Limping Child

Maryam AL-

Qahtani

A 13-year-old footballer

Pain in both knees

A hard, bony protuberance can be felt at the level of the tuberositas tibiae in both legs.

Tibiae Tuberosity

Objectives:

What is the tuberositas? 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?

A large tubercle or

rounded elevation(a

projection or

protuberance),

especially from the

surface of end of a bone

.

Tuberosit

as:

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 .

What is the probable

causes of the patient’s

complaints? Could there

be a malignancy?

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.

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).

The bony

knob just

below the

kneecap

becomes

infalmed and

painful.

Bony knob

Cause of the patient’s complain

NO malignancy involved in this case.

Diagnosis

History

The typical symptoms.

Physical examination

findings.

will check the knee for tenderness,

swelling, pain and redness

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

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

An x-ray can confirm

the diagnosis.

Radiographs

Plain radiographs are obtained to exclude other conditions (eg, tibialapophyseal fracture, tumors, osteomyelitis) in patients who have atypical features.

TreatmentIndicated : operative, conservative or

observation?

Tre

atm

en

t

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.

Goal:

Control of pain and swelling.

Continuation of activity.

Physical therapy (to strengthen the quadriceps and

improve quadriceps and hamstring flexibility).

Treatment involves:

RICE.Rest, Ice, Compressing, and Elevating the area.

Medication .

RICE:

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.

RICE

E = Elevate the leg.

A suitable

program can be

provided by a

physiotherapist

RICE

Summary:

Medication :

Analgesics and nonsteroidal anti-inflammatory drugs

(NSAIDs) may be given for pain relief and reduction of local

inflammation.

Most use :Acetaminophen or ibuprofen

Surgical Management

Excision of intra-tendon

ossicles.

Tibial sequestrectomy.

Quiz

I have Osgood-Schlatter disease .My Treatment Indicated :

operative

conservative

observation

What is most plain radiographs are obtained to exclude other conditions in patients who have atypical features of osgood-schlatter disease ?

Osgood-schlatter disease is a painful condition that usually affects the

rapidly growing knee.

Caused by small injuries due to repeated overuse.

The diagnosis of osgood-schlatter disease is made by clinical examination.

X-ray (plain radiographs )are obtained to exclude other conditions .

Treatment :conservative care.

References:

Osgood-Schlatter disease –up to data .

http://www.nlm.nih.gov/medlineplus/ency/article/001258.htm

http://emedicine.medscape.com/article/1993268-treatment.

http://www.mayoclinic.org/diseases-conditions/osgood-schlatter-disease/basics/causes/con-20021911

http://familydoctor.org/familydoctor/en/diseases-conditions/osgood-schlatter-disease/treatment.html

Goodbyes are not forever. Goodbyes are

not the end . They simply mean I will miss you, until we

meet again!