Module 33, General Medical Level

An 11 year old boy presented with a one year history of right knee pain. He stated that his knee recently "gave way" when running down the stairs at school. He described his discomfort as a deep achy pain on the medial aspect of his knee. There was no history of trauma, nor had the pain limited his activities until recently. The boy denied numbness, paresthesias or weakness in his right leg. He had no fevers, chills, and any recent illnesses. Examination revealed an obese adolescent male in no acute distress. Height is 149cm(50%) Weight is 59 Kg (>95%). The right knee appeared atraumatic without any areas of point tenderness. There was diffuse pain in the knee with passive ROM. No effusion was present in the knee.

Question 33A

A careful examination of the ligamentous stability of the knee should next be performed.

Question 33B

An x-ray of the knee was obtained and read as being normal. The child should than be started on oral anti-inflammatory medication.

Question 33C

After all the x-rays were returned as normal, the child should be send for CBC, ESR, Rheumatoid factor level, Lyme titer.

Question 33D

The mother is concerned about x-ray exposure and does not want the child to have x-rays. You agree to observe the child and see if his symptoms will resolve.

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Question 33E

At this age with the above trauma a torn meniscus is the most likely problem, especially more likely than a torn ligament in the knee.

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