Module 33, General Orthopaedist 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. An xray of the knee was obtained and found to be normal.

Question 33A

The next study in the work up should be to order an MRI scan to rule out a torn meniscus.

Question 33B

An arthroscopy of the knee is performed and inflammation of the anterior fat pad is noted as the only pathology. This anterior fat pad inflammation is common in obese young adolescent boys.

Question 33C

The boy is send to physical therapy for quadriceps and hamstring stretching and general conditioning. The physical therapist noted limited internal rotation at the hip and requests your OK for working on hip stretching exercises. You encourage her to start.

Question 33D

The mother calls to tell you that after taking ibuprofen the boy is continuing to complain of knee pain with activity and that she notices that he is walking with his feet point more out. You suggest that he needs to return immediately to your office or to an emergency room to obtain x-rays.

Question 33E

Two weeks after the child had the arthroscopy which demonstrated the inflamed fat pad he returns to the office for a post operative visit. The mother says that be was feeling much better while he was off of it but over the last week he has again increased his activity and is again complaining of medial knee pain when he walks. You reassure the mother that this is a common recovery from this type of treatment.

Go to Next Question Module, Go to Pediatric Orthopaedist Level Modules, Go to Question Module Home Page, Go to Case Presentation Home Page, Orthopaedic Department Home Page.