A 12-years-old male patient not known to have any medical illness previously brought to the clinic with his parent with recent new onset of limping and right knee pain, no history of trauma, no history of involvement in aggressive sports. The knee pain started two weeks back more at the medial side of the knee no related to movement of the joint, constant pain and not improved by resting.
No previous medical illness, no surgical history.
foot progressing angle: Mild external rotation right foot
Hip: mild groin tendernss and lateral hip
ROM: mild limitation in internal rotation, normal flexion and extension, no spastisty
Knee: diffuse medial side tenderness, no signs of infection, normal ROM
Ankle and subtalar joint: normal
Foot: normal foot thigh angle, no MTA
Spine: normal, no midline deformity, no abnormal hairy patches or lesions
Distal neurovascular intact
Reference: Paediatric Knee Radiographs: Normal Appearances of the Knee Joint in the Growing Patient
Reference: Early diagnosis of slipped capital femoral epiphysis on magnetic resonance imaging: A case report with review of literature
What findings can be seen on diagnostic imaging? What are the next best steps in management?