Case history
Case history #1
A healthy 15-year-old boy presents with a 6-month history of right knee pain. He denies a specific traumatic injury. The pain is worse after playing football or soccer, or other rigorous sporting activity. His pain is exacerbated by running on uneven ground or by hill- and repetitive stair-climbing. He reports recurrent right knee effusions, but denies catching or locking. Occasionally his knee feels as if it "gives way," but he has had no frank episodes of instability. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) improve his pain. The pain is now interfering with his ability to participate in sporting activity.
Case history #2
A healthy 17-year-old girl presents with 8 months of right ankle pain. She sustained an inversion injury to her right ankle while playing volleyball about 1 year ago. She was initially treated with an air cast splint for a presumed ankle sprain. Her initial pain resolved with treatment. She now reports recurrent ankle pain and swelling with increased activity over the course of the past 8 months. Her pain is worse after running and playing volleyball or soccer. She reports intermittent catching in her ankle and recurrent effusions. Her pain is improved with NSAIDs.
Other presentations
Presentations may also include elbow pain and loss of motion in an adolescent who is involved in sports that require frequent use of the elbow joint. The pain is often worse on the lateral aspect of the elbow and is exacerbated by throwing or heavy lifting, and when performing push-ups. On examination loss of full elbow extension is present. Occasional swelling and catching in the elbow joint may also be noted by the patient.
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