HAWKSWORTH · Knee OA

Patient Details

Name: Roy / Rosie Hawksworth
Age: 62 years
Opening statement: "My left knee is giving me trouble Doctor."

Clinical Details

You have been having increasing pain in your left knee for about 3 months. At first it was just for a couple of days a week, but now it aches every day. It’s worse when you first get up but eases off quickly. By the end of a day at work it has become quite uncomfortable and you have thought about taking painkillers — but you do not like tablets, so you only used a gel a friend gave you (orange and white tube; can’t remember the name) and it helped.

The pain is not there all the time, but towards the end of a long walk and now a dance session your knee aches. It’s not painful when sitting and has not disturbed your sleep. In the evenings after sitting watching television it hurts when you first get up and is stiff, but after three or four paces it is better. Last week you were unable to dance for the whole evening. You have noticed it has become more difficult to kneel under cars.

Response to questions

Open questions (e.g. “tell me more about the problem”): Describe the pain as an ache; initially only a day or two at a time, now every day after standing or walking a long way. With further questions you can add that the gel helped and that you get pain/stiffness in the evenings after sitting.
Closed questions:
- “I cannot remember injuring my knee Doctor”
- “I have not noticed any swelling”

Patient Perspective (ICE & Feelings)

Ideas: Not sure what is wrong. Cannot remember injuring the knee. A friend has said your joints are wearing out because of your age — you wonder if it’s “wear and tear.”

Concerns: Worried that if it gets worse you might not be able to dance or go for long walks. If much worse, it might affect work (though as lead mechanic you can do more paperwork and less heavy work).

Expectations: Expecting the GP to have a look at your knee.

Feelings: If asked about concerns, say you are worried it will get worse and stop you dancing, which will upset your partner.

Past Medical History

Hypertension (since age 55 years)

Drugs & Allergies

Amlodipine 5 mg once daily
No allergies

Family History

Father died aged 60 from a stroke (doctor said from untreated blood pressure)
Mother aged 90, remarkably well and independent (partner helps change her bed weekly)
Brother with mental health problems (used drugs when younger)

Social History

Married to Susan/Sid (60, works part-time in a local corner shop); good, loving relationship; married at 22
Three grown-up children
Full-time lead mechanic at a local garage (apprenticeship from age 16)
Share a love of ballroom dancing — still dance at least once a week (no longer competitively)
Enjoy walks in the country; model engineering (recently built a quarter-scale traction engine used at the town carnival)
Never smoked
Glass of wine when out — about 4–6 glasses per week

Simulated Patient Non-verbal Behaviour

Normal affect; cheerful and pleasant
Walking normally

Information for the Student (before seeing patient)

Name: Roy / Rosie Hawksworth
Age: 62 years (record may show 60)
PMH: Hypertension since age 55
Medication: Amlodipine 5 mg once daily
Other: Never smoked · Alcohol — no record
Last 12 months: Sinusitis treated with doxycycline (9 months ago)

Physical Examination Findings

Left knee not swollen or warm; skin normal
Small effusion detectable on sweep test
Tender over distal insertion of medial collateral ligament
Pain-free range of movement with slight loss of flexion compared to right knee
Left hip has a pain-free range of movement

Second Consultation – Actor Information

You have returned for your X-ray results. You want to know what it says and what it means. You are keen to know if you will need surgery and what can be done about the pain (it is affecting work and hobbies). You question whether you need referral to a specialist and wonder if it will continue to get worse. You are happy to take any recommendations for management.

Second Consultation – X-ray Report

LEFT KNEE (AP and lateral, weight-bearing)

Clinical details: Increasing pain in left knee mainly after activity. No previous injury. ? OA

Report: Narrowing of the joint space is seen with evidence of osteophyte formation and subchondral sclerosis.

Primary Care Block · University of Buckingham