Anterior knee pain without trauma in the ER: Chronic Osgood
Transkript
Anterior knee pain without trauma in the ER: Chronic Osgood
İzmir Üniversitesi Tıp Dergisi Izmir University Medical Journal İzm Üniv Tıp Derg 2013; 1:37-39 Izm Univ Med J 2013; 1:37-39 CASE REPORT OLGU SUNUMU Anterior knee pain without trauma in the ER: Chronic Osgood-Schlatter disease in an adult patient Acil serviste travmaya bağlı olmayan diz ağrısı: Erişkin bir hastada kronik Osgood- Schlatter hastalığı 1 Cem Ertan , Dilek Ertan 2 1 İzmir Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı, İzmir / Türkiye Özel Deva Tıp Merkezi, Radyoloji Kliniği, Manisa / Türkiye 2 Sorumlu Yazar/Corresponding Author: Cem Ertan, MD, Asst. Prof. Izmir University School of Medicine, Department of Emergency Medicine Medical Park Izmir Hospital Emergency Department Izmir/TURKEY E posta: cem_ertan@hotmail.com Geliş Tarihi/Received: 07.09.2013 - Kabul Tarihi/Accepted: 03.11.2013 Abstract Osgood-Sclatter’s disease is the apophysitis of the tibial tuberosity and is a common disease of the adolescents. It causes knee pain and may result in enlargement of the tuber tibialis. Here we present a 39 years old male patient with knee pain and no recent trauma who ended up with diagnosis of Osgood-Sclatter’s disease. Key words: Osgood–Schlatter disease , knee pain Özet Osgood-Sclatter hastalığı tuberositasis tibia’nın apofiziti olup, ergenlerde sık görülen bir durumdur. Diz ağrısına ve tibia çıkıntısının büyümesine neden olabilir. Burada acil servise yakın zamanda travma öyküsü olmaksızın diz ağrısı yakınmasıyla başvuran ve sonuçta Osgood-Sclatter hastalığı tanısı alan 39 yaşında bir erkek hastayı sunuyoruz. Anahtar kelimeler: Osgood–Schlatter hastalığı, diz ağrısı Introduction Osgood-Sclatter’s disease (OSD) is the apophysitis of the tibial tuberosity and is a common disease of the adolescents which may cause knee pain with minor trauma and repetitive knee flexion, and may result in enlargement of the tuber tibialis (1). The disease is typically seen in young boys (10-15 years of age) and young girls (8-13 years of age) especially in those engaging with sports activities (21% vs 4,5%) (2,3). Although it is a disease of the young, adults may also present with OSD related symptoms. Case Presentation A 39 years old male attended to our ED with right anterior knee pain which started a few days ago, and worsened today. He denied any recent trauma but, recalled a sports related injury about one year ago. Musculoskeletal examination revealed tenderness on the tuberositas tibia and inferior portion of the patellar ligament at the right knee. There were 37 Ertan ve ark Ertan et al İzmir Üniversitesi Tıp Dergisi Izmir University Medical Journal no findings to suggest any articular or soft tissue problems. Antero-posterior and lateral x-rays and the magnetic resonance imaging (MRI) of the right knee were ordered. Antero-posterior and lateral x-rays of the right knee showed two bony fragments of 2x1 cm and 1x0.5 cm on lateral view (Figure 1). diagnostic tool of choice (4). Non-steroidal anti-inflammatory drugs were prescribed for the patient, and he was discharged with orthopedic follow up suggestion. Discussion Figure 1. Anterior posterior and lateral Xrays of the knee. MRI was the next diagnostic evaluation and it showed 2 bony fragments, of which, the larger one was measured as 12 mm (Figure 2). Also a fluid interface was detected between the Hoffa fat pad and the bony fragments. OSD is a traction apophysitis of the tibial tuberosity due to repetitive strain from the quadriceps muscle and chronic avulsion of the tibia, and it is a common disease of the rapidly growing adolescents, characterized with anterior knee pain provoked with knee flexion, rough contact to the inflamed zone and minor trauma (1). The diagnosis of the disease is mostly simple in the risk group, with physical findings and patient history, nevertheless tumors, cystic lesions and infections must be ruled out (5). But in adult patients the mainstay of the diagnosis is to conjoint the disease to the clinical condition. In our case the clinical suspicion led to MRI evaluation of the patient. The MRI study excluded infectious findings and the presence of other lesions of the bone such as cysts, masses or fractures. In conclusion chronic OSD must be recalled in adults presenting to the ED with anterior knee pain and no history of recent trauma. References 1. Kaya DO, Toprak U, Baltaci G, et al. Knee Surg Sports Traumatol Arthrosc. DOI 10.1007/s00167-012-2116-1 2. Köylü OK, Köylü A, Baltacı D, et al. OsgoodSclatter hastalığı olgu sunumu. Konuralp Tıp Dergisi 2010;2(3);16-18 3. Dunn JF. Osgood-Sclatter’s disease. Am Fam Physician. 1990;41;173-176 Figure 2. MRI of the knee. The final diagnosis of the patient was chronic OSD as evidenced by the MRI, which is the İzm Üniv Tıp Derg 2013; 1:37-39 Izm Univ Med J 2013; 1:37-39 4. Tuncel E, Yazıcı Z. Çocuk Hastalıklarında Radyolojik Bulgular, İstanbul: Nobel & Güneş Yayınevi, 2002; pp 249. 5. Morgan B, Mullick S, Harper WM, Finlay DB. An audit of knee radiographs performed 38 Ertan ve ark Ertan et al İzmir Üniversitesi Tıp Dergisi Izmir University Medical Journal for general practitioners. Br J Radiol. 1997 Mar;70:256-60 İzm Üniv Tıp Derg 2013; 1:37-39 Izm Univ Med J 2013; 1:37-39 39