Clinicians who evaluate knee pain must understand how the history and physical examination findings direct the diagnostic process and subsequent management.
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Obtaining a thorough patient history is crucial in identifying the cause of knee pain in a child (Table). For example, a history of significant swelling without trauma suggests bacterial infection, inflammatory conditions, or less likely, intra-articular derangement. A history of swelling after trauma is concerning for potential intra-articular derangement.
A report of warmth or erythema merits consideration of bacterial infection or inflammatory conditions, and mechanical symptoms (eg, locking, catching, instability) should prompt consideration of intra-articular derangement.
Nighttime pain and systemic symptoms (eg, fever, sweats, night sweats, anorexia, malaise, fatigue, weight loss) are associated with bacterial infections, inflammatory conditions, benign and malignant musculoskeletal tumors, and other systemic malignancies. A history of rash or known systemic inflammatory conditions, such...