MDM //

Given exam and history, low suspicion for septic arthritis at this time given location of pain (not over knee joint but superior to area), subacute nature, and relative comfort to range of motion and axial loading. Nontoxic appearing and no overt systemic symptoms. Atraumatic with low suspicion for fracture or dislocation. No overt e/o necrotizing fasciitis. Given tenderness and area of erythema, will treat for cellulitis. Neurovascularly intact per routine as above with no overt e/o compartment syndrome. After extensive discussion with patient and wife regarding observation and treatment of possible cellulitis versus arthrocentesis and risks (overlying cellulitis, lower pretest probability of septic arthritis, risk of inoculation of joint) and benefits of both, mutual decision making to trial antibiotics and not pursue further arthrocentesis at this time. Patient tolerating discomfort, continue to be at baseline and well appearing. As above, does not have signs of systemic symptoms or neurovascular compromise. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with increase in pain, inability to range or bear weight, or fevers.



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