Chapter 11 Pain in adolescence Case 11.1 A 15-year-old female presents with constant anterior knee pain that is aggravated by exertion. The pain has been progressive and has increased over the last 4 years. No relieving factors are reported. On examination the patient appears to have excessive femoral anteversion, squinting patella combined with patella alta, and an increased Q-angle with excessive external tibial rotation. Questions 1. What is your differential diagnosis? Justify your choices. 2. What additional testing would you wish to perform? 3. What is the most likely diagnosis? What information directed you to this conclusion? Case 11.2 A 16-year-old male soccer player presented with a 1-week history of his left knee ‘giving-way’ or locking as he walked following an incident at soccer. The incident involved a slide tackle from behind while his knee was in an extended position with his foot dorsiflexed on the ground. He has been unable to return to play since the incident. On physical examination, the left knee appeared minimally swollen but did not feel warm. The anterior drawer test was positive. There was an audible click when the flexed left knee was extended while varus pressure was applied (McMurray test). Questions 1. Describe: a the ‘anterior drawer test’ b McMurray test. 2. What is the most likely diagnosis? What leads you to this conclusion? 3. What further testing would you perform to confirm your diagnosis? 4. What is the function of: a the ACL ligament b the PCL ligament c the tibial collateral ligament d the fibular collateral ligament. 5. What is the investigation of choice for confirmation of an ACL or PCL tears? 6. What is O’Donoghue’s unhappy triad? Case 11.3 A 17-year-old male defensive lineman (American football) sustains a heavy tackle on his left side and falls onto his right shoulder with his right arm in an adducted position. The player describes sharp pain that is localised to the anterior aspect of his right shoulder. On observation, the right scapula appears to be depressed downward in relation to the clavicle, which remains in normal anatomic position. His passive range of motion (ROM) is limited and painful in both abduction and adduction. He also demonstrates guarding during the examination. Questions 1. What is your differential diagnosis? Describe a common presentation of each. What is the most likely diagnosis? 2. What further testing would you perform to confirm your diagnosis? 3. His X-ray is shown in Figure 11.1. What is the diagnosis? 4. Explain the likely mechanism of injury for this patient. Figure 11.1 (Source: Taylor J, Hughes T, Resnick D. Skeletal Imaging Atlas of the Spine and Extremities. Missouri: Saunders; 2010: 846, Fig 13.27 A) Case 11.4 History A 15-year-old schoolboy, Lachlan, is accompanied by his mother to your office. Lachlan, who appears pale, tells you he awoke this morning with a stiff neck and headache and that both seem to be getting worse as the day goes on. He describes the headache as ‘all over his head’ as well as behind his eyes, and that the whole of the back of his neck and shoulders feel tight and heavy. Whilst Lachlan can think of no specific reason as to why the symptoms came on, upon questioning he explains that a week ago he played several games of football whilst interstate at a school football carnival, but that he did not seem to injure his neck at the time. Lachlan had previously sought chiropractic care last year when he awoke with an extremely painful neck on one side with very limited motion. While he responded quickly to treatment during that episode, he says that this time the pain and stiffness feels different. Upon questioning, he tells you that he feels generally tired and unwell. When asked where he stayed while playing football, Lachlan replies that he stayed at a boarding school dormitory with the rest of his team. Questions 1. Using only this information, list the possible causes of Lachlan’s presenting symptoms. Justify your answer. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Eating disorders, substance abuse and behavioural disturbances in adolescence Miscellaneous cases in infancy and childhood Sports injuries Acute joint pain Acute back pain Upper limb pain Stay updated, free articles. Join our Telegram channel Join Tags: Cases in Differential Diagnosis for the Physical and Manipulativ Dec 26, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off on Pain in adolescence Full access? Get Clinical Tree
Chapter 11 Pain in adolescence Case 11.1 A 15-year-old female presents with constant anterior knee pain that is aggravated by exertion. The pain has been progressive and has increased over the last 4 years. No relieving factors are reported. On examination the patient appears to have excessive femoral anteversion, squinting patella combined with patella alta, and an increased Q-angle with excessive external tibial rotation. Questions 1. What is your differential diagnosis? Justify your choices. 2. What additional testing would you wish to perform? 3. What is the most likely diagnosis? What information directed you to this conclusion? Case 11.2 A 16-year-old male soccer player presented with a 1-week history of his left knee ‘giving-way’ or locking as he walked following an incident at soccer. The incident involved a slide tackle from behind while his knee was in an extended position with his foot dorsiflexed on the ground. He has been unable to return to play since the incident. On physical examination, the left knee appeared minimally swollen but did not feel warm. The anterior drawer test was positive. There was an audible click when the flexed left knee was extended while varus pressure was applied (McMurray test). Questions 1. Describe: a the ‘anterior drawer test’ b McMurray test. 2. What is the most likely diagnosis? What leads you to this conclusion? 3. What further testing would you perform to confirm your diagnosis? 4. What is the function of: a the ACL ligament b the PCL ligament c the tibial collateral ligament d the fibular collateral ligament. 5. What is the investigation of choice for confirmation of an ACL or PCL tears? 6. What is O’Donoghue’s unhappy triad? Case 11.3 A 17-year-old male defensive lineman (American football) sustains a heavy tackle on his left side and falls onto his right shoulder with his right arm in an adducted position. The player describes sharp pain that is localised to the anterior aspect of his right shoulder. On observation, the right scapula appears to be depressed downward in relation to the clavicle, which remains in normal anatomic position. His passive range of motion (ROM) is limited and painful in both abduction and adduction. He also demonstrates guarding during the examination. Questions 1. What is your differential diagnosis? Describe a common presentation of each. What is the most likely diagnosis? 2. What further testing would you perform to confirm your diagnosis? 3. His X-ray is shown in Figure 11.1. What is the diagnosis? 4. Explain the likely mechanism of injury for this patient. Figure 11.1 (Source: Taylor J, Hughes T, Resnick D. Skeletal Imaging Atlas of the Spine and Extremities. Missouri: Saunders; 2010: 846, Fig 13.27 A) Case 11.4 History A 15-year-old schoolboy, Lachlan, is accompanied by his mother to your office. Lachlan, who appears pale, tells you he awoke this morning with a stiff neck and headache and that both seem to be getting worse as the day goes on. He describes the headache as ‘all over his head’ as well as behind his eyes, and that the whole of the back of his neck and shoulders feel tight and heavy. Whilst Lachlan can think of no specific reason as to why the symptoms came on, upon questioning he explains that a week ago he played several games of football whilst interstate at a school football carnival, but that he did not seem to injure his neck at the time. Lachlan had previously sought chiropractic care last year when he awoke with an extremely painful neck on one side with very limited motion. While he responded quickly to treatment during that episode, he says that this time the pain and stiffness feels different. Upon questioning, he tells you that he feels generally tired and unwell. When asked where he stayed while playing football, Lachlan replies that he stayed at a boarding school dormitory with the rest of his team. Questions 1. Using only this information, list the possible causes of Lachlan’s presenting symptoms. Justify your answer. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Eating disorders, substance abuse and behavioural disturbances in adolescence Miscellaneous cases in infancy and childhood Sports injuries Acute joint pain Acute back pain Upper limb pain Stay updated, free articles. Join our Telegram channel Join Tags: Cases in Differential Diagnosis for the Physical and Manipulativ Dec 26, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off on Pain in adolescence Full access? Get Clinical Tree
