A 12-Year-Old Male with a 6-Month History of Knee Pain and Swelling

Differential Diagnosis

• Chondromalacia patellae
• Infectious apophysitis
• Osgood-Schlatter disease
• Patellar tendon avulsion/rupture
• Sinding-Larson-Johansson syndrome

Diagnosis

• This patient was diagnosed with Osgood-Schlatter disease, which is seen in active adolescents—especially those who engage in pursuits that entail jumping and kicking
• Diagnosis is clinical and can be achieved without imaging; however, plain radiographs can be obtained to rule out other etiologies
• In advanced disease, images may show radiodense fragments or ossicles separated from the tibial tuberosity

 

Learnings/What to Look for

• Osgood-Schlatter is bilateral in 25% to 50% of patients
• Age of onset may be slightly earlier in girls (8–12 years of age) than in boys (10–15 years of age)

 

Pearls for Urgent Care Management and Consideration for Transfer

• First-line treatment for Osgood-Schlatter disease is conservative and nonsurgical. It includes:
  • Ice treatment for 20 minutes every 2 to 4 hours
  • Analgesics and nonsteroidal anti-inflammatory drugs for pain and inflammation
• Longer-term treatment approaches include:
  • Reducing physical activities that increase symptoms
  • Exercises to strengthen the quadriceps and hamstrings

 

Acknowledgement: Images and case provided by Teleradiology Specialists, www.teleradiologyspecialists.com.