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Uncovering The Spark: A Case Of Knee Pain In A Young Athlete - Page #1
 

Author: Karen Vaz, MD, MS
Senior Editor: Drew Duerson, MD
Editor: Jason Blackham, MD

Patient Presentation:
A healthy 10-year-old male presented to a sports medicine clinic with a one-month history of left knee pain. He was referred from an outside hospital for further evaluation of abnormal knee radiographs.

History:
One month prior to presentation, the patient awoke with left knee pain after being unusually active the previous day. He denied any specific trauma or injury. The pain was localized to the medial aspect of the knee and progressively worsened over time.

Walking, running, squatting, climbing stairs, and ambulating on uneven surfaces exacerbated his symptoms. He participated in basketball, baseball, and jiu-jitsu but had recently decreased his participation because of pain. His symptoms improved with rest and shortly after cessation of activity.

He denied swelling, instability, catching, locking, or paresthesias. He also denied any recent systemic illness. Nonsteroidal anti-inflammatory drugs improved his pain.

Physical Exam:
Vital signs were as follows: temperature 36.1 degrees Celsius, heart rate 75 beats/minute, respiratory rate 16 breaths/minute, blood pressure 107/79 mmHg, and body mass index 23.2 kg/m².

The patient was alert, oriented, and well appearing. Skin was well perfused without rashes or lesions.

Examination of both hips was unremarkable.

Examination of both knees demonstrated no effusion or erythema. The patient had full knee flexion and 5 degrees of painless hyperextension bilaterally. Tenderness to palpation was present only over the left medial femoral condyle. Strength was full throughout the bilateral lower extremities.

Lachman, McMurray, valgus stress, varus stress, and patellar apprehension tests were negative. Single-leg squat on the left reproduced pain and demonstrated dynamic valgus.

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, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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