Knee Pain in Children, Part III: Stress Injuries, Benign Bone Tumors, Growing Pains.

Abstract

1. Michael Wolf, MD* 1. *Pediatrics and Orthopedic Surgery, St Christopher’s Hospital for Children, Philadelphia, PA. Clinicians who evaluate knee pain must be able to recognize stress injuries, benign bone tumors, or growing pains and pursue the appropriate management. After completing this article, the reader should be able to: 1. Describe the presentation and treatment of stress injuries that may cause knee pain in children. 2. Delineate the presentation and treatment of benign bone tumors that may cause knee pain in children. 3. Describe the presentation of growing pains in children. According to the treatment algorithm cited in the first part of this three-part article on knee pain in children, the initial concerns that the clinician must address are limb- and life-threatening conditions, hip pathology, and effusion-related conditions. After eliminating these potential causes, clinicians can turn to their attention to stress injuries and benign bone tumors (Table). If none of these diagnoses is captured in the patient review, a final possibility is growing pains. View this table: Table. Specific Causes of Knee Pain in Children ### Anterior Knee Pain #### Patellofemoral Syndrome. Patellofemoral syndrome involves dysfunction of the patellofemoral joint that presents as anterior knee pain. With this syndrome, altered forces and tracking mechanics at the patellofemoral joint place excessive stress on the joint. Physical examination findings include patellar facet tenderness and a painful patellar grind test. Rarely, patellofemoral syndrome can present with a small effusion. The key to treatment is identification of the inappropriate biomechanical forces that are causing stress in the joint. In young patients, such abnormal forces are related to tight hamstrings or quadriceps, weak hip external rotators (gluteus medius and gluteus minimus), or a tight lateral retinaculum of the patella. These conditions can be addressed with home exercises or physical therapy. In addition, open patellar bracing can be …