellofemoral pain is a possible cause, which typically affects people younger than 40 years who are physically active 2.
• First-line management of knee pain comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition 2, 3.
• However, the patient declined physical therapy (PT) and nonsteroidal anti-inflammatory drugs (NSAIDs), which are common treatments for knee pain 2, 3, 4.

Management Plan for Bilateral Foot Dryness

• The patient is complaining of bilateral foot dryness, for which Minerin (urea) cream has been prescribed.
• There is no direct evidence in the provided studies regarding the management of bilateral foot dryness.

Management Plan for Diagnosed Lipoma

• The patient has been diagnosed with a lipoma, which is a common benign tumor.
• The patient was educated regarding lipomas and what to expect, which is appropriate as lipomas are typically not harmful and do not require treatment unless they are causing symptoms or are cosmetically concerning.
• There is no direct evidence in the provided studies regarding the management of lipomas.

Overall Management Plan

• The patient's management plan should focus on addressing the underlying causes of their symptoms, including the knee pain and bilateral foot dryness.
• Given the patient's decline of PT and NSAIDs, alternative treatments such as exercise therapy at home or other pain management options could be considered 4.
• Regular follow-up appointments should be scheduled to monitor the patient's symptoms and adjust the management plan as needed.