Objective: To describe the conservative management of a 6.5-year-old with chronic knee pain.
Clinical Features: A 6.5-year-old boy had consistent right knee pain primarily at night with no known mechanism of injury. He was evaluated using history, orthopedic and neurologic examination, and x-ray. He was 3rd-percentile, and had frequent urinary tract infections, headaches, visual disturbances, and constipation. His fingernails and toenails appeared normal. Overall knee function was normal. The lateral femoral and tibial condyles were prominent and tender. X-rays revealed agenesis of the patella. Family history revealed no known members with this condition. Additional family history included glaucoma, elbow joint dislocation and kidney health disorders.
Intervention and Outcome: Home exercise recommendation to address continued biomechanical change in the knees was initiated. He responded to chiropractic intervention and age-appropriate exercises, with a reported decrease in pain and dysfunction. We monitored him at each treatment visit for concurrent health issues. We also recommended referral for co-management of his visual disturbance and urinary tract infection.
Conclusion: Early detection from portal-of-entry physicians may help improve patient health outcomes when appropriate diagnosis and referral is used.
Author keywords: Nail-Patella Syndrome; Chiropractic; Exercise
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