Septic Joint

Case 2

A 13-year-old male is complaining of mild recurrent bilateral anterior knee pain without fever, joint swelling, erythema, or limitation of ambulation for the past 3 months. He is accompanied by his mother. 

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  • Prenatal and birth history: unremarkable.
  • Developmental history: mother reports normal development.
  • Past medical/surgical history: no major medical illnesses; no surgical history; no previous hospitalizations.
  • Social history: actively involved on his school’s soccer team for 2 years.
  • Family and environmental risks: none.
  • Immunization history: up to date.
  • Medications: none.
  • Allergies: no known drug allergies.
  • Vital signs: temperature 98.7°F; pulse 72 beats per minute; respirations 18 per minute; blood pressure 120/70 mmHg; pulse oximeter 100%.

Physical examination revealed a well-nourished adolescent male without any acute distress. Significant bilateral tenderness was noted when palpating the tibial tubercles, and extending his knees against resistance reproduced pain. The remainder of the musculoskeletal examination was unremarkable (e.g., deep tendon reflexes, strength, and sensation). Other systems examinations were unremarkable (e.g., heart, lungs, etc.). 

Answer the following questions based on Case 2. 

1. What is the most likely diagnosis for this patient?
2. What is the pathogenesis of this disorder?
3. What additional information assists in making the diagnosis?
4. What are treatment strategies for this patient?
5. What education would the provided to the patient and mother?