Carlos, 68 year-old, came to see me for left knee pain. He had knee pain for at least 3 months. The nature of the pain was constant, pain was worsen by walking. In the physical examination, his knee movement(ROM) was no restriction on both sides and no pain was elicited during knee movement and muscle palpation. He had a history of lower back pain and operation for lumbar decompression and fusion. It was suspected that the pain was referred by the lumbar region.
Carlos was sent to take X ray for both lumbar and knee regions. The result showed that left knee only had mild to moderate degeneration changes. However, the fracture of the left screw at L4 was noted. The pain came from his lower back due to the broken screw at L4, which innervated the left knee area and result in the L4 segment slipped forward. The fragment of the broken screw was removed and replaced a new screw to stabilise the L4 vertebra. After the operation, his knee pain disappeared. As a chiropractor, making a correct diagnosis is crucial and co-managing with other professions is so important in this case.