The Vanishing Limp: When You

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The Vanishing Limp: When You - Page #1

Author: Arvind Balaji, MD Co Author #1: Matthew F. Grady, MD Senior Editor: Jessalynn Adam, MD Editor: Rahul Kapur, MD Patient Presentation: A nine-year-old male soccer player with recent history of knee pain and limp presents to sports medicine clinic for clearance to return to sport. History: A nine-year-old male soccer player presents to sports medicine clinic with one week of left knee pain and an associated limp. He denies any trauma or injury. Pain was insidious in onset, worsened over two to three days, and caused the patient to limp. He continued to play soccer despite the pain and limping. He was ultimately taken to a local urgent care by parents five days after symptom onset, and X-rays of both knees were obtained. X-rays were negative for fracture, but abnormalities of the left femoral condyle were identified by the radiologist. The family was encouraged to follow up with sports medicine clinic prior to return to sport. At the time of evaluation, parents reported no history of knee swelling and his limp had resolved. Parents reported no systemic symptoms of fever, night sweats, or weight loss. Physical Exam: Vitals: Normal for age General: well-appearing male, appears his stated age Hip: ROM symmetric, full, and painless bilaterally Left knee: ROM of knees is full bilaterally and slightly painful laterally at end-range of knee flexion on left side. No overlying ecchymosis, redness, or soft tissue swelling. No tenderness to palpation of medial or lateral joint line or patella facets. There is no pain over tibial tuberosity or inferior pole of the patella. No localized warmth to touch. He is able to walk without antalgic gait. He performs single-leg hop without pain on both legs. There is no effusion and ligament testing including Lachman, McMurrays, Posterior Drawer, valgus, and varus stress are normal. Negative Wilsons test. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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