Author: Christopher Penton, MD
Senior Editor: Carolyn Landsberg, MD
Editor: Jennifer Gaitley, MD

Patient Presentation:
A 13 year old female presented to urgent care for initial evaluation of insidious onset of left leg pain over the course of several weeks.

History:
She began playing indoor volleyball for her middle school one month previous. She also plays softball year round. She complains of gradually increasing inferomedial knee pain without radiation. She is able to bear weight but pain is exacerbated when doing so. She experienced acute worsening of this knee pain after awkwardly falling when diving for a ball on the volleyball court. She has been using crutches at school but admits that she has been bearing weight on the leg at home with worsening pain. The pain is moderate at the end of the school day, but generally she has only mild pain. She denies any swelling, bruising or instability. She states she would like to return to play as soon as possible. No pertinent medical, surgical family or social history.

Physical Exam:
Left knee:
Inspection: No effusion, muscle wasting or asymmetry when compared to the right
Palpation: Tenderness to palpation over the proximal third of the medial lower leg. Non-tender patellar tendon, lateral joint line, pes anserine bursa.
Active ROM: Full flexion and extension
Strength: 5/5 lumbosacral myotomes
Reflexes: Patellar reflex 2+ bilaterally
Neurovascular: Normal sensation in all lower extremity dermatomes, femoral and dorsalis pedis pulses regular and equal bilaterally
Special tests: Clark's negative. McMurray negative. Thessaly negative. Lachman negative. Posterior Drawer negative. Varus and valgus stress negative.

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