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Query: UMLS:C0231749 (knee pain)
 2,815 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Knee problems are frequently seen in young athletes. It is important for the examining physician to be mindful of the complex differential diagnosis of knee pain in the adolescent, and not presume a traumatic origin of this pain. A case of osteoid osteoma of the distal medial condylar epiphysis of the femur in a 15-year-old athletic male, who presented with limitation of extension of the knee and medial joint pain and swelling, which could easily be misinterpreted as internal derangement, is discussed as an example of this problem.
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PMID:Osteoid osteoma as a cause of knee pain in the young athlete: a case study. 68 30

Between 1970 and 1979, 17 patients underwent conversion of ankylosed hip to total hip arthroplasty. The patients' ages ranged from 38 to 82 years and the duration of fusion prior to conversion ranged from five to 60 years. The primary indication for conversion to total hip replacement in all patients was disabling pain in the low back, the ipsilateral knee, and the contralateral hip. The reason for ankylosis varied: five patients had previously undergone fusion for posttraumatic arthritis, two patients for tuberculous arthritis, six patients for osteoarthritis, one for a previous old slipped capital femoral epiphysis which had undergone spontaneous fusion after internal fixation, and two patients for ankylosing spondylitis. Relief of preoperative pain in the lower back was seen in 12 of 13 patients, knee pain was relieved in four out of four patients, and contralateral hip pain was relieved in seven out of 10 patients. Complications included heterotopic ossification, infection, perforation of the posterior shaft of the femur, and failure of trochanteric fixation with subsequent dislocation. Predictable pain relief from pain in the contralateral hip was less predictable and directly related to the degree of osteoarthritis in the contralateral hip. In these patients it is suggested that conversion of the fused hip to total hip arthroplasty be staged with total hip replacement in the contralateral hip as well. The end results were least satisfactory in patients with ankylosing spondylitis.
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PMID:Conversion of ankylosed hips to total hip arthroplasty. 645 15

Slipped capital femoral epiphysis (SCFE) is a fairly common condition affecting older children and adolescents, and has the potential for long-term, crippling sequelae. Early recognition is the single most important controllable factor, but the diagnosis is often missed or delayed, resulting in progression of the slip. A SCFE should be suspected and promptly evaluated in any older child or adolescent presenting with a limp or complaints of hip, groin, thigh, or knee pain, especially if the patient is overweight. The diagnosis is usually made by anteroposterior and frog-leg lateral radiographs of the hips. Common errors at initial presentation include: not obtaining hip radiographs (due to either no hip pain or the lack of an impressive history and physical findings); misreading hip radiographs (the findings can be subtle); and lack of timely referral. Early involvement of and treatment by an orthopedic surgeon can greatly reduce the potential complications. We present three cases of SCFE that highlight common errors made at initial presentation, and a discussion that includes the differential diagnosis of an older child or adolescent with a painful limp.
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PMID:Missed slipped capital femoral epiphysis: illustrative cases and a review. 777 88

Slipped capital femoral epiphysis (SCFE) is an uncommon skeletal disorder of adolescence often overlooked because of its nonspecific clinical presentation. Anteroposterior radiography may fail to demonstrate a minimal slip even when clinical examination raises suspicion of the disease. On the other hand, prompt diagnosis is essential to obtain better therapeutic results. In our patient population joint effusion, which often accompanies SCFE, was readily recognized and quantified by ultrasonography (US). US also permitted recognition of the initial SCFE and assessment of the degree of slip by measuring the height of the physeal step. As to metaphyseal remodeling, plain radiography seems to be more informative than US; however, US has a role in the follow-up of SCFE because of the risk of slippage in the contralateral hip. This work suggests that US is useful as a primary imaging tool in the evaluation of subjects with limp or hip or knee pain to rule out SCFE.
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PMID:Slipped capital femoral epiphysis: ultrasonographic findings. 848 Feb 7

Six children have been operated on due to benign chondroblastoma at the mean age at first operation of 14.2 years (range 11-17 years). Mean follow-up was 4 years (2-7 years). Mean delay of the diagnosis was 12 months (6-24 months). One-stage surgery was successful in child with proximal fibula involvement, child with distal femoral epiphysis involvement (knee arthrodesis followed), two children with proximal tibia involvement. In 1 case of distal femoral epiphyseal involvement two revisions were necessary, 1 similar case is in the course of treatment. At the follow-up three children presented with the knee pain and restricted range of motion.
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PMID:[Treatment of benign chondroblastoma]. 985 58

A 42-year-old man with Erdheim-Chester disease (EC) is presented. This is the first case of this disease reported in Korea. The patient complained of knee pain and plain roentgenogram of the bilateral legs revealed diffusely increased density, coarsened trabecular pattern, and cortical thickening in the diaphysis, and metaphysis as well as epiphysis. Magnetic resonance imaging revealed that the lesions showed low signal intensity on T1-weighted images and heterogeneously low and high signal intensity on T2-weighted images. Histological examination of the biopsy specimen showed a xanthogranulomatous lesion consisting aggregations of foamy histiocytes and Touton-type giant cells. Immunohistochemical staining showed positive reaction to anti-S-100 and lysozyme in the cytoplasm of the giant cells.
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PMID:Erdheim-Chester disease: a case report. 1040 77

A retrospective review was performed of 106 patients to determine the effect of knee pain as the initial complaint of slipped capital femoral epiphysis (SCFE). Sixteen (15%) patients had a primary complaint of distal thigh or knee pain or both at initial presentation to our institution or to a referring physician. Ninety (85%) patients described primarily hip, groin, or proximal thigh discomfort. Of the 106 patients with SCFE, 65 patients received no operative treatment before being evaluated at our institution and were the subject of the remainder of the study. Of these, 15 (23%) patients had distal thigh or knee pain or both as their chief complaint (group I), and 50 (77%) patients had hip, groin, or proximal thigh pain (group II). There was no difference between the groups with respect to age, gender, or slip stability. Group I patients were more likely to receive a misdiagnosis (p < 0.05) and undergo unnecessary or uninformative radiographs (p < 0.05). Additionally, patients in group I were found to have slips of greater radiographic severity (p < 0.05). Although not statistically significant, there was a trend for group I patients to experience a longer delay to diagnosis and to require a proximal femoral osteotomy as treatment for their slips. We conclude that isolated distal thigh or knee pain or both is a common presentation of SCFE. Furthermore, this symptom complex, when compared with the more classic presentation of SCFE, leads to higher rates of unnecessary radiographs, misdiagnoses, and severe slips, potentially increasing long-term morbidity.
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PMID:Knee pain as the initial symptom of slipped capital femoral epiphysis: an analysis of initial presentation and treatment. 1041 93

The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations.
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PMID:Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome. 1041 45

Three young people, a boy aged 15 years and two girls aged 9 years and 13 years, had already suffered groin pain and knee pain for many months. They exhibited an antalgic walk, diminished function of the hip and radiographic signs of a slipped capital femoral epiphysis (SCFE). The complaints disappeared following in situ fixation with one or more screws. Epiphysiolysis of the caput femoris through the growth plate is a disorder of the growing hip. It is the most prevalent hip disease in adolescents. Obese boys are the most commonly affected. The aetiology is not known. The later SCFE is diagnosed and treated, the greater the chance of premature coxarthrosis. Avascular necrosis and chondrolysis are complications that can arise as a result of the operation.
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PMID:[Pain and gait problems in 3 (almost) adolescents with a dislocated hip]. 1145 Jun

Treatment of slipped upper femoral epiphysis (SUFE) is directed at preventing progressive slippage, minimizing deformity and avoiding avascular necrosis and chondrolysis. Delay in treatment adversely affects long-term outcomes. In a retrospective study we assessed delays between symptom onset and evaluation of the patient in an orthopaedic department. 27 patients aged 10-16 years were grouped by source of referral (general practitioner or accident and emergency department), and hips were classified as stable or unstable according to ability to bear weight. The 27 children had 37 affected hips, 31 stable and 6 unstable. In the 20 patients referred by general practitioners, mean delay from symptom onset to orthopaedic evaluation was 119 days (range 2-504); in the 7 referred from accident and emergency departments it was 95 days (1-482). In the latter group the slips were more likely to be acute and unstable. 9 (45%) of the patients in the general-practitioner group had hip radiography before referral, all correctly diagnosed though not all the examinations included the recommended frog-lateral views. Long delays between onset and diagnosis of SUFE are most likely in patients with mild symptoms, able to bear weight on the hip. Any adolescent with undiagnosed hip or knee pain that has lasted more than a week should undergo radiological investigation of the hip, with frog-lateral as well as anteroposterior views.
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PMID:Delay in diagnosis of slipped upper femoral epiphysis. 1220 20


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