A 16-Year-Old Boy With Concerning, Recurrent Knee Problems

Zoran Rajković, MD; Dino Papeš, MD


February 05, 2019

Physical Examination and Workup

Upon examination, the patient appears to be in good condition. He is awake, alert, and in no acute distress. His vital signs show him to be afebrile, with a blood pressure of 125/75 mm Hg, a pulse of 75 beats/min, a respiratory rate of 15 breaths/min, and an oxygen saturation of 98% on room air. His skin is slightly pale but with normal skin turgor. Examination of his oral cavity shows dry mucus membranes. He has normal heart sounds. Auscultation reveals clear lungs without wheezes, rhonchi, or rales. The abdomen is soft and without tenderness, distention, masses, or hernias.

Examination of the left hip is unremarkable, with normal range of motion noted. Examination of the left knee shows swelling with positive patellar ballottement indicating the presence of an effusion. The patient is holding his knee in mild flexion. On testing the range of motion, both terminal extension and flexion cannot be tested due to pain. Physical examination tests of the meniscus and ligaments are negative.

The patient's workup includes a complete blood count (CBC), which is normal. In addition, x-rays of the knee are obtained. An example similar to the findings in this patient are shown in Figure 1. Arthrocentesis is also performed, yielding 30 mL of old blood. This is sent for cell count and culture, but no evidence of infection is discovered.

Figure 1.


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