More Pain

Musculoskeletal System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S26_F3.jpg"}},{"insert":"\n\n"},{"insert":"Matthew, 16, is at your office today for his mandatory physical prior to soccer tryouts next month. You\u0027ve known him for several years now as a perfectly healthy and courteous young man.\n\nThe examination proceeds as usual, and you find nothing out of the ordinary until you test his patellar reflex. To your surprise, you notice Matthew grimacing in pain as you examine his right knee.\n\nThe skin overlying the limb appears normal, and there are no gross deformities, or palpable masses. However, you do note some stiffness and pain on extension.\n"}]}


{"ops":[{"insert":"When you ask him if he\u0027s had trouble with his right leg, Matthew replies, \u0022Oh yeah, I\u0027ve had growing pains in my shin for a couple of months now. It feels stiff after practice.\u0022\n\nFurther questioning reveals that the pain worsens with activity, is relieved when at rest, and occurs intermittently at night. There is no history of recent trauma, and his medical, surgical, and family histories are completely unremarkable.\n"}]}


{"ops":[{"insert":"\u0022This is normal for Matthew\u0027s age, right? He recently had a growth spurt,\u0022 says his father.\n\nWhat will you do?\n"}]}
1. Recommend stretches, ice, and ibuprofen as necessary
2. Order plain x-rays of the right lower limb
3. Order a radionuclide bone scan