13 year old daughter knee swelling? (scoliosis, skin, dermatologist, cancer)
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I agree with starting with PCP, as there are many things this could be, and you could miss something going straight to one particular kind of specialist first.
Osgood-Schlatter syndrome is one thing to consider, especially if she is active. It is basically damage to the knee from overuse during a growth spurt, affecting boys and girls around 11-14 ish. The tendon starts to separate from the knee and, as well as pain and swelling, you may see a large firm lump immediately below the knee from extra bone growth at the top of the tibia. My 13yo son just resumed playing soccer after a complete break for 8 months. He had pain over a number of months that I too thought was growing pain, but it got pretty debilitating and X-rays confirmed OS, with tiny fractures at the top of the tibia. Ceasing activity for a while is really the only way to treat it, plus painkillers/anti-inflammatories. More commonly affects one knee, but can be both. Will ultimately require surgical intervention if left untreated.
Another possibility if she is tall or has long limbs or digits is Marfan syndrome. It is a disorder of connective tissue that is often hereditary, but can also result from a self-mutating gene. Joint issues are often the first sign. My niece presented in virtually exactly the same way as your daughter at the same age and that's what she was diagnosed with in the end, but it took my sister pushing the doctor a bit to get him to even consider it as a possibility.
Good luck with this, it's hard as a parent to know when you really need to see a doctor. You get flak for being over-anxious if you take your kid to the doctor for what seem like garden-variety ailments needing only treatment at home, and you get flak if you don't take them and it turns out to be something more.
I still recommend PCP for a kid. This is a fairly common condition in kids. Probably easier to get an appt. too.
Not necessarily, my practice offers same day/next day service for Orthopaedic complaints and this is clearly an Orthopaedic complaint. Pediatrician will most likely refer to Ortho anyway...
You should take her to an Orthopaedic Surgeon not a Rheumatologist.....
How do you know it's orthopedic?
Quote:
Originally Posted by parentologist
Not clearly ortho. Could be Lyme, or jra. In any event, get her seen pronto.
Exactly. or worse, cancer.
I would still skip the PCP. They will likely put her on crutches or just pass her off to a specialist, in other words, a wasted trip/appointment/money. If it was acute, sure, but for lingering pain for a year, she needs to see a specialist, preferably one that works in a multi-specialty clinic so they can confer on a diagnosis/treatment without having to wait weeks to get into 3 or 4 different doctors.
I would still skip the PCP. They will likely put her on crutches or just pass her off to a specialist, in other words, a wasted trip/appointment/money. If it was acute, sure, but for lingering pain for a year, she needs to see a specialist, preferably one that works in a multi-specialty clinic so they can confer on a diagnosis/treatment without having to wait weeks to get into 3 or 4 different doctors.
Not what I, as a pediatric nurse of many years, would advise. Which specialist would you suggest she start with?
The PCP, with whom the family has a relationship, is the best IMO. At worst, s/he says "Nothing I can do anything about, make an appt. with Dr. X" and gives the parent a referral. I don't necessarily mean a written referral, though some insurances require that, but at least a business card. At best, the child has a condition s/he can treat.
Not clearly ortho. Could be Lyme, or jra. In any event, get her seen pronto.
Bilateral knee pain for over a year is the definition of an Orthopaedic complaint and an orthopedist is perfectly capable of making the diagnoses of Lyme or JRA if those truly were the cause...
Seeing an Orthopaedist is the most appropriate course for this complaint and something I as an Orthopaedic provider with many years experience would most definitely recommend....
I see kids with knee pain every day many brought directly by their parents and just as many referred by their pediatricians.....
There are "lots of things" knee pain could actually be and the most appropriate provider the one with most experience dealing with all types of knee issues is an experienced orthopedist...
I've lost count how many "knee pains" referred to me by other providers turned out to be other problems one of the most common being SCFE....
Quit guessing as damage could be going on. Could be numerous things. Primary dr needs to see her then he can make a referral. This would have to be done depending what insurance you have and what they require.Do it this week!!!!
Bilateral knee pain for over a year is the definition of an Orthopaedic complaint and an orthopedist is perfectly capable of making the diagnoses of Lyme or JRA if those truly were the cause...
Seeing an Orthopaedist is the most appropriate course for this complaint and something I as an Orthopaedic provider with many years experience would most definitely recommend....
I see kids with knee pain every day many brought directly by their parents and just as many referred by their pediatricians.....
There are "lots of things" knee pain could actually be and the most appropriate provider the one with most experience dealing with all types of knee issues is an experienced orthopedist...
I've lost count how many "knee pains" referred to me by other providers turned out to be other problems one of the most common being SCFE....
OK, having read through all the comments, I still stand by my recommendation to start with the ped; however, if the parent wants to start with an ortho, I think that's OK, if the insurance allows it.
OK, having read through all the comments, I still stand by my recommendation to start with the ped; however, if the parent wants to start with an ortho, I think that's OK, if the insurance allows it.
Would add that if OP is going to start with Ortho, they should see a pediatric orthopaedic surgeon. Or maybe sports. She's an adolescent, so she's kind of on the bubble of whether or not many non pediatric surgeons would be willing to see her.
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