Mini Mono

Author: Alison McInerney / Editor: Steve Fordham / Reviewer: Louise Burrows, Amanda King / Codes: A6, CC1Published: 06/05/2023

A 3-year-old girl presents to the Emergency Department (ED) with a swollen left knee, limping. The swelling had started 9 days previously but had not initially caused any distress. There was no significant history of trauma preceding the onset of symptoms.

After 2 days the GP had been consulted and referral was made to the Orthopaedic surgeons for review. The patient was seen by the orthopaedic SHO at this time and diagnosed with a soft tissue injury and discharged, no investigations were performed.

The swelling of the knee had continued to increase and was now limiting mobility and causing distress. The patient’s mother also mentioned a 3 day history of swelling of the right 4th toe. Past medical history and drug history were unremarkable. The patient lived on a smallholding with both parents and younger and older sisters.

On examination the patient was afebrile with no rashes or lympahdenopathy. She was fully weight-bearing with both feet flat to floor but with an antalgic gait. The left knee was markedly swollen with no erythema or heat and did not appear tender on palpation. There was no effusion but the knee was markedly stiff with a reduced ROM. Examination of the left hip and foot and ankle were normal. The right 4th toe appeared diffusely swollen with no colour changes and again was non-tender. The rest of the right foot and lower limb were normal.

X-rays of the left knee were requested.



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