Osgood-Schlatter Disease Sioux City
Young athletes complaining of pain and swelling on the tibial tuberosity might be suffering from a condition called Osgood-Schlatter disease. They describe a chronic soreness, localized to the upper shin bone, and exacerbated by running and jumping activities. The pain, tenderness, and location of swelling are characteristic and diagnostic of Osgood-Schlatter. Resisted knee extension increases the pain. Osgood-Schlatter can occur on both legs at the same time or just one leg.
Near the upper knee, the strong quadriceps muscle becomes the patellar tendon, which travels to the patella bone, or kneecap. The patellar ligament connects the kneecap to the tibia tuberosity. The patella ligament transfers forces from the quadricep muscle onto the tibia bone. Running and jumping sports place a significant amount of chronic repetitive stress on the tibial tuberosity. Until a person reaches skeletal maturity, a growth plate exists underneath the attachment site of the patellar ligament. This growth plate becomes aggravated and irritated with repetitive stress, so that it becomes a site of pain anytime stress is applied to the shin. Osgood-Schlatter disease can be confused with chondromalacia patella or patella tendonitis, but the location of pain indicates a different injury.
Rest, ice, and activity modification are important for treatment and recovery. Limiting running, jumping, and pounding forces allows the area to heal. Light stretching and strengthening can help stabilize the knee and relax the quadriceps. Osgood-Schlatter braces provide relief and reduce the pounding forces, but they will not solve the problem. Rest and time are the best treatment options. X-rays are not usually needed for evaluation. The pain, location, history, and aggravating factors provide enough clinical information for diagnosis. An x-ray may show mild swelling signs and possible increased space across a growth plate, but in most cases x-rays do not provide any benefit to diagnosis or treatment. The size of the growth plate may shock some parents, but it is probably normal for someone affected by Osgood-Schlatter. Eventually the bone will ossify (fuse) as the child becomes skeletally mature. An adult may have larger bumps at the tibial tuberosity, which does not increase the risk for future knee injuries.
For most athletes, Osgood-Schlatter pain improves with rest and icing. The injury will self-resolve over time. Further evaluation is not usually needed unless the athlete continues to aggravate the growth plate and knee pain.
As previously mentioned, ice and rest are the best therapies for reducing stress and strain. Braces during activity will help control pain symptoms. Therapy utilizing electricity and cold laser can be used to decrease some of the pain and inflammation. Proprioceptive or knee stabilization exercises can be incorporated into treatment to enhance recovery. However, most treatment provides only minimal relief to the patient. Most children are better off with rest and ice over time.
In severe cases, if the knee pain does not disappear with with rest, a bone avulsion may be suspected. In this event, follow-up x-rays can be taken, and reviewed by the radiologist. This occurs in a very small percentage of patients.