Knee Pain in Children, Part III: Stress Injuries, Benign Bone Tumors, Growing Pains

Michael Wolf

doi:10.1542/pir.2015-0042

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Michael Wolf, MD*

^*Pediatrics and Orthopedic Surgery, St Christopher’s Hospital for Children, Philadelphia, PA.

AUTHOR DISCLOSURE
Dr Wolf has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Practice Gap

Clinicians who evaluate knee pain must be able to recognize stress injuries, benign bone tumors, or growing pains and pursue the appropriate management.

Objectives

After completing this article, the reader should be able to:

Describe the presentation and treatment of stress injuries that may cause knee pain in children.
Delineate the presentation and treatment of benign bone tumors that may cause knee pain in children.
Describe the presentation of growing pains in children.

Introduction

According to the treatment algorithm cited in the first part of this three-part article on knee pain in children, the initial concerns that the clinician must address are limb- and life-threatening conditions, hip pathology, and effusion-related conditions. After eliminating these potential causes, clinicians can turn to their attention to stress injuries and benign bone tumors (Table). If none of these diagnoses is captured in the patient review, a final possibility is growing pains.

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Table.

Specific Causes of Knee Pain in Children

Acute and Chronic Stress Injuries to Vulnerable Knee Structures

Anterior Knee Pain

Patellofemoral Syndrome.

Patellofemoral syndrome involves dysfunction of the patellofemoral joint that presents as anterior knee pain. With this syndrome, altered forces and tracking mechanics at the patellofemoral joint place excessive stress on the joint. Physical examination findings include patellar facet tenderness and a painful patellar grind test. Rarely, patellofemoral syndrome can present with a small effusion. The key to treatment is identification of the inappropriate biomechanical forces that are causing stress in the joint. In young patients, such abnormal forces are related to tight hamstrings or quadriceps, weak hip external rotators (gluteus medius and gluteus minimus), or a tight lateral retinaculum of the patella. These conditions can be addressed with home exercises or physical therapy. In addition, open patellar bracing can be …