Osgood-Schlatter

Disease
Musculoskeletal
By: Christine Couperus-Mashewske

Definition of the Problem

Osgood-Schlatter disease is a painful swelling of the bump
on the upper part of the shinbone, just below the knee. This
bump is called the anterior tibial tubercle.
MedlinePlus, 2015

Pathophysiology
During adolescence (9-13) the tibia tubercle consists of
cartilaginous tissue. Then it begins to Ossify. Over the few years
when it is ossifying is when Osgood-Schlatter (OSD)disease
occurs most often. After the growth plate of the proximal tibia
fuse usually when aged 14-18, OSD usually subsides. The
commonly accepted theory regarding the development of OSD is
that repeated traction (traction apophysitis) on the anterior
portion of the ossification center leads to multiple subacute
fracture or tendinous inflammation, resulting in benign, selflimited disturbance manifested as pain, swelling, and tenderness.
Medscape, 2015

Etiology
Theories suggest that this condition is a result of
repeated knee extensor mechanism that causes partial
avulsions or miroavulsion of the chondrofibro-osseous
tibial tubercle.
During reparative phase of this stress fracture, new
bone is laid down in the avulsion space, which may
result in a deviated and prominent tibial tubercle.
When an individual with an injured tibial tubercle
continues to participate in sports, more and more
microavulsions develop, and the reparative process
may result in a markedly pronounced prominence of
the tubercle
Medscape, 2015
2015

Pictures: Imgur, 2015 & Patient.co.uk,

Incidence
One study found that OSD affected approximately 21% of
athlete adolescents surveyed, as compared with a
frequency of 4.5% in age-matched nonathletic controls.
One Finnish study found that OSD affected 13% of
athletes.

Medscape, 2015

Screening/ Risk factors

Age-Osgood-Schlatter disease occurs during pubertys
growth spurts. Age ranges differ by sex because girls
experience puberty earlier than boys. Osgook-Schlatter
disease typically occurs in boys 13-14 and girls 11-12.
Sex-Osgood-Schlatter disease is more common in boys,
but the gender gap is narrowing as more girls become
involved with sports.
Sports- The condition happens most often with sports
that involve a lot of running, jumping and swift changes in
direction; football, volleyball, basketball, hockey, soccer,
skating, gymnastics, and ballet.

Clinical Findings
The main symptom is painful swelling over a bump on the
lower leg bone (shinbone). Symptoms occur on one or both
legs.
There may be leg pain or knee pain, which gets worse with
running, jumping, and climbing stairs.
The area is tender to pressure, and swelling ranges from mild
to severe.
Pain increased with knee extension against resistance or
kneeling.
Erythema over tibial tuberosity. PEARL- only OSD hurts over
tibial tubercle.

Differential Diagnosis

Tibial plateau fracture

Infrapatellar bursitis
Patellar tendinitis
Stress fracture of the proximal tibia
Proximal tibial neoplasm
Patellar fracture
Domino, Frank (2013)-5-Minute Clinical Consult

Social/Environmental
Considerations
The involvement with repetitive- jumping sports such as
football, volleyball, basketball, hockey, soccer, skating,
gymnastics, and ballet.
There is a two fold increased greater chance of a person
having OSD who play the above sports compared to those
who do not.

Laboratory Tests/Diagnostics
No blood tests are indicated unless other diagnostic
considerations are entertained.
Diagnosis is done by clinical exam
A bone x-ray may be normal, or it may show swelling or
damage to the tibial tubercle- a bony bump below the
knee.
X-rays are rarely used unless practitioner wants to rule
out other causes of pain
Domino, Frank (2013)- 5-Minute Clinical Consult. & MedlinePlus, 2015

Management/Treatment
Guidelines
Osgood-Schlatter disease will almost always go away on
its own once the child stops growing.
Osgood- Schlatter disease usually gets better without
formal treatment.
Until the child stops growing, the practitioner may
recommend mild pain relievers and physical therapy.
MedlinePlus, 2015

Pharmacological
First line medication includes: over the counter pain
medications such as acetaminophen(Tylenol),
Ibuprofen(Advil, Motrin) or naproxen (Aleve) may be
helpful.
Second line medication includes: more potent analgesics
such as narcotics may be considered short-term use or in
extreme situations
Injectable corticosteroids universally not recommended.
Domino, Frank (2013)-5-Minute Clinical Consult

Non Pharmacological
Frequent ice applications after exercise
Rest
In more severe cases, avoidance of activities that increase
pain or swelling
Consider physical therapy referral for quadriceps isometric
strengthening, hip extensions, adductor strengthening, and
hamstring and quadriceps stretching exercises.
Knee immobilization in extension in severe cases
Domino, Frank (2013)-5- Minute Clinical Consult

Complications
Rarely, the heavy fragmented and inflamed tibial ossicle
will avulse and require surgery.
75% return to normal sport activity and 89% are not
restricted from competition due to recurrent pain.
60% of adults with prior OSD still report occasional
symptoms and have pain with kneeling. Most persons with
OSD will have residual knobby tibial tubercles that never
completely resolve. They may decline in size but will
remain throughout life to some extent.
5-Minute Clinical Consult, 2013

Follow up

Athletes may return to play if tolerated.

Presence of pain does not preclude competition.
If symptoms worsen return to practitioner.
Except in rare complicated cases, this is a self-limiting
illness that resolves within 2 years of full skeletal
maturation.
Domino. Frank (2013)-5-Minute Clinical Consult

Counseling/Education
Consider avoidance of jumping sports. Assure family
that symptoms and findings will diminish with time and
rest.
Can play sports with mild pain.
Quad stretching and strengthening important.
Suggest that your child switch to activities that dont
involve jumping or running, such as cycling or
swimming, until symptoms subside.

Consultation/Referral
When conservative therapy is unsuccessful, consideration
of surgery warrants a referral.
Surgical excision of a painful tibial tubercle rarely needed,
<5%.

Domino, Frank (2013)-5-Minute Clinical Consult, 2013

10 Multiple Choice Questions

1) Osgood- Schlatter disease is a:

A) painful swelling on the elbow
B) painful swelling on the foot
C) painful swelling of the anterior tibial tubercle
D) bone cancer

Answer 1
Answer- C
Osgood-Schlatter disease is a painful swelling of the
bump on the upper part of the shinbone. This bump is called
the anterior tibial tubercle.

Question 2
Osgood-Schlatter disease is most common
A) ages 40-50
B) ages 11-14
C) ages 20-30
D) ages 65-75

Answer 2
Answer B
Osgood-Schlatter disease typically occurs in boys 1314 and girls 11-12.
This is the time that the adolescence tibia tubercle fuses
from cartilaginous material to bone.

Question 3
How does Osgood-Schlatter disease evolve
A) When an adolescence sits and does homework
B) When an adolescence swims
C) When an adolescence participates in running, and
jumping sports
such as; volleyball, football, basketball, and
gymnastics.
D) When an adolescence plays video games

Answer 3
Answer C
Common theories suggest that this condition is a result
of repeated knee extensor mechanism that causes partial
miroavulsion during repetitive- jumping sports.

Question 4
The incidence of OSD affects how many adolescence?
A)
B)
C)
D)

5%
13-21%
25%
35%

Answer 4
Answer- B
One study found that OSD affected approximately 21% of
adolescents surveyed, as compared with a frequency of
4.5% in age-matched nonathletic controls.
One Finnish study found that OSD affects 13% of athletes.

Question 5
Is OSD more common in boys or girls ?
A) Boys
B) Girls

Answer 5
Answer A
OSD is more common in boys, but the gender gap is
narrowing as more girls become involved with sports.

Question 6
The main symptom Osgood-Schlatter disease is?
A) A painful swelling over a bump on the lower leg
bone (shinbone) or tibial tubercle.
B) A painful swelling over the elbow
C) A painful swelling over the ankle
D) A non-painful swelling on the big toe

Answer 6
Answer- A
The main symptom of OSD is a painful swelling over a
bump on the lower leg bone (shinbone).

Question 7
Only Osgood-Schlatter disease hurts over where?
A) fibula bone
B) tibial tubercle
C) femur bone
D) scapula

Question 8
Current treatment guidelines for OSD include- pick all
A) mild pain relievers such as Tylenol or Ibuprofen
B) Aspirin
C) Rest
D) Physical Therapy

Answer 8
Answer- A, C, D---------------NOT B- No aspirin to persons
less than 18.
Never use aspirin or salicylate-containing products to
treat children under 18 years old unless given permission by
a pediatrician due to like between viral illness and Reyes
Syndrome (Poison Control, 2015).
Rest, mild pain relievers, and physical therapy are all
appropriate intervention for OSD.

Question 9
When considering return to sports activity, check all
appropriate suggestions.
A) If symptoms worsen return to practitioner
B) Presence of pain does not preclude competition
C) All adolescence with OSD should stop their jumping
sports for 5 years
D) Athletes may return to play if tolerated

Answer 9
Answer- A, B, D

- Not C
Except in rare cases OSD is a self-limiting illness that
resolves within 2 years of full skeletal maturation.

Question 10

Sports activities that do not involve running or jumping

include- check all
A) Swimming
B) Boxing
C) Cycling
D) Walking

Answer 10
Answer A,C,D-

Not B- boxing involves running

and jumping
These activities may keep you child fit and active until the
symptoms of OSD subside.

References
Domino, Frank. (2013). The 5-Minute Clinical Consult.
Philadelphia, PA:
Wolters/Kluwer/Lippincott Williams & Wilkins.
Mayo Clinic(2015). Osgood-Schlatter disease. Retrieved in
January, 2015 from:
http://www.mayoclinic.org/diseases-conditions/Osgood-schalt
ter-diseaseMedlinePlus(2015) Osgood-Schlatter disease. Retrieved in
January, 2015 from:

References
Medscape (2015). Osgood-Schlatter disease. Retrieved in
January, 2015 from:
http://emedicine.Medscape.com/article/1993268-overview