Differential Diagnosis for 22-year-old Pregnant Female with Knee Pain
- Single most likely diagnosis:
- Medial knee pain due to ligament sprain or strain: The patient's symptoms of medial knee pain that worsens with standing or extended walking, combined with a recent history of a motor vehicle accident (MVA), suggest a possible ligament sprain or strain. The medial collateral ligament (MCL) is commonly injured in such scenarios.
- Other Likely diagnoses:
- Pes anserine bursitis: This condition, characterized by inflammation of the bursa at the insertion of the sartorius, gracilis, and semitendinosus muscles on the medial aspect of the knee, could explain the patient's medial knee pain, especially given her pregnancy status which may alter her gait and put additional stress on these areas.
- Tendinitis or stress fracture: The patient's recent increase in activity or altered biomechanics due to pregnancy could lead to overuse injuries such as tendinitis or, less commonly, stress fractures around the knee.
- Do Not Miss diagnoses:
- Deep vein thrombosis (DVT): Although the patient denies swelling, DVT is a critical diagnosis to consider, especially in pregnant women who are at increased risk due to hypercoagulability. The presentation can sometimes be subtle, and missing this diagnosis could be catastrophic.
- Osteonecrosis: This condition, although less common, could present with knee pain and should be considered, especially if there's a history of trauma or corticosteroid use.
- Rare diagnoses:
- Neuroma or nerve entrapment: The patient's description of tingling and numbness on the lateral side of the knee could suggest a neuroma or nerve entrapment, although this would be less common.
- Infection or septic arthritis: While the patient does not present with typical signs of infection such as fever or significant swelling, in pregnant women, the immune response can be altered, making some presentations atypical. This diagnosis is critical and should be considered, especially if the patient's condition worsens or does not respond to initial treatment.