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Kid unable to walk. Leg pain, swollen knee. Prescribed PCM. Slight improvement. Suggestion?

My son is 4 yrs old. wt 15.0 kg ht 102 cm. He was very active. On 11 April after waking up he complained leg (left) pain and unable to get up by its own. He is unable to walk till now. There is no sign of external injuries but it looks mild swelling on left knee. I had consulted a pediatric specialist. He has given PCM and kept him under 3 days observation. Today there is significant improvement. He is standing up, moving the leg and fingers normally but still unable to walk. I need your advice.
Asked On : Tue, 16 Apr 2013
Answers:  3 Views:  35
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Pediatrician 's  Response

Thanks for writing to health care magic.

Is it only pain or there is obvious swelling of the knee joint.

Does your kid have any joint swelling?

Are any other joints also involved?

Is there any redness of the joint?

Is there increased warmth of the joint?

Did he have any history of sore throat in the recent past?

If your kid has any of the above we cannot just wait with simple paracetamol and he needs to be investigated further.

Please reply in detail so that we can help you better.
Take care.
Answered: Tue, 16 Apr 2013
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Pediatrician, Critical Care Dr. Tejas Shah's  Response
Thanks for posting your query here.

It is difficult to pinpoint exact cause for this issue. There could have been an injury or sometimes a virus/bacteria infection can also lead to infection of the joint leading to swelling and restriction of the movements.

Is he been running any fever?
Has he suffered any recent infection like cough/cold/diarrhoea-vomiting?

I would suggest continuing same medications for now. If things still not settle within next 48 hours, your son needs to have a Ultrasound scan of the knee and hip joint to rule out inflammation/infection of the joint.

Please do revert back if things don't improve or if you have further queries.

Dr Tejas Shah
Answered: Tue, 16 Apr 2013
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Pediatrician Dr. Himanshi Kashyap's  Response

From the history you have given looks like your son must be suffering from toxic synovitis which commonly happens post viral infection and usually improves in a weeks time with anti inflammatory.

Since your son is now able to stand but still not able to walk you must keep a watch on the swelling and whether there is increased inflammation or appearance of fever which would indicate an infection for which you might need to get him examined by a orthopedic doctor.

Take Care
Answered: Tue, 16 Apr 2013
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