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Obtain AP, frog leg lateral, Dunn view, and false profile hip radiographs
12%
911/7404
CT scan to obtain tibial tubercle-trochlear groove measurements
4%
320/7404
Physical therapy regimen focused on quadriceps and core muscle strengthening program
80%
5958/7404
Physical therapy regimen focused on Graston, ASTYM, and iontophoresis techniques
2%
161/7404
Obtain chest CT, skeletal survey, and refer to an orthopaedic oncologist
0%
14/7404
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The patient's clinical presentation is most consistent with patellofemoral pain and is most appropriately treated with a physical therapy regimen emphasizing quadriceps (including VMO) as well as hip and core strengthening in a non-painful fashion. Patellofemoral pain is the most common condition affecting adolescents and is thought to have several different etiologies including biologic, mechanical, and emotional causes. A classic symptom of patellofemoral pain is the "theatre sign" which manifests as anterior knee pain with sitting for long periods of time with the knee in flexion. Dalton authors a Level 5 review adolescent athlete injuries. Overuse or repetitive trauma injuries comprise approximately 50% of all pediatric sport-related injuries. Outerbridge and Micheli present a Level 5 review discussing that adolescents are susceptible to overuse injuries just as adults are, but also are at risk for injuries due to their immature skeleton at the epiphyseal plate and apophysis. Figures A-C demonstrate a normal knee with a mild amount of lateral patellar tilt present. Lateral tilt can be visualized on the Merchant view by positioning the knee in flexion at 45° and the x-ray beam is angled 30°. Lateral patellar tilt is not specific for the presence of patellofemoral pain but is believed to be a possible contributing factor to anterior knee pain. Incorrect Answers: Answer 1: Obtaining AP, frog leg lateral, Dunn view, and false profile hip radiographs is useful in the evaluation of femoroacetabular impingement (FAI) Answer 2: A CT scan to obtain tibial tubercle-trochlear groove measurements is helpful in the setting of recurrent patellar dislocations. Answer 4: A physical therapy regimen focused on Graston, ASTYM, and iontophoresis techniques would be helpful in the treatment of chronic tendinopathies. Answer 5: Obtaining a chest CT, skeletal survey, and referral to an orthopaedic oncologist is indicated in the work-up of a suspected tumor.
3.4
(25)
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