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
