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Knee Pain

Contents
  1. Read book excerpt
  2. Restless Legs Syndrome: Introduction
  3. Restless Legs Syndrome Misdiagnosis
  4. Restless Legs Syndrome Causes
  5. Restless Legs Syndrome Complications
  6. Restless Legs Syndrome Treatments
  7. Clinical trials
  8. Diagnosis of Restless Legs Syndrome
  9. Restless Legs Syndrome Overview
  10. More book excerpts for Restless Legs Syndrome

Knee Pain: Excerpt from In A Page: Pediatric Signs and Symptoms

Knee pain is a common complaint that is readily evaluated by focusing on the anatomic structures. A focused history and exam will often give the diagnosis. Because hip pain can radiate to the knee, a thorough lower extremity exam should always be performed.

Differential Diagnosis

  • Septic arthritis
    –Characterized by redness, swelling or effusion, warmth, pain with active and passive ROM, fever or chills
    –Requires urgent evaluation and diagnosis
  • Osgood-Schlatter disease (OSD)
    –Repetitive microtrauma to the bone-tendon junction where patellar tendon inserts into the secondary ossification center of the tibial tubercle
    –Onset at early adolescence, more often in athletes
  • Sinding-Larsen-Johansson disease
    –Similar to OSD, except localized to distal pole of the patella
  • Meniscal pathology
    –Meniscal tears are usually associated with acute trauma, and involve pain and swelling with mechanical symptoms such as popping, clicking, or locking
    –Discoid meniscus: Mechanical symptoms and plain X-rays show squaring, widening, and cupping
  • Ligamentous injury
    –Medial collateral ligament sprain via overuse injury or valgus force to knee
    –Anterior cruciate ligament tear associated with sport noncontact pivoting injury, associated with a “pop” and immediate swelling
    –Posterior cruciate tear associated with direct trauma to anterior tibia or hyperflexion with plantar flexed foot
    –Lateral collateral ligament injury is rare
    • Osteochondritis dissecans
      –Trauma resulting in separation of subchondral bone and cartilage at lateral aspect of medial femoral condyle
    • Patellar subluxation/dislocation
      –Lateral displacement of patella associated with increased Q angle, genu valgum, and femoral anteversion (more common in women)
    • Bursitis
      –Chronic friction over pes anserine, iliotibial band, or capsular bursa leads to inflammation and thickening of the bursa
  • Bipartite patella
    –Common variant of patellar ossification

Workup and Diagnosis

    • History
      –Specific location, duration, onset, aggravating or alleviating factors, and pain characteristics
      –Previous trauma, preceding illness, or associated symptoms
      –Past medical history and family history including bone, hematologic, or metabolic disorders
    • Physical exam
      –Bilateral hip, knee, and ankle exam
      –Redness, warmth, effusion, active and passive ROM
      –Palpate joint line, patella, tibial tubercle, pes anserine, and medial/lateral ligaments
      –Patella tracking or apprehension, varus/valgus stress, Lachman, and anterior posterior drawer tests
      –Crepitus along the flexion arc and McMurray test
    • Labs
      –Often not needed unless concerned about infection
      –CBC with differential, platelets, PT/INR, ESR, CRP
      –Knee aspirate for cell count and differential with Gram stain, culture, and crystals
    • Radiography
      –Plain X-ray: Screening knee films include AP, lateral, Merchant views
      –AP pelvis and frog-leg lateral of the pelvis or femur films if indicated by exam findings
  • MRI to show soft tissues such as meniscus and ligaments
    –May demonstate joint effusion in synovitis/infection, marrow edema in osteomyelitis, ligament rupture

Treatment

  • Septic arthritis requires immediate surgical intervention and, unlike hip sepsis, the knee may be easily ruled out by aspiration in either emergency room or clinic
  • Generally rest, ice, NSAID therapy, and short course of physical therapy to improve strength is the treatment of choice for many of the more common ailments, including bipartite patella, bursitis, patella subluxation, small osteochondritis dissecans lesions, ligament sprain, Osgood-Schlatter and Sinding-Larsen-Johanssen disorders
  • Knee immobilization is warranted in acute injuries and non-weight bearing when fracture or ligament injury is suspected, to allow time for diagnostic evaluation to be performed while keeping the patient comfortable and protected from further injury
  • Knee arthroscopy is minimally invasive and helpful with diagnosis or treatment in case of ligament repair, Osteochondritis dissecans repair and realignment procedures

Book Source Details

  • Book Title: In A Page: Pediatric Signs and Symptoms
  • Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
  • Year of Publication: 2007
  • Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Restless Legs Syndrome

More Medical Textbooks Online about Restless Legs Syndrome

Review other book chapters online related to Restless Legs Syndrome:

Medical Books Excerpts
  • BACK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • BREAST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • CHEST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • EYE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • FACE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • FLANK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • HEEL PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • HIP PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • JAW PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • JOINT PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • Back Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Chest Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Hip Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Knee Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Toeing Out
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Toeing In
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • MYOCLONUS
  • "Differential Diagnosis in Primary Care" (2007)
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  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
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  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • Myoclonus
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Arm pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Back pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Chest pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Eye pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Flank pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Rectal pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Seizures
  • "A Pocket Manual of Differential Diagnosis" (1999)
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  • Back Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Chest Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Myoclonus
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Arm pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Back pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Chest pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Facial pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Flank pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Seizures
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Chest Pain, Atypical
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Low Back Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Abdominal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Calf Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Chronic Pelvic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Hip Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Knee Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Neck Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Pleuritic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Shoulder Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Scrotal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Seizures
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Eye Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Hip Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Myoclonus
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Abdominal pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Back pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Chest pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Eye pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Flank pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Jaw pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Neck pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Myoclonus
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Arm pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Back pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Breast pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Chest pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Eye pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Facial pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Flank pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Jaw pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Neck pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Rectal pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Seizures
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Abdominal Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Back Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Chest Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Myoclonus
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Arm pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Back pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Chest pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Flank pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Jaw pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Neck pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
 

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9

 » Next page: Toeing Out (In A Page: Pediatric Signs and Symptoms)

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