Page 126 - ASOP ROT Study Guide

7 . 2 Pain Around the Knee

A very common cause of the referral of children is pain around the knee. This is seen in both sexes
from about ten to twelve years of age, and is more common in girls as they develop secondary sexual
characteristics.

Osgood Schlatter's disease
Osgood Schlatter's disease is an inflammation of the attachment of the patellar tendon to the growing
tibial epiphysis, caused by excess traction by the quadriceps. The cause is unknown but it may be an
overuse injury as it is commoner in very active children who are often involved in organized sport.

The condition causes tenderness and discomfort, which are worse after exercise. There may also be
swelling. The condition is episodic and usually can be treated by rest. Only rarely is it necessary to
enforce rest with a plaster. The child will cease to have symptoms in middle adolescence when the
epiphysis fuses.

Adolescent knee pain
Adolescent knee pain occurs most commonly in girls and is of unknown cause. It is not the same as
dislocation of the patella. Rarely, on arthroscopy, an area of patella cartilage is seen to be eroded -
chondromalacia patellae. Most, but not all girls grow out of the condition and a watching brief should be
kept. If symptoms persist, an arthroscopy may be necessary, but speculative surgery is to be avoided.

8. MAJOR PROBLEMS

8 . 1 Congenital Dislocation of the Hip (CDH)

Introduction
CDH occurs in one or two live births per thousand. It is a badly named condition because the hip is rarely
completely dislocated at birth, but it is abnormal and is likely to become irretrievably dislocated if ignored.
A better name would be congenital hip dysplasia, reflecting the underlying abnormality of the femoral head,
the acetabulum, or both. The condition is more frequent in girls than boys and there is a familial and
racial tendency. In a significant number of children the condition is bilateral (both hips).

Clinical presentation
All children should be screened at birth and checked again at three, six and twelve months. At birth it is
diagnosed using a technique in which the examiner either tries to dislocate the hip or tries to relocate it if
it is dislocated. This test may produce a slight click, which is a suspicious sign, or a definite clunk as the
hip dislocates or relocates.

Occasionally the test will fail to find an abnormality and the condition goes undetected at birth. It becomes
apparent later, either before weight bearing (sitting), or after weight bearing (standing) or even walking has
been established. Clinical signs include shortening of the limb, asymmetrical skin creases, limited
abduction and a limp.

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