Module 35, General Orthopaedist Level

A 2 year and 6 month old white male presented to clinic with a 2-3 month history of limping on the right lower extremity. There was no history of trauma to the extremity, or a history of constitutional symptoms such as fever, chills, sweats, malaise or weight loss. Prenatal, perinatal and postnatal course were all normal. Examination of the right lower extremity was significant for a distinct absence of ankle dorsiflexion and eversion activity to motor testing. Plantar flexion strength was graded as 5/5. Sensation was intact on the entire plantar aspect of the foot, with patchy sensation on the dorsum of the foot, including the first web space.

Question 35A

This history and physical examination is most consistent with a herniated L5-S1 disc.

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Question 35B

After completion of the physical examination the next test to obtain is an MRI scan.

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Question 35C

The gait of this child would include toe dragging from his foot drop.

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Question 35D

On physical examination a mass is found at the lateral knee joint. This is most likely a synovial sarcoma

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Question 35E

Based on an otherwise completely normal physical examination this peroneal nerve palsy may be of congenital origin and needs no further work up.

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