paediatric knee injury

Question 1

a 7 y.o. boy is admitted as an emergency with pain and swelling of his knee

(a) list 3 likely non-traumatic causes of these sx

Answer 1

• inflammatory
  
  • JIA (juvenile idiopathic arthritis)
  • bursitis (e.g. superficial)
  • HSP (Henoch-Schonlein purpura)
• infectious
  
  • ​septic arthritis
  • reactive arthritis
  • osteomyelitis

Question 2

(b) child refuses to talk to you and clings to his mother.

describe 2 ways to assess pain in this child

Answer 2

1. ask the child or the mother
2. observation of the position he holds his knee in i.e. query pseudoparalysis
3. general behaviour of child
4. observation of gait
5. gentle examination if appropriate

Question 3

(c) list 3 features you would look for on examination of his knee

Answer 3

1. joint tenderness
2. restriction of movement
3. very warm joint / redness
4. swelling or deformity

Question 4

(d) you consider aspiration of the joint.

list 2 other ix you would want to undertake

Answer 4

1. bloods ⇒ culture, FBC (↑ WCC), CRP, ESR
2. imaging ⇒ US (to guide aspiration) and plain XR (not diagnostic but used as baseline)