Pictorial case study: Osgood-Schlatter's disease

A 14-year-old boy presented with his mother. He had noticed pain below his right knee for a few weeks and more recently a tender swelling. He was a very keen sportsman and was otherwise well.

 

On examination, there was a very prominent tender lump over the upper tibia which was tender to touch. Knee examination was normal and movements were full and pain-free. What is the diagnosis, management and differential diagnoses?

Diagnosis and management

The diagnosis is Osgood-Schlatter’s disease or traction apophysitis of the tibial tuberosity. It is an overuse condition affecting young teenagers (mainly boys) and is uncommon over 16 years. It is most common in those who frequently play sports.

The diagnosis is clinical and no diagnostic tests are needed. It usually resolves in a few months with rest. Analgesia may be required in some cases. If the problem persists, refer for physiotherapy. If it persists for two years or more, then refer for the knee to be immobilised in a plaster cast.

Possible different diagnoses

Avulsion of the tibial tubercle.

Jumper’s knee.

Sindig-Larsen-Johanssen disease.

Differential diagnosis

Avulsion of the tibial tubercle

More common in 12–16-year-olds.

Swelling, pain and tenderness over the tuberosity.

Compartment syndrome may occur.

Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire

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