Author: Tyler Schmitz, DO
Co Author #1: Jennifer Maynard, MD
Co Author #2: Jeremy Rush, MD
Senior Editor: Yaowen (Eliot) Hu, MD, MBA
Editor: Caitlyn Mooney, MD
Patient Presentation:
A five year-old male presents with his grandmother to the sports medicine clinic with the chief complaint of left knee pain.
History:
Ten days before presentation, the patient's sister landed on his left anterior knee at a trampoline park. Afterwards, he could not bear weight fully, and he had swelling prompting an emergency room visit where x-ray s were normal. He has been using ibuprofen three times per day for pain relief. He denied any giving way, catching, locking, popping, numbness, or tingling.
Physical Exam:
General: Normal weight prepubescent male in no acute distress
Gait: Antalgic gait favoring his left knee with knee in slight flexion on tiptoes.
Neurological: Sensation intact to light touch and symmetric throughout bilateral L2-S1 dermatomes.
Left knee: (Exam limited due to guarding)
Inspection: Moderate effusion present. No gross deformity, erythema, ecchymosis, warmth.
Palpation: Tenderness along distal femur laterally, at popliteal fossa, and over patella. Nontender at medial or lateral joint line or over tibial plateau.
Range of motion: Active range of motion 20-60 degrees.
Special tests: Equivocal Anterior and Posterior Drawer, Negative Lachman test, Negative Varus and Valgus stress, and Negative McMurray test
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.