Complaints Of Knee Pain Research Articles

How Accurate Are Patients at Diagnosing the Cause of Their Knee Pain With the Help of a Web-based Symptom Checker?

Background:Researching medical information is the third most popular activity online, and there are a variety of web-based symptom checker programs available.Purpose:This study evaluated a patient’s ability to self-diagnose their knee pain from a list of possible diagnoses supplied by an accurate symptom checker.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:All patients older than 18 years who presented to the office of 7 different fellowship-trained sports medicine surgeons over an 8-month period with a complaint of knee pain were asked to participate. A web-based symptom checker for knee pain was used; the program has a reported accuracy of 89%. The symptom checker generates a list of potential diagnoses after patients enter symptoms and links each diagnosis to informative content. After exploring the informative content, patients selected all diagnoses they felt could explain their symptoms. Each patient was later examined by a physician who was blinded to the differential generated by the program as well as the patient-selected diagnoses. A blinded third party compared the diagnoses generated by the program with those selected by the patient as well as the diagnoses determined by the physician. The level of matching between the patient-selected diagnoses and the physician’s diagnoses determined the patient’s ability to correctly diagnose their knee pain.Results:There were 163 male and 165 female patients, with a mean age of 48 years (range, 18-76 years). The program generated a mean 6.6 diagnoses (range, 2-15) per patient. Each patient had a mean 1.7 physician diagnoses (range, 1-4). Patients selected a mean 2 diagnoses (range, 1-9). The patient-selected diagnosis matched the physician’s diagnosis 58% of the time.Conclusion:With the aid of an accurate symptom checker, patients were able to correctly identify the cause of their knee pain 58% of the time.

Effects of intra-articular application of pulsed radiofrequency on pain, functioning and quality of life in patients with advanced knee osteoarthritis.

The number of studies and evidences is inadequate especially with regard to the efficacy of pulsed radiofrequency (PRF) application in non-spinal indications. The purpose of this study was to investigate the effect of PRF on pain, functioning and quality of life in patients with advanced knee OA. The study included 21 patients with complaints of knee pain. Intra-articular PRF was applied for 10 minutes at 42◦C. Pain severity was assessed using the 10 cm standard visual analogue scale (VAS). Outcome measures also included a 20-meter walk test, a 6-minute walk test, WOMAC, Lequesne index, and the Short Form-36 (SF-36). All measurements were assessed before treatment and 4 and 12 weeks after the treatment. A statistically significant improvement was found in VAS scores at rest and after walking, subscores of SF36-pain and SF36-social functioning, and Lequesne score at week four (p < 0.05). This improvement was maintained for the scores of VAS-walking at week 12 (p < 0.05). It is possible to state that intra-articular PRF application is effective and safe for the pain treatment of patients with advanced knee OA. Therefore, we think that PRF application will be included in chronic pain treatment guidelines in the future with the increase in the number of future studies.

Primary Intraosseous Cavernous Hemangioma of the Proximal Tibia: A Rare Case Report

Primary intraosseous cavernous hemangioma is a rare benign skeletal tumor, which occurs at all ages, but is more common in the 4th decade of life. Bone hemangioma is a vascular hemartoma of bone structures and primary lesion accounts for less than 1% of all bone tumors with a male to female ratio of 1/1.5. We present a rare case of a 55 year old female patient, presenting with complaints of knee pain for 2 years with no significant traumatic history. Radiological investigation was done and patient then underwent tumor excision with curettage and bone cementing of the right proximal tibia. Histopathological sample was later diagnosed as cavernous hemangioma.

Burden of Rheumatic Diseases in A Rural Community of Bangladesh

Objective: To estimate the magnitude, burden of illness and help-seeking behavior of patients with musculoskeletal complaints and to provide incidence of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis, gout, and other inflammatory and non-inflammatory rheumatic diseases in a rural community of Bangladesh. Methods: The study was conducted in a few villages near Dhaka city which were considered to be a fairly representative sample of Bangladeshi rural population. Data were collected with the help of modified Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and a diagnosis using American College of Rheumatology (ACR) criteria was established. Results: During the 18 months study period, 2685 adults (15 years and above) were included. A total of 441 (M=163, F=278) developed new musculoskeletal (MSK) pain. The incidence rates were 10.9/100 person-years (PY) for the whole population, 8.2/100 PY for males and 13.6/100 PY for females. Nonspecific low back pain (NSLBP), fibromyalgia and osteoarthritis of knee were common MSK problems. A total of 302 patients had complaints of low back pain, of them 204 persons had noninflammatory low back pain; 262 respondents had complaints of knee pain, 38 had satisfied the criteria of knee OA; a total of 116 respondents suffered from fibromyalgia during the study period. Of the respondents (M=17, F=24) 41 had inflammatory arthropathy. Among the incidences of inflammatory arthritis, rheumatoid arthritis 120 (M=101, F=147), spondyloarthropathies 150 (M=252, F=49), ankylosing spondylitis 75 (M=151, F=0), reactive arthritis 50 (M=101, F=0), and psoriatic arthritis 256 (M=0, F=49) per 100,000 / PY respectively were observed, Conclusions: Rheumatic diseases are common in the rural community of Bangladesh, affecting nearly a quarter of adult population. Non-specific low back pain (NSLBP), fibromyalgia and osteoarthritis of knee joints are common joint disorders; point prevalence estimates of most common diagnoses were similar to other community surveys using COPCORD methodology.DOI: http://dx.doi.org/10.3329/jom.v15i2.20685 J MEDICINE 2014; 15 : 125-130

Esophageal Bronchopleural Fistula (EBF) Arising From Barrett’s Esophagus Without Dysplasia: A Rare but Life-Threatening Complication

Introduction: An EBF is very uncommon and it is formed secondary to instrumentation, malignancy, surgery or post-pneumectomy complication. Barrett’s esophagus refers to the replacement of normal squamous epithelium by columnar epithelia caused by chronic gastric acidic secretions. We report an unusual case of a benign EBF arising from Barrett’s esophagus without dysplasia. A 63-year-old female with PMH of HTN, CKD stage 4, COPD came in with complaints of knee pain, vomiting, fever and chills. During the work-up for septic arthritis, a mild pneumonia was noted and treated as community-acquired pneumonia. After a week of IV antibiotics, the patient continued to have a productive cough with poor oral intake and cachexia. Review of old CT chest scans showed chronic distal esophageal thickening and right lower lobe atelectasis, therefore a chronic aspiration pneumonia was suspected. A repeated CT Chest showed extensive bronchiectatic changes of the lower right lobe and an abnormal distal esophagus concerning for a spontaneous esophageal perforation. Differential diagnosis included iatrogenic perforation, malignancy, and Boerhaave’s Syndrome. Upper gastrointestinal series with gastrografin showed leakage of contrast material from esophagus that accumulated inside the thoracic cavity. The patient was kept strict nothing by mouth and a bronchoscopy was performed to evaluate for possible tracheo-esophageal fistula, but did not show any pathology. Patient continued to have increasing cough and secretions with a high suspicion of a connection between the thoracic cavity and the esophagus. An EGD was performed which showed a large subepithelial mass extending from mid-esophagus to the gastroesophageal junction with superficial ulcerations along with a large fistulous tract opening at the right posterior esophageal wall. Biopsies of the subepithelial mass revealed granulation tissue with extensive intestinal metaplasia consistent with Barrett’s esophagus without dysplasia, same as present with prior EGD. There was evidence of foreign body pigmentation within the Barrett’s esophageal tissue suggestive of pill esophagitis from oral iron. This patient may also have undiagnosed esophageal dysmotility. Patient was a poor surgical candidate and a surgical jejunostomy feeding tube was placed for better nutrition supplementation. Patient underwent an esophageal self-expandable metallic stenting and was managed conservatively. To our knowledge, this is the third reported case of acquired benign EBF associated with Barrett’s esophagus. Albeit this is rare, extensive and friable Barrett’s esophagus in the setting of esophageal dysmotility-induced stasis is a perfect setup for a pill-induced benign EBF.

Localized Nodular Tenosynovitis Originated near the Medial Plicae

The authors report a case of localized nodular tenosynovitis originating from the medial plicae of the knee that was grossly observable, palpable, and symptomatic. A 41-year-old male visited our hospital with a complaint of knee pain that began 4 years ago. He complained of intermittent catching and a mass that appeared in the medial side of the knee 18 months ago. On magnetic resonance imaging, the mass was found on the plicae area of the medial side of the knee, and thus excisional biopsy was performed under arthroscopy. Histological study showed characteristics of localized nodular tenosynovitis originating from the synovium of the knee. At the 1-year postoperative outpatient follow-up, no symptoms or signs of recurrence were found. Since the authors experienced excellent postoperative results of arthroscopically assisted resection of a grossly observable and palpable localized nodular tenosynovitis originating from the synovium of the knee plicae, we report the case with a review of the literature.

Multiple Osteochondritis Dissecans of Knee Joint in a Patient with Wilson Disease, Focusing on Magnetic Resonance Findings

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.

Can standing knee radiographs predict chondral lesions in young- and middle-aged population?

The aim of the study is to investigate the correlation between arthroscopic findings and joint space width on the standing knee radiographs at various flexion degrees in the young- and middle-aged patients with complaints of knee pain. Middle-aged patients with complaint of knee pain ongoing more than 6 months and failure in conservative treatment methods were included. Weight-bearing full extension, 30 and 45° of flexion radiographs were obtained. Joint space width was calculated on radiograms. Arthroscopy was performed to evaluate the chondral pathologies. Correlation analysis was performed. Fourty-three patients (18 female, 25 male) with a mean age of 44.6 (20-63) were included. Mean joint space width was 4.87 mm ± 1.45 (2-10) mm in medial and 5.43 mm ± 1.47 (1-9) in lateral on standing extension radiographs. In 30° flexion radiographs, mean joint space width was 4.33 mm ± 1.25 (1.5-7.5) in medial and 5.36 mm ± 1.69 (1-9) in lateral. In 45° flexion radiographs, medial joint space was 4.28 mm ± 1.59 (2-9) in medial and 5.15 mm ± 1.59 (1.5-9) in lateral. In arthroscopic evaluation, one knee had grade 1 (2.3%), three knees had grade 2 (7%), nine knees had grade 3 (20.9%), and twelve knees had grade 4 (27.9%) lesions in the medial compartment. In the lateral compartment, two knees had grade 3 (4.7%) and one knee had grade 4 lesion (2.3%). Radiological data did not correlate with the arthroscopic findings. Standing knee radiographs do not correlate with the arthroscopic findings in the middle-aged population with chondral lesions in knee joint. Case series with no comparison group, Level IV.

Study of correlation between clinical, magnetic resonance imaging, and arthroscopic findings in meniscal and anterior cruciate ligament injuries

<b>Background:</b> Approx. 28% of patients presents to orthopedic OPD with complaints of knee pain. Common medical complications include an unstable knee, chronic knee pain, and post traumatic arthritis. <b>Aim:</b> To study the correlation between clinical, magnetic resonance imaging (MRI), and arthroscopic findings in knee injuries. <b>Materials and Methods:</b> About 30 cases with history of rotational injury having knee pain and recurrent swelling were subjected to study. <b>Results:</b> MRI had better sensitivity (0.95 vs. 0.85) and specificity (1.0 vs. 0.5) in comparison with clinical examination for medial meniscus. In lateral meniscus injury (sensitivity 0.65 vs. 0.61 and specificity 0.95 vs. 0.92) and in ACL injury (Sensitivity 0.77 vs. 0.8 and specificity 1.0 vs. 0.96) the sensitivity and specificity of MRI versus clinical examination showed minimal difference. <b>Conclusion:</b> Our conclusion is that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison with MRI scan. MRI may be used as an additional tool for diagnosis.

Osteonecrose espontânea do joelho em atleta tratamento com o uso de câmara hiperbárica: relato de caso e revisão de literatura

Osteonecrosis is a clinical syndrome characterized by osseous necrosis of a load-bearing portion of the femoral condyle, followed by subchondral fracturing, subsequent segmental collapse and arthrosis. It most frequently affects obese women over the age of 55 years. Its treatment is still a matter of controversy in the literature. The authors report the case of a 24-year-old male patient who was a professional soccer player, who presented with a complaint of knee pain one day after physical activity. Imaging examinations performed early on already demonstrated the start of the lesion. The treatment, which was successful, used the following: withdrawal of support, physiotherapy, medications (such as NSAIDs and bisphosphonates) and a hyperbaric chamber. Although hyperbaric chamber therapy is new, its use in association with drug therapy and withdrawal of support may bring good results in treating idiopathic osteonecrosis, even for athletes with high physical demands. However, there is a need for further reports and studies with greater evidence, in order to demonstrate the validity of this treatment.

Reliability and Diagnostic Accuracy of the Lachman Test Performed in a Prone Position

Prospective, blinded, diagnostic accuracy study. To investigate the reliability and diagnostic accuracy of the Lachman test, performed in a prone position, to detect the presence of an anterior cruciate ligament (ACL) tear. Direct arthroscopic visualization and a consensus of clinical findings, including joint arthrometry and magnetic resonance imaging, were used as the reference standards. An alternative position for evaluating the integrity of the ACL has been proposed as a means for examiners with smaller hands to adequately stabilize the thigh of a larger individual; however, the diagnostic accuracy of this method has not been established. Fifty-two consecutive patients with a complaint of knee pain were independently evaluated in a prone position for the status of their ACL by 2 physical therapists, before any other diagnostic assessment. The 31 men and 21 women ranged in age from 16 to 57 (mean ± SD, 34.3 ± 4.2) years and in acuity of knee injury from 21 to 365 (mean ± SD, 195 ± 130) days. Twenty-three of 52 (44%) of the patients had a torn ACL. The agreement between examiners was 90%, with a kappa coefficient of 0.81. The sensitivity of the prone Lachman test was 70% and the specificity was 97%, resulting in a positive likelihood ratio of 20.17 and a negative likelihood ratio of 0.32. The positive predictive value was 94% and the negative predictive value was 80%. The diagnostic odds ratio was 64.0, with a number needed to diagnose of 1.5. The prone Lachman test is a reliable evaluation technique that can be used to confirm the presence of an ACL tear; however, the test should not be used as the sole criterion to rule out the presence of the injury. Diagnosis, level 2b.

Prevalence of Pain on Palpation of the Inferior Pole of the Patella Among Patients with Complaints of knee Pain

CONTEXT AND OBJECTIVEPatellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy.METHODSPalpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded.RESULTSOf the total number of individuals evaluated, 124 (39%) felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3%) received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity.CONCLUSIONSPalpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands.

Anterior knee pain following the lateral parapatellar approach for tibial nailing

Anterior knee pain after intramedullary nailing of tibial shaft fractures is a common clinical problem, with various etiologies. We have used a lateral parapatellar approach with atraumatic elevation of the infrapatellar fat pad to expose the starting point. Our hypothesis was that this approach leads to a low incidence of knee pain. We conducted a retrospective study of 78 patients suffering from tibia fractures treated by a single surgeon. Fifty patients were available for the study. All fractures were fixed with a reamed intramedullary nail using the modified lateral approach. Complaints of knee pain and range of motion as well as keeling ability were examined in the clinic visit and recorded in the patients' charts. Lysholm knee scores were collected following the last follow-up visit. Average follow-up was 13 months (range 6-26 months). Nine patients (19%) had subjective anterior knee pain when directly questioned. Eighty-two percentage of patients had no difficulty kneeling and this was significantly correlated with lack of knee pain. Good or excellent knee scores were reported by 92% of patients. Average knee flexion was 130 degrees . There was a negative correlation between the presence of open fracture and outcome. No correlation was found between knee pain and nail insertion depth or coronal alignment. The modified lateral parapatellar approach with careful dissection of the fat pad may significantly reduce anterior knee pain after intramedullary nailing of the tibial shaft.

Child – parent agreement on reports of disease, injury and pain

BackgroundStudies on school students are indicating that somatic complaints and pain have increased during the past decades. Throughout this period there has been a change in methodology from proxy reports by parents to having the students themselves act as the respondents, possible explaining some of the increase in prevalence. The aim of this study was to compare the agreement of answers from students with answers given by their parents regarding the students' medical background and subjective rating of perceived health with specific focus on frequency of headache, musculoskeletal pain and tiredness.MethodsThe participating students came from eleven different schools in Sweden. The schools were a sub sample of randomly selected schools originally participating in a larger multidisciplinary base study. Those 8th grade students present at school on the test date became the subjects of the investigation. A total of 232 students answered, assisted by the test leader, a specially designed self-complete questionnaire at school. Their parents were, at the same time, contacted and 200 answered a similar mailed-out questionnaire. One hundred and eighty-six (186) corresponding student-same parent questionnaires were registered for which comparisons of answers could be made and analysis conducted.ResultsWhen a child is in good health, in absence of diseases, pain and injuries, his or her assessment matches up with their parent. Children and parents also showed agreement in cases of severe injuries and frequent (daily) complaints of knee pain. Less frequent headaches, back- and musculoskeletal pain and other complaints of minor injuries and less wellbeing, such as students' tiredness, were all under-reported and under-rated by their parents.ConclusionWhen assessing the perceived health and wellbeing of students, their own expressions should be the basis for the data collection and analysis rather than relying entirely on parental reports.

Slipped Capital Femoral Epiphysis: The Importance of Early Diagnosis

Slipped capital femoral epiphysis typically occurs in adolescents. Presentation may include limp or vague pain in the hip, thigh or knee. Knee pain, in particular, is a common complaint among adolescents and may be due to patello-femoral syndromes, Osgood-Schlatter disease, patellar tendonitis, or chondromalacia patella, to name a few. However, it is vital to remember that the complaint of knee pain may be present because of referred pain from pathology at the hip. Every child presenting with a complaint of hip, thigh or knee pain must undergo a hip examination. Likewise, a "groin pull" is exceedingly rare in children and must be a diagnosis of exclusion. Any child with complaints of hip, thigh, or knee pain, or physical examination findings of out-toeing, decreased internal rotation, or obligate external rotation with flexion, should be presumed to have SCFE until proven otherwise. There is a high rate of delay in diagnosis of SCFE, which leads to opportunities for progression of deformity, which in turn leads to increased risk of arthritis. Delay in diagnosis also may allow a stable SCFE to become an unstable one, with a much higher risk of development of AVN. When suspected, the diagnosis is confirmed with x-rays (AP and frog-lateral of the pelvis). Therefore, a high index of suspicion for this disorder, and the attainment of appropriate radiographs, should allow for prompt diagnosis and referral for treatment. Treatment is urgent and surgical. Early diagnosis and proper treatment are the mainstays of prevention of adverse sequelae.

Persistent popliteal pain derived from cavernous hemangioma involving gracilis tendon and tendon sheath

Hemangiomas arising from tendon and tendon sheath are rarely reported, and may be confused with other lesions of tendons. In this case report, a 19-year-old woman was diagnosed with a cavernous hemangioma originating in the left gracilis tendon and tendon sheath. When her symptoms initially developed, MRI did not delineate the lesion due to the relatively small size of the tumor. Nine years after the onset of the patient's complaints of knee pain and swelling, the tumor was adequately diagnosed on physical examination and MRI, and was resected with complete relief of symptoms.

Interdisciplinary Health Assessment of the Older Individual: A Conceptual Framework for Curricular Integration

Background and Purpose. Evidence indicates that interdisciplinary health assessment of the older adult improves identification of needs and referral to appropriate services, as well as improving quality of life. Objectives. The objectives of this article are: (1) to dif ferentiate between and summarize evidence in support of a multidisciplinary and interdisciplinary approach to health assessment of the older adult, (2) to provide a conceptual framework for fostering interdisciplinary geriatric education, and (3) to describe challenges encountered in implementing interdisciplinary educational strategies for the professional (entry-level) physical therapist student. Framework. Three broad curricular elements are proposed as the foundation for progressing the physical therapist student toward multidisciplinary and interdisciplinary health care practice for the older adult: (1) the student must develop into a competent practitioner, with a scientific understanding of the varied motor control changes potentially encountered by the older adult, (2) the student must understand the indications for a multidisciplinary or interdisciplinary health care assessment and respect the roles of other professionals in the health care assessment of the complex older adult, and (3) the student must gain a practical understanding of the dynamics involved in team decision making and prioritization of treatment approaches. Approaches to addressing these curricular goals within one curriculum are described and critiqued. Betty Smith is a 78-year-old woman who arrives at the doctor's office with chief complaints of knee pain and difficulty doing her grocery shopping. She has lost 5 lb in the last year, and radiology reports reveal midstage degenerative joint disease in both knees. The physician prescribes anti-inflammatory medication, an analgesic, and a referral to a physical therapist for gait training with an assistive device. The physical therapist discovers that Betty also has problems with balance and fatigue and learns that her fear of falling has resulted in increased avoidance of activities outside the home. After examination and treatment, the physical therapist discharges Betty as independent with an assistive device on level surfaces and on stairs with rails. Betty does not take her anti-inflammatory medication because it causes digestive problems. Betty continues to have pain, balance problems, fear of falling, and fear of going outside, resulting in the continued decline in her functional abilities and inability to shop adequately for her groceries. Loretta Sizemore is an 80-year-old woman whose complaints and diagnoses are similar to Betty's. Loretta attends an interdisciplinary geriatric clinic and receives services as follows: (1) the pharmacist recommends an analgesic that does not interfere with balance, (2) the physical therapist recommends physical therapy for gait training with an assistive device, exercises to improve strength and balance, an evaluation for assistive equipment at home, and education to develop strategies to confront her fear of falling, (3) the social worker connects Loretta to appropriate community meal programs to help her obtain better nutrition, counseling services to address her depressive symptoms, and church and community resources for socialization and spiritual guidance, and (4) the physician makes a referral for a nutritional assessment to educate Loretta about her dietary needs. Betty and Loretta typify patients whose pathology (osteoarthritis) neither explains nor predicts the functional limitations and overall decrease in quality of life experienced by these individuals. It may not be reasonable to assume that one health care professional can effectively assess all of the factors that need to be addressed in clinical management of the person with complex and chronic health problems. A coordinated team representing multiple disciplines can provide a cohesive and thorough assessment and treatment plan for the person with multiple needs. …

Anatomy, Biomechanics, and Physical Findings in Posterolateral Knee Instability

Posterolateral injury is often associated with additional ligamentous injury to the knee. Proper evaluation of these injuries requires a knowledge of the anatomy and biomechanics of the posterolateral corner. Biomechanical studies reveal that the popliteal tendon, the popliteofibular ligament, the arcuate ligament, and the LCL are the principal structures responsible for maintaining stability of the posterolateral corner. Knowledge of the biomechanics of the posterolateral corner provide insight into the clinical evaluation and treatment of posterolateral knee instability. Patients with acute and chronic posterolateral instability present with complaints of knee pain and instability of the knee in extension. Patients may also complain of dysthesias or motor weakness owing to associated peroneal nerve injury. Patients may also present with symptoms pertaining to associated ligamentous injury to the knee. Thorough examination is needed to document neurovascular status, and the presence of posterolateral and associated knee instability. Although many tests are used to document posterolateral knee instability, the authors prefer varus stress testing and the prone external rotation test. Accurate diagnosis of all knee ligament pathology will allow appropriate planning for the surgical treatment of isolated posterolateral knee instability and combined instability patterns.

The Limping Child

Evaluation of a limping child requires careful consideration and a basic knowledge of potential problems affecting the child. The most important point is not to miss or delay diagnosis of the septic hip. This is truly an orthopedic emergency. Complaints of knee pain should not throw the physician off the track of a diagnosis of hip disease. It is also important to be aware of how the medical history affects the musculoskeletal system. Many causes of limp are best analyzed by repeat examination and stepwise laboratory and radiographic evaluation. One should realize that a painful limp can be caused by something as mundane as a thorn in the heel or as serious as a tumor of the spine: Be suspicious.

The Limping Child

Evaluation of a limping child requires careful consideration and a basic knowledge of potential problems affecting the child. The most important point is not to miss or delay diagnosis of the septic hip. This is truly an orthopedic emergency. Complaints of knee pain should not throw the physician off the track of a diagnosis of hip disease. It is also important to be aware of how the medical history affects the musculoskeletal system. Many causes of limp are best analyzed by repeat examination and stepwise laboratory and radiographic evaluation. One should realize that a painful limp can be caused by something as mundane as a thorn in the heel or as serious as a tumor of the spine: Be suspicious.