Module 68, General Orthopaedist Level
This 11 year old female presented to Orthopaedic Clinic complaining
of right knee pain . There was no history of trauma. This pain increased
with activity and decreased at rest and had been present for approximately
one year. A past history of osteomyelitis of the right tibial shaft at
age two was elicited. This infection was treated with IV antibiotics and
the child had no problems until the recent symptoms started one year ago.
When asked to localize the pain the patient pointed directly to the tibial
tubercle. Prominence of the right tibial tubercle was noted as compared
to the left.. The tibial tubercle was warm, slightly red, swollen and tender
to palpation. There was pain with resisted knee extension but no pain to
passive knee range of motion. There was no joint line tenderness or effusion.
The right knee had full range of motion with no hamstring or quadriceps
tightness. There was no instability to varus or valgus stress. Lochman
and MacMurray tests were negative. There was no pain to palpation over
the infrapatellar ligament and patellar tracking was normal.
Question 68A
This indicates a small sequestrum from her previous osteomyelitis.
Question 68B
This
girl should be given Feldene 20 mg daily orally for 4 weeks with activity
limitation to avoid jumping sports.
Question 68C
Sindlig-Larsen-Johansson
Disease is a like diagnosis in this girl.
Question 68D
The
above condition was discovered simultaneously by Robert Bayley Osgood (1873-1956)
at Boston General Hospital and Carl Schlatter (1864-1934) in Zurich, in
1903. They described the condition as analogous to Perthes disease of the
hip which occurs in the tibia. This continues to be the current understanding.
Question 68E
If
this girls symptoms disappear no further follow up is indicated.
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