Osteochondritis in Children
The ultimate cause for these conditions is unknown, but the most commonly cited etiologic factors are rapid growth, heredity, trauma (or overuse), anatomic conformation, and dietary imbalances; however, only anatomic conformation and heredity are well supported by scientific literature. The way that the disease is initiated has been debated.
Although failure of chondrocyte differentiation, formation of a fragile cartilage, failure of blood supply to the growth cartilage, and subchondral bone necrosis all have been proposed as the starting point in the pathogenesis, recent literature strongly supports failure of blood supply to growth cartilage as most likely.
These conditions nearly all present with an insidious onset of pain referred to the location of the bony damage.
Some, notably Kienbock's disease of the wrist, may involve considerable swelling, and Legg-Calvé-Perthes disease of the hip causes the victim to limp. The spinal form, Scheuermann's disease, may cause bending, or kyphosis of the upper spine, giving a "hunch-back" appearance.
In humans, these conditions may be classified into three groups:
Kienbock's disease of the hand, and other conditions not completely characteristic of the osteochondrosis,
The prognosis for these conditions is very variable, and depends both on the anatomic site and on the time at which it is detected.
In some cases of osteochondrosis, such as Sever's disease and Freiberg's infraction, the involved bone may heal in a relatively normal shape and leave the patient asymptomatic.
On the contrary, Legg-Calvé-Perthes disease frequently results in a deformed femoral head that leads to arthritis and the need for joint replacement.
The condition occurs in active boys and girls aged 9–16 coinciding with periods of growth spurts. It occurs more frequently in boys than in girls, with reports of a male-to-female ratio ranging from 3:1 to as high as 7:1. It has been suggested the difference is related to a greater participation by boys in sports and risk activities than by girls.
The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thigh to the tibial tuberosity. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit.
The syndrome may develop without trauma or other apparent cause; however, some studies report up to 50% of patients relate a history of precipitating trauma.
Intense knee pain is usually the presenting symptom that occurs during activities such as running, jumping, squatting, and especially ascending or descending stairs and during kneeling.
The pain is worse with acute knee impact. The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or striking the knee.
Pain is mild and intermittent initially. In the acute phase the pain is severe and continuous in nature. Impact of the affected area can be very painful. Bilateral symptoms are observed in 20–30% of patients.
The symptoms usually resolve with treatment but may recur for 12–24 months before complete resolution at skeletal maturity, when the tibial epiphysis fuses.
In some cases the symptoms do not resolve until the patient is fully grown. In approximately 10% of patients the symptoms continue unabated into adulthood, despite all conservative measures.
Male with Osgood-Schlatter disease
Diagnosis is made clinically, and
Treatment is conservative with RICE (Rest, Ice,Compression, and Elevation),
Apply Body oils + Pain-relieving gels like Brugel, Voveron etc
Gradual resumption of sports.
Bracing or POP orthopedic cast give quicker resolution.
Surgical excision may rarely be required in skeletally mature patients.
Healthy eating, Hot Cold sponging bag
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^ O. Josh Bloom and Leslie Mackler (February 2004). "What is the best treatment for Osgood-Schlatter disease?".Journal of Family Practice 53 (2). PDF version
^ Hariri, S.; York, S. C.; O'Connor, M. I.; Parsley, B. S.; McCarthy, J. C. (2011). "Career Plans of Current Orthopaedic Residents with a Focus on Sex-Based and Generational Differences". The Journal of Bone and Joint Surgery 93 (5): e16. DOI:10.2106/JBJS.J.00489.PMID 21368070.
^ Strickland JM, Coleman NJ, Brunswic M and Kocken R. (2008). "Osgood-Schlatter's Disease: An active approach using massage and stretching". Presentation at the European Congress of Sports Science Conferenceappendix1. ISSN 1536-7290.