Clinical Musings (Adolescents) II

We will continue with our discussion of adolescent conditions and injuries that we often see in the clinic.

A year ago a young boy and his father came to the clinic. The boy was 11 years old and was a basketball player. He stated that he plays basketball everyday before and after school. He stated that he was starting to feeling pain in his knees. He stated that this pain is worsening and that running and jumping are extremely painful. His father stated that he holding his son from basketball at this time.

Upon inspection it was seen that the child's knee was indeed swollen at the tibial tuberosity, which can be seen below. This is the structure that anchors your knee cap and the entire quadriceps muscles to the rest lower leg. There is a growth plate at this point and is commonly irritated in growing children. It was also seen that the boy's tibial tuberosity was extremely tender to the touch. He also presented with significant tightening of the quadriceps muscles with testing. What this child was experiencing was Osgood-Schlatter's disease (OS).

http://en.wikipedia.org/wiki/File:Gray345.png

Much like Sever's Disease (Discussed last week), Osgood-Schlatter's disease is a terrible name for a somewhat common condition. Much like Sever's Disease, OS is not a disease at all,  but an apophysitis (please see my last post for more information about apophysitis). Instead of a apophysitis of the heel, OS is an apophysitis of the patella tendon. This condition is also caused by rapid bone growth that muscles and tendons cannot keep up with leading to pulling on the growth plate of the tibial tuberosity. 

If left untreated this condition can lead to progressive bone growth at the tibial tuberosity and eventual deformation of the structure. As seen below, the bone growth will become permanent and could cause life long irritation. 

http://en.wikipedia.org/wiki/File:MaleWithOsgoodSchlatter.jpg

The treatment for this condition holding the patient from all jumping and running activities. In the beginning ice is very important to decrease inflammation because NSAIDS (Advil other OTC anti-inflammatories) are not always safe for adolescents. Progressive stretching of the quadriceps and manual mobilizations should also be done by a therapist. 

This patient was non-compliant with treatment and continued with basketball. He is now 15 and has a permanent deformation at the tibial tuberosity that is painful with most active movements.