Author: Nicola McDonald / Editor: Maya K Naravi / Reviewer: Phil Delbridge / Codes: SLO5, TC2, TP7Published: 05/02/2022

An 11-year-old girl presents to Paediatric A&E complaining of left knee and thigh pain. She had fallen whilst playing netball onto her left knee 7 days previously. She attended A&E on this occasion; X-ray of her left knee normal. She was discharged with analgesia and crutches.

She has re-presented today with on-going knee and thigh pain. Instead of improving, her knee and thigh pain has got worse. She is now unable to weight bear at all.

On examination, she is sitting in a wheelchair. She is afebrile. HR 80/min, CRT <2sec, sats 99% RA. Weight 50kg.

Examination is limited by pain. You note obvious wasting of her quadriceps muscles on her left side with reduced range of movement in both her left hip and left knee. You are unable to assess her gait as she cannot walk.

You check her knee X-ray from the previous week and it has been formally reported as normal.

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