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A 13 Year-old Male With Recurrent Right Knee Effusions - Page #1
 

Author: Ryan Sprouse, MD
Editor: Christian Fulmer, DO

Patient Presentation:
A 13 year-old male with recurrent right knee swelling over the past three years.

History:
A 13 year-old male was referred to our clinic for an evaluation of right knee swelling of two weeks duration. He has a history of a right knee injury three years ago - he cannot recall exact mechanism but believes he twisted his knee while motorbiking. Since that time, he has had four episodes of severe right knee swelling. With each episode, the right knee swelling is minimally painful, comes on gradually, is not associated with redness, and gradually resolves over the course of a few weeks. It is unclear if the initial injury was associated with swelling. When the swelling is not present, the patient has minimal pain and no mechanical symptoms. He has no significant past medical history. There is no family history of pediatric cancers, rheumatoid disease, or autoimmune disease. He denied fever, weight loss, and night sweats, other joint pain (or swelling?), myalgias, skin rashes, and neurologic complaints. He lives in eastern West Virginia with his family.

Physical Exam:
Vitals: blood pressure 96/62, heart rate 81, temperature 97.4, respiratory rate 12, weight 85 pounds.
General: Well nourished, no acute distress. Cardiovascular: Peripheral pulses normal, no cyanosis or edema.
Respiratory: Non-labored breathing.
Musculoskeletal: Antalgic gait. Right knee with obvious large effusion. Limited range of motion secondary to effusion. Normal knee flexion and extension strength. Minimal diffuse tenderness to palpation of the knee. Ligaments are intact to varus, valgus, anterior and posterior drawer, Lachman's stress testing. McMurray's test is negative. Thessaly test is negative.
Neurologic: Cranial nerves are grossly intact. Normal strength and sensation across all extremities.
Skin: No knee erythema or ecchymosis. No skin rashes.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.


NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.
 

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