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Osgood - Schlatter disease - Coggle Diagram
Osgood - Schlatter disease
definition
disease of the apophysitis of the tibial tuberosity that causes anterior knee pain during adolescence and is usually self limiting. occurs as a result of repetitive strain from the patella tendon. usually unilateral but can affect both knees in 20-30% of people
risk factors
age - more common in children undergoing spurts with symptoms peaking in boys at age 12-15 years, and girls at about 8-12 years
sporting activity - children active in sports including running, jumping and repetitive bending of the knee
biomechanical risk factor - such as quadriceps muscle tightening and reduced flexibility of hamstring muscle, in particular shortening of the rectus femoris
male gender
when to suspect
if no other features to suggest another clinical cause of knee pain then osgood-schlatter disease may be diagnosed
exclude other causes of knee pain - trauma, systemic symptoms, bone or joint pain, pain at rest and referred pain
if serious alternative cause is suspected refer urgently yo specialist assessment or arrrange investigations
typical pain associated with Osgood-schlateer disease starts in adolescence and is: localised to the tibial tuberosity, gradual in onset and initially mild and intermittent but may progress to become severe and continuous
tends to be unilateral but may be bilateral in up to 30% of people
relieved by rest and made worse by kneeling and activity such as running, jumping, or kneeling
finding associated with Osgood-Schlatter disease on examination
tenderness over the tibial tuberosity
pain provoked by resisted knee extension
tightness of the quadriceps and hamstrings
swelling or bony enlargement of the tibial tuberosity
normal passive movement
the absence of effusion
do not routinely x ray the knee to confirm a diagnosis of Osgood-Schlatter disease - x ray tend to be normal or may demonstrate anterior soft tissue swelling, thickening of the patellar tendons, fragmentation of the tibial tubercle or ossicle
differential diagnosis
several other possible causes of knee pain can present with features similar to Osgood-Schlatter disease - if serious alternative cause is suspected urgent investigation of refer to specialist services may be appropriate
tumour - bone tumour are rare cause of knee pain that is typically severe, persists at night or are rest and may be associated with bone or joint pain at other sites may be associated with systemic features such as weight loss or general malaise
inflammatory arthritis - juvenile idiopathic arthritis
referred pain from hip
trauma
infection
other causes - osteochondritis, dissecans, patellofemoral pain syndrome, chondromalacia patellae and patella dislocation
management
explain the diagnosis and signpost to sources of information
advise about options that may provide pain relief if needed. these include: analgesia and NSAIDS
intermittent application of ice packs
protective knee pads
advise the person or their parent/carer that they will not usually need to stop sporting activity, a reduction in activity may be significant to control pain
advise them to continue taking exercise but to seek advise if symptoms worsen
modify exercise if having difficulty tolerating their usual exercise, may include reducing exercise duration, frequency or intensity
if symptoms recur advise them to stop exercise or reduce their intensity
management of persistent symptoms
for people whose symptoms do not improve or worsen: reassess the possible cause of knee pain and refer for specialist assessment to a paediatrician or orthopaedic surgeon if diagnosis uncertain
consider referral to physio who may provide advise on stretching
strengthening and reducing muscle imbalance of the quadriceps, hamstrings, calf muscles and iliotibial band
for people whose symptoms persist into adulthood, refer for specialist assessment to an orthopaedic surgeon, if symptoms severe consider surgical treatment
advise that protective knee pads may be useful to relieve pain on kneeling