Clinicians who evaluate knee pain must be able to recognize limb- and life-threatening conditions, hip pathology, or joint effusion and pursue the appropriate management.
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As noted in the first part of this three-part review of knee pain in children, the clinician can use the information gained from the history and physical examination in an algorithm to establish a working diagnosis and direct subsequent evaluation and management. The initial priorities are to identify emergent limb- and life-threatening conditions, hip pathology, or effusion (Table).
The knee is the most common site of septic arthritis in children. Usually, septic arthritis is characterized by the acute onset of steadily progressive knee pain with fever and a physical examination demonstrating effusion, warmth, erythema, and limited motion. Concern for septic bacterial arthritis in children warrants emergent evaluation, including knee radiographs (anteroposterior [AP] and lateral)...