A 15-year-old soccer player presents with complaints of gradually increasing pain and swelling on the anterior aspect of the left knee/top of the shin. The patient reports that the pain is aggravated when he crouches down or when he kneels down and that he has noticed a lump forming there. He also reports that his knee pain is relieved by resting his knee in the extended position. The patient reports no previous history of knee problems, and has medical and surgical history are both unremarkable. Upon questioning, the patient denies any history of the knee giving away, or locking.
Do you have enough information at this point to make a provisional diagnosis?
This subjective history has all the hallmarks of Osgood-Schlatter disease -- a traction periostitis of the tibial apophysitis type.
What tests and measures will you be using in the physical examination to confirm the diagnosis?
The tests and measures used to diagnose this type of injury include palpation (pinpoint tenderness over the tibial tuberosity, and mild swelling), passive range of motion (limitation of end range knee flexion secondary to pain), resisted testing (resisted knee extension reproduces pain), and positive Ely test.
The physical examination revealed the following positive findings:
- Postural examination reveals bilateral pronation of the feet.
- Prominence over the left tibial tubercle.
- Palpation reveals pinpoint tenderness over the left tibial tuberosity.
- Limitation of passive left knee flexion secondary to pain.
- Pain reproduced at 120° of active left knee flexion.
- Pain with resisted left knee extension.
- Neurologic tests all negative.
Did the findings in the physical examination confirm your provisional diagnosis?
The findings from the physical examination should have confirmed a diagnosis of Osgood-Schlatter disease.
What is the difference between epiphysis and apophysis?
What causes Osgood Schlatter's disease?
What is the difference between Osgood Schlatter's disease and Sindig-Larsen-Johansson apophysitis?
What biomechanical foot deformity predisposes someone to develop Osgood Schlatter's disease?
How would you describe the prognosis for this condition to the patient?
What will be your planned intervention?