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Child has swelling in knee, difficulty walking, painful. History of Osgood-schlatters of knee. How can I help her?

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My daughter is 12 yo, 5 feet 5 inches and is hypermobile. Her sister had a history of Osgood-schlatters of both knees ata ge 8, then went on to be diagnosed with bilateral patello femoral dysfunction. There has been no injury/surgery.

Last year in Sept, my 12yo had acute swelling in one knee, less obvious in the left knee, intense pain and difficulty walking. The gp said it wasnt exactly like her sisters bilateral patello issue, but was similar enough to be the same thing. Took her to the physio, who said it was the worst case she had ever seen, and wouldnt touch her until the swelling subsided. Went on to do resistance and strengthening exercises and issue resolved by December. There have been a few flare-ups since then, but none as bad. Skip forward to April this year - diagnosed with compex regional pain syndrome in her hands - presented as mottled, hampered fine motor skills, cold skin, extreme sensitivity to touch. Ok, on Thursday night, she was in pain with the knees, Friday morning extreme swelling, warm to touch, had difficulty walking. All consistent with the patello issue, but she is now experiencing acute pain at rest, together with acute pain with light touch. She cried herself to sleep at midnight, after having ibuprofen 5-hourly, and says she feels like a cat is scratching her from the inside. When the pains hit, she looks as if someone is pricking her with a pin, or being shocked.
All blood tests were normal, apart from a slightly elevated rheumatoid factor (15 in Dec, 18 in April).
Is it likely it was the onset of CRPS in the Knees 12 months ago rarther than the hands 4 months ago, or what else could it be? Apart from Physio and anti-inflammatories, how can I help her? Thanks
Posted Sat, 15 Sep 2012 in Child Health
Answered by Dr. Taher Kagalwala 12 hours later

This is indeed a most distressful tale of an otherwise normal adolescent suffering from debilitating attacks of pain. Initially, the doctors thought it to be a patello-femoral syndrome, which is usually self-limiting and goes away in most sufferers as the child grows to maturity; later, the diagnosis has been revised to CRPS, an illness of uncertain cause that does not have quite the rosy outcome that the other illness has, and definitely not as good an outcome as Osgood-Schlatter disease.

I can say that your daughter is already receiving two of the four recommended therapies, viz. medication and physiotherapy. Plus, she is voluntarily taking rest when the pain becomes unbearable. Now, she should also use ice applications to the knee to reduce pain. In the longer term, sports medicine and orthopedic specialists also recommend surgery to remove or cut the nerves that innervate the affected part, but mixed results have been the outcome, with some individuals experiencing more, rather than less, pain after the surgery.

Before we sort of "give up" on her knees, it might be prudent to go in for bone scans, treat her with bone-strengthening medicines like calcium and phosphonates, a trial of steroids to reduce the inflammation, and cognitive-behavioural therapy.

I also recommend that you see a sports medicine doctor to confirm or rule out CRPS as a diagnosis.

With warm regards and a prayer for your daughter,

-Dr. Taher
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