Osgood-Schlatter Disease
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A 13-year-old footballer presented with pain in both knees. Based on the history and physical examination findings, the patient likely has Osgood-Schlatter disease, a common knee condition in young athletes. This disease involves inflammation of the tibial tuberosity, a bony protrusion below the kneecap where the patellar tendon attaches. Conservative treatment including rest, ice, compression, elevation and medications is usually effective in relieving symptoms within 6-18 months. Surgery is rarely required.
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Osgood-Schlatter Disease
- 1. A 13-year-old footballer Pain in both knees
- 2. Objectives: What is the tuberosity ? What is its function ? What is the probable causes of the patient’s complaints? Could there be a malignancy? What diagnostic will you use ? What treatment is indicated : operative, conservative or observation?
- 3. A large tubercle or rounded elevation(a projection or protuberance), especially from the surface of end of a bone . Tuberosity:
- 4. Tibial tuberosity function: Location : At the superior end of the TIBIAL anterior border Function : provides distal attachment for the patellar ligament, which stretches between the inferior margin of the patella and the tibial tuberosity .
- 5. A hard, bony protuberance can be felt at the level of the tuberositas tibiae in both legs. Tibiae Tuberosity
- 6. What is the probable causes of the patient’s complaints? Could there be a malignancy?
- 8. Osgood-Schlatter disease is a painful condition that usually affects the rapidly growing knee. The bony knob just below the kneecap, where the tendon attaches to the leg bone (shinbone, or tibia), becomes painful.
- 9. occurs in young athletes because of too much stress on the knee. This disorder occurs more often in boys, at (13 and 14 years of age).
- 10. The bony knob just below the kneecap becomes inflamed and Bony knob
- 11. Cause of the patient’s complaint NO malignancy involved in this case.
- 12. Diagnosis
- 13. History The typical symptoms. Physical examination findings. will check the knee for tenderness, swelling, pain and redness
- 14. The typical symptoms. Painful swelling over a bump on the lower leg bone (shinbone). leg pain or knee pain , which gets worse with running, jumping, and climbing stairs. History:Diagnostics of choice
- 15. Diagnostics of choice Extending the knee against resistance Evaluation of range of motion of the hip to make sure that the knee pain is not related Pain on examination may be reproduced by Squatting with the knee in full flexion Straight-leg raising usually is painless
- 16. An x-ray can confirm the diagnosis. Radiographs Plain radiographs are obtained to exclude other conditions (eg, tibial apophyseal fracture, tumors, osteomyelitis) in patients who have atypical features.
- 17. Treatment Indicated : operative, conservative or observation?
- 18. Treatment Benign and a self-limiting condition. 90% of patients treated with conservative care were relieved of all of their symptoms approximately 1 year (or 6 to 18 months ) after onset of symptoms.
- 19. Goal: Control of pain and swelling. Continuation of activity. Physical therapy (to strengthen the quadriceps and improve quadriceps and hamstring flexibility).
- 20. Treatment involves: RICE. Rest, Ice, Compressing, and Elevating the area. Medication .
- 21. RICE: R = Rest the knee from the painful activity.
- 22. I = Ice the affected area for 20 minutes, 3 times a day. C = Compress the painful area with an elastic bandage. RICE
- 23. E = Elevate the leg. A suitable program can be provided by a physiotherapist RICE
- 25. Summary:
- 26. Medication : Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) may be given for pain relief and reduction of local inflammation. Most use : Acetaminophen or ibuprofen
- 27. Surgical Management Excision of intra-tendon ossicles. Tibial sequestrectomy.
- 28. Interesting Facts About OSD:• 15% of teenage suicides occur due to depression caused by OSD during the game seasons • OSD has been proved to occur in dogs! (though a new system of classification of the disease is required)
- 29. Quiz
- 30. • osgood schlatter's disease is osteochondritis of ? a- tibial tubercle b- femoral head c- lunate d- capitulum of humerus
- 31. • osgood schlatter's disease is osteochondritis of ? a- tibial tubercle b- femoral head c- lunate d- capitulum of humerus
- 32. TAKE CARE OF YOUR KNEE
Editor's Notes
- http://www.wisegeek.org/what-does-tibial-tuberosity-mean.htm A large tubercle or rounded elevation, especially from the surface of a bone.
- At the superior end of the anterior border, a broad, oblong TIBIAL TUBEROSITY provides distal attachment for the patellar ligament, which stretches between the inferior margin of the patella and the tibial tuberosity . The tibial tuberosity/tibial crest projects cranially from the proximal part of the shaft and is an important palpable landmark
- In this case, the patient’s complaints meet with a condition called (Osgood-Schlatter Disease ) This condition: Causes pain at the tibial tuberosity or bony bit at the top of the shin. usually caused by overuse and irritation of the tendon ( the patient is a footballer ) common in teenagers (13 and 14 years of age). (our patient is a 13 Y\O)
- The physical examination is very specific, with point tenderness over the tibial tubercle. Other physical examination findings may include the following: Proximal tibial swelling and tenderness Enlargement or prominence of the tibial tubercle Reproducible and aggravated pain by direct pressure and jumping (quadriceps contraction) Pain with resisted knee extension (quadriceps contraction) Full range of motion of the knee Hamstring tightness No effusion or meniscal signs Negative Lachman test (no knee instability) Normal neurovascular examination No abnormal findings in the hip and ankle joints Tenderness to palpation over the proximal tibial tuberosity at the site of patellar insertion may be present. A firm mass may be palpable. Erythema of the tibial tuberosity may be present. Some patients may have quadriceps atrophy.
- DIAGNOSTIC EVALUATION — The diagnosis of Osgood-Schlatter disease is made by clinical examination. Radiographs are not necessary unless the patient has atypical complaints (pain at night, pain that is unrelated to activity, acute onset of pain, associated systemic complaints) or pain that is not directly over the tibial tubercle. (See 'Imaging' below and 'Differential diagnosis' below.) During the physical exam, your doctor will check your child's knee for tenderness, swelling, pain and redness. X-rays may be taken to look at the bones of the knee and leg and to more closely examine the area where the kneecap tendon attaches to the shinbone
- X-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. http://www.medicinenet.com/osgood-schlatter_disease/article.htm can be diagnosed clinically based on the typical symptoms and physical examination findings. X-ray testing is sometime performed in order to document the status of the calcification at the insertion of kneecap (patellar) tendon. During the physical exam, your doctor will check your child's knee for tenderness, swelling, pain and redness. X-rays may be taken to look at the bones of the knee and leg and to more closely examine the area where the kneecap tendon attaches to the shinbone http://www.mayoclinic.org/diseases-conditions/osgood-schlatter-disease/basics/tests-diagnosis/con-20021911 Overview Risk Factors Symptoms Diagnosis Treatment Complications What Is Osgood-Schlatter Disease? During the growth spurts of adolescence, certain muscles and tendons can cause pain or discomfort. Osgood-Schlatter disease is a condition connected to these growth spurts, specifically affecting the knee. This condition is typically diagnosed in growing adolescents, especially boys ages 10 to 15. Teenage athletes engaged in sports involving a lot of jumping or running tend to be more susceptible to this condition. Osgood-Schlatter disease (OSD) is caused by irritation of the bone growth plate in the area of the tibial tuberosity, which is the top part of the shinbone (tibia) right under the knee. This irritation results in a painful lump in that area, which is the main sign of OSD. In medical terms, the lump is called a “bony prominence of anterior the tibial tubercle,” caused by a traction tendinitis. It is believed that as the bone at the top of the tibia becomes hardened (ossified), it also becomes more vulnerable to the effects of repeated forceful traction through the attached patellar tendon. This area will be tender to the touch and can make kneeling quite painful. Who Gets Osgood-Schlatter Disease? Individuals who play sports like basketball, volleyball, soccer, long-distance running, and gymnastics are also more likely to develop OSD than those who do not participate in these activities. More boys than girls are affected with the condition. This is changing, though, because more and more girls are participating in sports during adolescence. According to the Mayo Clinic, OSD affects nearly one in five teenage athletes (Mayo, 2011). Recognizing the Symptoms of Osgood-Schlatter Ads by SpeeditUpAd Options Ads by OffersWizardAd Options Common symptoms of OSD include: knee or leg pain painful or tender swelling on the shinbone pain gets worse with impact activities like running or STAIRS Some individuals experience symptoms of OSD for several years. The symptoms typically resolve once the growth spurt of adolescence is finished. How Is Osgood-Schlatter Diagnosed? A physical exam will typically be able to provide a physician with enough information to make a diagnosis of OSD. If you suffer pain when you try to kneel, your doctor will probably suspect this disease. Sometimes a bone X-ray will be performed in order to rule out other potential causes of your knee pain. http://www.healthline.com/health/osgood-schlatter-disease How is Osgood-Schlatter disease diagnosed? Your doctor will examine your child and discuss his or her symptoms. Your doctor may also want to get a knee X-ray to make sure the pain isn't caused by something else DIAGNOSTIC EVALUATION — The diagnosis of Osgood-Schlatter disease is made by clinical examination. Radiographs are not necessary unless the patient has atypical complaints (pain at night, pain that is unrelated to activity, acute onset of pain, associated systemic complaints) or pain that is not directly over the tibial tubercle. (See 'Imaging' below and 'Differential diagnosis' below.) Examination — A description of the complete knee examination for children and adolescents is provided separately. (See "Approach to the child or adolescent athlete with acute knee pain or injury", section on 'Physical examination'.) The characteristic examination findings of Osgood-Schlatter disease include tenderness and soft tissue or bony prominence of the tibial tubercle [17]. Pain may be reproduced by extending the knee against resistance, stressing the quadriceps, or squatting with the knee in full flexion [19]. Straight-leg raising usually is painless. Pain that is more prominent in the patellar tendon than the bony prominence is suggestive of patellar tendinopathy (jumper's knee) [20]. (See "Causes of chronic knee pain in the child or adolescent athlete", section on 'Tendonitis'.) The hamstrings may be shortened and the quadriceps taut. Quadriceps flexibility is assessed by passively flexing the knee with the patient prone (ie, the Ely test) (figure 3). The range of motion of the knee is not affected, and the knee and patellofemoral joints are stable [19,21]. The remainder of the knee examination is usually normal. Erythema and warmth of the tibial tubercle, which suggest an acute inflammatory process, require additional evaluation (eg, for osteomyelitis). However, these findings must be interpreted with caution in patients who have used an ace wrap or heating pad before presenting for evaluation [21,22]. Examination of patients with knee pain should include evaluation of range of motion of the hip to make sure that the knee pain is not related to referred pain from pathology in the hip (eg, due to slipped capital femoral epiphysis, Legg-Calvé-Perthes disease) [23]. (See "Overview of hip pain in childhood", section on 'Examination'.) Imaging — It is not necessary to obtain radiographs in patients with clinical findings characteristic of Osgood-Schlatter disease. Plain radiographs are obtained to exclude other conditions (eg, tibial apophyseal fracture, tumors, osteomyelitis) in patients who have atypical features. Computed tomography or magnetic resonance imaging is not indicated. (See 'Differential diagnosis' below.) Atypical features include, but are not limited to [21-23]: ●Erythema or warmth in addition to pain at the tibial tubercle is suggestive of an inflammatory process, such as osteomyelitis. (See "Hematogenous osteomyelitis in children: Clinical features", section on 'General clinical features'.) ●Acute onset of pain (particularly after an injury) may indicate avulsion fracture of the tibial tubercle [24]. (See "Proximal tibial fractures in adults", section on 'Tibial tubercle avulsions'.) ●Pain at night, rest-related pain, mechanical symptoms (catching or locking), associated systemic complaints, and/or tenderness that is not directly localized to the tibial tubercle may indicate tumor, infection, or osteochondritis dissecans. (See "Clinical assessment of the child with suspected cancer", section on 'Bone and joint pain' and "Hematogenous osteomyelitis in children: Clinical features", section on 'General clinical features' and "Osteochondritis dissecans (OCD): Clinical manifestations and diagnosis", section on 'Clinical manifestations'.) The radiographic findings of Osgood-Schlatter disease are best depicted on the lateral radiograph. The findings are nonspecific and must be correlated with clinical findings to make the diagnosis. Soft tissue swelling anterior to the tibial tubercle may be the only abnormality (image 1). Other signs may include [7,19]: ●Elevation of the tubercle away from the shaft ●Irregularity, fragmentation, or increased density of the tubercle ●A superficial ossicle in the patellar tendon ●Calcification within or thickening of the patellar tendon These findings may be difficult to distinguish from normal variation in the ossification of the tubercle. One or more ossicles may be present but may be normal variants [25]. Changes in the surrounding soft tissues and the infrapatellar FAT pad may be more reliable diagnostic features [26]. DIFFERENTIAL DIAGNOSIS — Osgood-Schlatter is one in a spectrum of conditions that cause anterior knee pain in children and ad
- OSD is a self-limiting condition. In a study by Krause et al, 90% of patients treated with conservative care were relieved of all of their symptoms approximately 1 year after onset of symptoms
- Conservative measures for Osgood-Schlatter disease include control of pain and swelling, continuation of activity, and physical therapy (to strengthen the quadriceps and improve quadriceps and hamstring flexibility)
- R = Rest the knee from the painful activity. I = Ice the affected area for 20 minutes, 3 times a day. C = Compress the painful area with an elastic bandage. E = Elevate the leg.
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- Surgical Excision of intra-tendon ossicles. Tibial sequestrectomy. esistant to conservative measures