www.medscape.org This article is a CME certified activity. To earn credit for this activity visit: http://www.medscape.org/viewarticle/749267 CME Information CME Released: 09/09/2011; Reviewed and Renewed: 09/30/2013; Valid for credit through 09/30/2014 Target Audience This activity is intended for clinicians in primary care, orthopaedic surgery, and pediatrics. Goal The goal of this activity is to reinforce and highlight common concepts, situations, and presentations that clinicians will encounter on a regular basis in order to provide supportive continuing education that illustrates real-world conditions and situations. Learning Objectives Upon completion of this activity, participants will be able to: 1. 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Author(s) Zoran Rajković, MD Primarius, Chief of Emergency Department; Head of the Traumatology and Orthopedic Surgery Department, Zabok General Hospital, Zabok, Croatia Disclosure: Zoran Rajković, MD, has disclosed no relevant financial relationships. Dr. Rajković does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States. Dr. Rajković does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States. Dino Papeš, MD Staff Physician, Department of Surgery, Zabok General Hospital, Zabok, Croatia Disclosure: Dino Papeš, MD, has disclosed no relevant financial relationships. Dr. Papeš does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States. Dr. Papeš does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States. Editor(s) Andréa B. Lese, MD Co-Director of Clinical Review, Medscape Reference Case Presentations; Resident, Department of Orthopedic Surgery and Rehabilitation, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut Disclosure: Andréa B. Lese, MD, has disclosed no relevant financial relationships. Jonathan N. Grauer, MD Associate Professor, Yale University School of Medicine; Co-Director, Orthopedic Spine Service, Yale-New Haven Hospital, New Haven, Connecticut Disclosure: Jonathan N. Grauer, MD, has revealed financial relationships with: Stryker; Medtronic, Inc.; Regeneration Technologies; Smith & Nephew; DePuy Orthopaedics Justin A. Siegal, MD MRI Section Head, Radiology, Virginia Mason Medical Center, Seattle, Washington Disclosure: Justin A. Siegal, MD, has disclosed no relevant financial relationships. Bruce Buehler, MD Professor, Department of Pediatrics, Pathology and Microbiology; Executive Director, Hattie B. Munroe Center for Human Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha Disclosure: Bruce Buehler, MD, has disclosed no relevant financial relationships. Craig A. Goolsby, MD Staff Physician, Department of Emergency Medicine, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas Disclosure: Craig A. Goolsby, MD, has disclosed no relevant financial relationships. Luis M. Soler, BA Editor, Medscape Reference, New York, NY Disclosure: Luis M. Soler, BA, has disclosed no relevant financial relationships. CME Reviewer(s) Nafeez Zawahir, MD CME Clinical Director, Medscape, LLC Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships. From Medscape CME Case Presentations A Teenage Athlete With a Painful Knee CME Zoran Rajković, MD; Dino Papeš, MD CME Released: 09/09/2011; Reviewed and Renewed: 09/30/2013; Valid for credit through 09/30/2014 Background Figure 1. Enlarge Figure 1. A 16-year-old boy is examined in the emergency department (ED) for acute-onset left knee pain and swelling. Two months ago, he suffered a patellar dislocation that was treated with rest, cryotherapy (ice), elevation, and immobilization. He recovered completely from this episode. The rest of his medical and surgical history is unremarkable. The family history is negative for knee problems or dislocations. He takes no medications on a regular basis and has no allergies. He is a high school student and a semiprofessional soccer player. This episode of knee pain started a week ago following a soccer match. The knee is moderately swollen and painful. At the onset of symptoms, the patient treated himself with cryotherapy, rest, and an elastic bandage, with mild improvement; however, the symptoms reappeared 3 days ago and have progressively worsened, prompting this visit to the ED. On examination, he appears to be in good condition. He is awake, alert, and in no acute distress. His vital signs show him to be afebrile, with a blood pressure of 125/75 mm Hg, a pulse of 75 beats/min, a respiratory rate of 15 breaths/min, and an oxygen saturation of 98% on room air. His skin is slightly pale but with normal skin turgor. Examination of his oral cavity shows dry mucus membranes. He has normal heart sounds. Auscultation reveals clear lungs without wheezes, rhonchi, or rales. The abdomen is soft and without tenderness, distention, masses, or hernias. Examination of the left hip is unremarkable, with normal range of motion noted. Examination of the left knee shows swelling with positive patellar ballottement indicating the presence of an effusion. The patient is holding his knee in mild flexion. On testing the range of motion, both terminal extension and flexion cannot be tested due to pain. Physical examination tests of the meniscus and ligaments are negative. The patient's workup includes a complete blood count (CBC), which is normal. In addition, x-rays of the knee are obtained (Figure 1), and an arthrocentesis is performed, yielding 30 mL of old blood. This is sent for cell count and culture,