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Ask Dr. Rick – October 2010

October 11, 2010

Osgood-Schlatter’s Disease

Osgood-Schlatter’s is an osteochondrosis of the proximal tibial apophysis. Generally, Osgood-Schlatter’s disease is associated with the rapid growth of adolescence. The area of concern is where the patellar tendon inserts into the tibia or the shin bone, and commonly, there is a large bump or knot that is extremely tender, painful and visible in the front part of the shin. The disease is more common in boys than girls. It is generally seen in boys around the age of 12 and girls around the age of 10. It develops due to an apophysis or growth plate where the patellar tendon inserts into the tibia and pull or stress related to jumping activities, running activities and twisting activities create damage to the insertion. Approximately 40 percent of adolescents will have bilateral complaint and commonly it is so uncomfortable the athletes will limit their activities due to pain. Upon seeing a physician, plain radiographs are taken and this will help make the diagnosis.

The treatment for Osgood-Schlatter’s disease is activity modification, not activity elimination, ice, nonsteroidal anti-inflammatory medications and possibly a light brace. If the pain is recalcitrant and does not improve with conservative measures, a cylinder cast to rest the patellar tendon insertion site will resolve the pain in almost every case. Pathology lasts for one to two years and resolves as the athlete nears skeletal maturity. In approximately a one-third of the cases, a large bump or ossicle will remain in the
anterior or front part of the tibia. This could become painful with kneeling or direct pressure and if symptomatic, the ossicle or bone can be removed.

In general, Osgood-Schlatter’s disease is self-limiting and resolves as the growth plate closes and is treated conservatively.

Ask Dr. Rick

“Dear Dr. Rick: I want to thank you for your column. It has been very, very helpful. My son, who is 4 years old, has popping in his elbow, and frequently when I hold his hand or pull on his arm, he gets discomfort in his elbow, won’t use his elbow. On three occasions, I have taken him to the doctor and the doctor has twisted or “reduced” his elbow and he subsequently is pain free. Could you please explain what is happening? Thank you very much.”
– Myra, Washington, MO

Dear Myra: This is very typical for nursemaid’s elbow. What occurs is a dislocation or subluxation of the radial head which is reduced. Generally, when the child has an x-ray taken, the arm is rotated. They place the arm on the x-ray cassette, and this generally causes the radial head to return to its normal position. It is important to try and limit the number of episodes, and as your child matures, this will resolve. If this does not resolve, I would suggest seeing an orthopedic surgeon or specifically, an orthopedic pediatric surgeon. Thank you for your question.

“Dear Dr. Rick: Over the last two years, I have had progressive pain in the ball of my foot near my great toe. I have lost range of motion and have trouble pushing off when I am trying to play tennis or climb stairs. The area near my great toe has gotten bigger and it is more difficult to wear soft-soled shoes. I am 62 years old, very active and do not want to give up my tennis or working out. I would very much appreciate your help on this.”
– Sy, Clayton, MO

Dear Sy: You are developing what is called hallux rigidus, which is an arthritic condition in your great toe that decreases your range of motion and progresses with spurring in the area of the great toe. Initially, this is treated conservatively with anti-inflammatories and possible cortisone injection. If this does not improve, there are a number of surgeries to regain your motion, resect the spur and decrease the arthritic component that is creating the pain. I suggest you see an orthopedic surgeon or podiatrist and start treatment before this progresses to inhibit your activities. This will not get better on its own and commonly conservative treatment can make this substantially better. Keep playing tennis. Thank you for your question.

The tip of the month includes a multivitamin and one baby aspirin a day to maintain good health.

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