Limping & Knee problems

Question 1

Knee problems: children and young adults

Answer 1

Chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy

Osgood-Schlatter disease
(tibial apophysitis)
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle

Osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking

Patellar subluxation
Medial knee pain due to lateral subluxation of the patella
Knee may give way

Patellar tendonitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

Question 2

Limping child

Answer 2

Transient synovitis
Acute onset
Usually accompanies viral infections, but the child is well or has a mild fever
More common in boys, aged 2-12 years

Septic arthritis/osteomyelitis
Unwell child, high fever

Juvenile idiopathic arthritis
Limp may be painless

Trauma
History is usually diagnostic

Development dysplasia of the hip
Usually detected in neonates
6 times more common in girls

Perthes disease
More common at 4-8 years
Due to avascular necrosis of the femoral head

Slipped upper femoral epiphysis
10-15 years - Displacement of the femoral head epiphysis postero-inferiorly