Knees
A 14-year-old female basketball player presents with anterior knee pain that is gradually worsening over the past three months. The pain is worse when squatting, or sitting for prolonged periods. On physical exam, there is pain with compression of the patella with the leg extended. What is the most likely diagnosis?
Patellofemoral syndrome
A 15-year-old competitive athlete presents with elbow pain. On exam, he has tenderness just distal to the left lateral epicondyle. Resisted extension of the wrist when the elbow is held at 90 degrees worsens the pain. Which sport is commonly associated with this injury and what is the injury?
Tennis, lateral epicondylitis
A 14-year-old male with obesity is presenting with gradually worsening left dull aching hip and knee pain over the past month. Internal rotation and flexion of the hip is decreased. You obtain frog leg lateral view film which shows widening and irregularity of the physis. What is the most likely diagnosis?
Slipped Capital Femoral Epiphysis (SCFE)
A 13-year-old girl is brought in by her mother for change in posture. She has been having occasional back pain after playing basketball. On Adams forward bending test, she has a noticeable thoracic rib hump on the right side. AP radiograph of the spin reveals a right thoracic curve measuring 17 degrees. What is your intervention?
Continue athletic activity as tolerated and monitor closely until skeletal maturity
An 18-year-old named John presents to your clinic after twisting his right ankle while playing soccer. On examination, there is swelling and tenderness over the right lateral ankle. He was able to bear weight after the injury and is currently bearing weight. Which physical exam findings will help you decide on obtaining an x-ray?
Tenderness at the posterior edge of the lateral malleolus or base of the 5th metatarsal (Ottawa Ankle Rules)
A 13-year-old boy who plays on his school’s soccer team presents to clinic with anterior knee pain that worsens with running and jumping. On exam, there is tenderness and swelling over the tibial tuberosity and pain is reproduced with resisted knee extension. What is the most likely diagnosis?
Osgood-Schlatter's
A 16-year-old avid baseball pitcher and golfer is now developing elbow pain with his sports. What is your most likely exam finding?
Point tenderness over the medial epicondyle and with resisted wrist extension and forearm pronation
A 15-year-old male cyclist presents with lateral knee pain that has gradually worsened over the past month. The pain sometimes radiates up to his hip. On exam, there is tenderness over the lateral femoral condyle and pain is reproduced with passive knee extension. What is the most likely diagnosis?
Iliotibial band syndrome
A 15-year-old male wrestler presents with insidious lower back pain that does not radiate. Physical exam is notable for worsening pain with extension of the spine and poorly localized tenderness in his lower thoracic spine. What is the most likely diagnosis?
Spondylolysis
A 17-year-old named Audrey was performing in a national hip hop dancing competition. She suddenly felt significant sharp pain and felt like "someone kicked her in the back of the leg". She is unable to bear weight. What is the physical exam to confirm her injury and what is the recommended management?
Thompson test
Surgical repair
An 18-year-old named Mina is playing on his high school varsity soccer team when he suddenly hears a loud "pop" in his left knee when pivoting. He develops significant pain, swelling and is unable to walk. On exam, he has a positive Lachman test. What is the most likely diagnosis and can you describe the test?
ACL tear - Patient lays supine, knees flexed 25 degrees. Examiner stabilizes femur with one hand, then with the other, apply sudden anterior force to the proximal tibia
A 17-year-old boy presents to urgent care after falling onto his outstretched hand while snowboarding. He noted immediate wrist pain and swelling. On exam, there is tenderness over the distal forearm with mild deformity. What is your most likely exam finding?
Distal radial fracture
A 16-year-old presents with a firm, painless mass the lateral portion of the left thigh which has been enlarging over the past 2 weeks. He plays on the high school soccer team and “is always being kicked”. X-ray shows around soft tissue mass with peripheral calcification that appears separated from the femur. What is the most likely diagnosis?
Myositis ossificans
A 17-year-old girl ballet dancer and gymnast presents with worsening lower back pain over 3 months. Her pain radiates occasionally to her buttocks and thighs with activity and worsens with back extension. No bowel or bladder function changes. On exam, there is a palpable step off at the inferior lumbar spine. What is the most likely diagnosis?
Spondylolisthesis
A 19-year-old college athlete is complaining of fatigue and is noted to have peripheral edema. Your lab findings show fasting blood glucose of 220 common hemoglobin A1 C 8.2%. What is the most likely performance enhancement drug he is using?
Growth hormone
A 19-year-old named Mina seems to have a dull aching along the inner joint line of his knee. His knee feels stiff and sometimes has "locking" sensation. On exam, he feels severe pain when placing the knee in full flexion, externally rotating the tibia, and applying a valgus stress while extending the knee. What is this test called and what does it indicate?
McMurray test - Medial meniscal tear
A 15-year-old named Audrey was skateboarding at an international skateboard competition. She hit a rock and fell forward with her wrist extended. On exam, she has significant tenderness at the anatomic snuff box. If she has sustained a fracture in the area, what is the most feared complication?
Avascular necrosis of the scaphoid
A 16-year-old male football athlete is presenting with 1 month of progressive knee pain. He has noticed his knee “lock up” on several occasions and now it’s beginning to appear swollen. There is mild effusion with limited ROM of the left knee. X-ray shows a well circumscribed, dense fragment of subchondral bone that is well demarcated from the surrounding medial femoral condyle. What is the most likely diagnosis?
Osteochondritis dissecans
A 15-year-old girl named Elizabeth was playing in a soccer game when hit her head and sustained a concussion injury. Her father brings her into your office the following day after she with improvement in symptoms. She is very keen on returning to playing soccer. How do you advise him and her concerning return to activity?
A 16-year-old butterflyer named Mina is having insidious anterior right shoulder pain that worsens during the pulling phase of his stroke. He also has pain when sleeping on the affected side. What physical exam maneuver is helpful in diagnosing his condition? What is your suspected diagnosis?
Empty can test and lift off test
Rotator cuff injury