The Kneediest Puzzle: Chronic Joint Pain With A Surprising Angle In A Young Girl

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The Kneediest Puzzle: Chronic Joint Pain With A Surprising Angle In A Young Girl - Page #1

Author: Maria Bianchi, MD Co Author #1: Andrew Peterson, MD, MSPH Senior Editor: Justin Mark Young, MD, FAMSSM Editor: Alan Shahtaji, DO Patient Presentation: 11 year old female with bilateral knee pain that began a few years ago and has gradually worsened. Parents say patient has always had problems with her knees and they have always knocked together. History: Pain was achy and located to bilateral anterior knees with associated pain in her proximal lower legs and distal thighs. She previously played basketball and soccer but stopped due to pain with running. She endorsed pain in the morning that lasted 30-60 minutes before self-resolving. No pain at night that woke her from sleep nor at rest. Had tried over-the-counter pain medications without relief. Compression sleeve did not help. Had done physical therapy for 2 months without improvement. No swelling, bruising, warmth, redness, nor pain elsewhere. Per parents, autoimmune joint pain workup with PCP was negative with normal inflammatory markers. Parents reported that she had left knee MRI and bilateral knee x-ray done. She took a multivitamin daily and was premenarchal. Physical Exam: BP 128/80 HR 57 BMI 25.70 kg/m2 Bilateral Knees: Inspection: Prominent bilateral genu valgum. No erythema, ecchymosis, swelling, and/or atrophy. Palpation: Bilateral medial joint line tenderness. Lateral joint line tenderness on right. IT band tenderness bilaterally. No tenderness along the patellar nor quadriceps tendon, no medial/ lateral patella tenderness. No posterior hamstring insertional tenderness. No popliteal fossa fullness. Range of Motion: Normal. Strength: Normal. Neuro: Normal. Gait: No difficulty with walking. Bilateral femoral anteversion. Medial sides of knees rub against each other with walking and running. Has difficulty and pain with running, swings arms wide laterally to assist with balance. Special testing: negative. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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