Patient Profile: L knee pain, 10 y/o, Female

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Patient Profile: L knee pain, 10 y/o, Female by Mind Map: Patient Profile: L knee pain, 10 y/o, Female

1. History

1.1. Mechanism of Injury

1.2. Date of Onset

1.3. Type of onset

1.4. Family history

1.5. Sports/Recreational Activities

2. Subjective Findings

2.1. Function and ADLs

2.2. Pain

2.2.1. Medial

2.2.2. Lateral

2.2.3. Joint

2.2.4. Tibia

2.3. Recreation activities affected

3. Objective Findings

3.1. ROM: expected to be hypermobile

3.2. Strength: hip flexion, knee extension and flexion, hip abduction, DF,and PF

3.3. Gait Assessment

3.3.1. Limp with medial knee pain

3.4. Posture: knee valgus or varus

3.5. Palpation

3.5.1. Tibial tuberosity

3.5.2. Patella Patella tracking, tilt, laxity

4. Common Pediatric Knee Dx

4.1. Genu Varum (bow leg)

4.1.1. Spontaneous resolution in 95%w/ walking

4.1.2. Presentation: toeing in, bow leg

4.2. Tibial Torsion

4.2.1. Presentation: toeing in, IR of tibia

4.2.2. Normal rotation is 20 deg of ER

4.2.3. Treatment: resolves with growth, shoes and stretching not helpful, boots and bars are a common treatment but not good evidence in support

4.3. Blount' Disease

4.3.1. Growth of upper medial tibial epiphysis from abnormal pressure, presentation: varus

4.3.2. More common in African Americans and females

4.3.3. Treatment: bracing if needed, ostetomy last resort

4.3.4. Presentation: varus

4.4. Genu Valgum (knock knees)

4.4.1. Present 3-5 y/o, resolves by 7-8

4.4.2. Differential dx: asymmetric growth, metabolic disorders, skeletal dysplasia, congenitall abnormalities, neuromuscular disorders

4.4.3. Check patella alignment: patellar dislocation Symptoms: rapid, acute swelling, pain and discoloration along site of injury Exam: Q angle Treatment: bracing

4.5. Osgood Schlatter Disease

4.5.1. Presentation: knee pain, pain w/ running and jumping, girls and boys about 8-14 y/o

4.5.2. Exam: tender over tibial tuberosity, tight RF Palpation of tibial tuberosity Thomas Test

4.5.3. Intervention: relative rest and activity modification, stretching of lower limbs

5. Clear the Hip

5.1. Developmental Hip Dysplasia DDH

5.1.1. History: first birth, female, breech position, left side

5.1.2. Exam: flat butt, dec abduction

5.2. Legg-Calves-Perthes Disease

5.2.1. Presentation: 4-10 y/o, M>F, limp and/or hip pain, intitially will refer to knee

5.2.2. Exam: dec hip IR, hip deformity

5.2.3. Treatment Good prognosis: age less than 6 y/o at onset of sx, less than 50% head involvement, no stiffness or shortening on exam Bad prognosis: age more 7 y/o at onset of sx, more than 50%, significant shortness and stiffness

5.2.4. Intervention Approaches Containment of necrosis or fragmentation. Contain the femoral head deep in acetabulum until healing occurs-- bracing in abduction Correction osteotomy

5.3. Slipped Capital Femoral Epiphysis

5.3.1. Presentation: limp and pain in hip or groin, medial knee, or thigh, M>F, 10-15 y/o, family history, obese children

5.3.2. Treatment: insertion of a single cannulated screw percutaneously under x-ray control Post-op recovery is rapid, crutches foe 6 weeks

6. Ligament Injuries

6.1. ACL

6.1.1. Mechanism of injury: rapid pivot, accelerating or decelerating suddenly, awkward landing, direct collision

6.1.2. Sports: basketball, soccer, football, and skiing

6.1.3. Presentation: pop is felt or heard, buckles, pain with swelling w/in hours, loss of full ROM, tenderness at joint line, and continued instability

6.1.4. Exam: Lachman test and pivot-shift test

6.1.5. Treatment Conservative: HS strengthening, bracing for comfort Surgical: especially for athletes, can be delayed in adolescents Rehab begins quickly 1-2 days post-op, hinge knee brace for 4-6 weeks, full WB, and no open chain quad exercises

6.2. PCL

6.2.1. Mechanism of injury: direct blow to front of knee, twisting or hyperextension injury, misstep like in a hole

6.2.2. Presentation: pain wit swelling rapidly and quickly, stiff and limp, difficulty walking, "give out"

6.2.3. Exam: knee will sag into extension, posterior drawer test, and reverse pivot shift

6.2.4. Treatment: RICE, immobilization until swelling and pain are under control, PT- ROM and quad strengthening

6.3. Meniscus

6.3.1. Mechanism of injury: young- trauma or athletic event, over 40 y/o- degeneration of tissue

6.3.2. Presentation: knee pain when going down stairs or getting up from chair, stiffness and swelling, loss of ROM, locking or clicking, and knee locking

6.3.3. Exam: palpated tenderness on joint line, McMurray test, pain with squatting

6.3.4. Treatment Conservative: small tears, RICE, crutches acute pain Surgical: young pts are better candidates, partial- recovery within 2-3 weeks, and repair- NWB 2 wks, no squatting for 3 mo

6.4. MCL

6.4.1. Mechanism of injury: valgus overload, direct blow, and commonly associated with ACL

6.4.2. Presentation: pain and tenderness on the medial side of knee, feel "pop", swelling, and feeling of instability

6.4.3. Exam: instability with valgus stress at 30 deg

6.4.4. Treatment: RICE, Immobilization short-term, bracing for athletes, and PT- strengthening w/in allowed ROM


7.1. Palpation: joint line, tibial tuberosity, patella, surrounding musculature

7.2. ROM: flexion, extension, valgus stress flexibility of HS and RF

7.3. Strength: clearing exam

7.4. Special Test

7.5. Alignment