Children & Knee Pain

Does your child have knee pain? Education and understanding are important drivers of well-being. The following information is a primer on knee pain, NOT a substitute for an in-depth evaluation from a health care practitioner. It is just one of many health resources encouraging preparedness to ease the interactive process with your doctor.

Generally, depending on the presentation, knee pain in the child is approached in the following way:

  1. Rule out threat to life or limb.
  2. Determine if pain is being referred to the knee from the hip.
  3. Determine if intra-articular derangement is present.
    1. Are anatomical structures in the knee joint damaged (eg. ACL, meniscus)?
  4. Determine a patho-anatomical cause.
    1. Is a specific knee structure causing pain (eg. muscle, tendon, ligament, capsule)?
  5. Determine a biomechanical cause or contributor.
  6. If no cause can be determined, growing pains may be considered.

What does this mean for you as a parent? The goal of this post is not to create fear, although there is inherent worry when reading the words child, knee pain, and threat to life in the same post. But there is power in understanding. The following lists identify key things to look out for that, when relayed to a health care practitioner, will help them effectively navigate the diagnostic process mentioned above. These lists are not comprehensive, but they give you an idea.

Threat to Life or Limb

The main concerns here are any systemic symptoms that cannot be explained.

  1. Swelling without trauma
  2. Warmth and redness
  3. Nighttime pain
  4. Systemic symptoms (fever, fatigue, change in weight, change in appetite, malaise, night sweats, etc.)
  5. Rash

These signs and symptoms may indicate any of the following: infection, inflammatory condition, malignancy.

Hip Referral

  1. Hip or thigh pain in addition to knee pain
  2. Limited/Reduced hip motion
  3. Limping
  4. Guarding of hip musculature

The most concerning indication of the above is a condition called slipped capital femoral epiphysis. If suspected, nonweight-bearing is strictly recommended!

Intra-articular Derangement

  1. Swelling and stiffness, especially following a traumatic force to the knee.
  2. Catching or locking
  3. Buckling or giving way

These signs and symptoms may indicate any of the following: fracture, cartilage injury, cruciate ligament rupture, meniscal tear, and patellar subluxation or dislocation.

Patho-anatomical & Biomechanical

Some important considerations to remember here include location (where is the pain exactly), the mechanism of injury (can you describe how the pain started), and what makes the knee pain better and what makes it worse (for instance: up/down stairs, up/down hills, sitting, squatting, kneeling, etc.). This information and more is used in combination with a detailed physical assessment to evaluate knee stability and determine if there are deficiencies in the kinetic chain, such as muscle imbalances or adjacent joint dysfunctions.

Bottom Line & Take-away

Hopefully this post enhances your knowledge and understanding of knee pain and the diagnostic process utilized by health care practitioners. If you suspect threat to life or limb, go to the emergency room! If you suspect hip referral, go to the emergency room and avoid weight-bearing. If your child has knee pain, be prepared to relay information related to location, chronology (when did it start, was there a traumatic event, what happened), and modifying activities (what makes it better, what makes it worse), in addition to other information. Understanding is a powerful health resource for you and your family.

References

Wolf, M. (2016). Knee pain in children: part 1: evaluation. Pediatrics in Review, 37(1), 18-24, doi: 10.1542/pir.2015-0040

Wolf, M. (2016). Knee pain in children, part 2: limb- and life-threatening conditions, hip pathology, and effusion. Pediatrics in Review, 37(2), 72-77, doi: 10.1542/pir.2015-0041