Step 2: Perform an Examination

Objective :

Know the relevant examination in a child with this history

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Skin (abdomen)

Some bone pathologies can be associated with skin changes such as Café-au-Lait spots. There are none present in this patient.

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Hip

Hip pathology often presents as knee pain in adolescents. A Slipped Capital Femoral Epiphysis, which commonly presents in boys in this age group, often presents with knee pain so it is important to examine the hip. Hip examination in this patient is normal.

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Groin

Lymphatics can be swollen in tumours or infections so it is important to examine these. The lower leg drains predominantly through the inguinal nodes. Lymph Node examination is normal in this patient.

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Knee

Look: There is a clear swelling just below the knee.

Feel: The swelling is firm and feels warmer than the surrounding area.

Move: The knee has a reduced range of movement due to pain.

Special Tests: The knee is stable and there is no effusion.

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Foot

It is important to assess the distal neurovascular status whenever examining someone’s limb. This patient has normal pulses and no abnormal neurological signs in the foot.

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More Info Next Step

The presence of a mass is always suspicious for neoplasia in this clinical setting. It is important to be precise whenever you examine a joint, and determine is the swelling from the joint or just associated with it. This is especially important around the knee, where a careful examination can distinguish synovial cavities, which are usually fluctuant, from solid tumours.