Page 1 of 2: radiograph knee diagnosis!

draditithegreat · Credits: 1247960 My Scrapbook

BACKGROUND
Parents bring their 12-year-old son to the urgent-care clinic with a chief complaint of right knee pain. The patient states that he has been having pain in the front part of his knee since he began the soccer season 3 months ago. His team has played well, and he proudly states that he had scored 5 goals over the season, a personal record. The boy is concerned about the pain because he does not want to disappoint his team by being unable to play. On further questioning, he states that the pain is present “all the time” but that “it gets worse when I am running.” Resting helps alleviate the pain. His parents have not given him any medications for the pain except acetaminophen (Tylenol). The patient’s medical history is noncontributory.

On physical examination, the patient’s vitals signs are as follows: temperature
[snip]°F; heart rate, 72 beats per minute; respiratory rate, 12 breaths per minute; blood pressure, 188/78 mm Hg. Physical examination reveals a healthy 12-year-old boy in mild distress. He walks with a limp when asked to climb onto the examination table. Findings on head and neck examination are normal, as are those on auscultation of the heart and lungs and on abdominal examination.

Evaluation of the right lower extremity demonstrates full range of motion of all joints, including the knee. Strength is normal, and he has no evidence of trauma, such as erythema or bruising. The McMurray and Lachman maneuvers, the anterior and posterior drawer tests, assessment of internal and external rotation, and varus and valgus stress tests on the right knee joint all yield unremarkable results. No patellar subluxation is identified; however, he has a point of focal tenderness immediately over the inferior pole of the patella. The right hip is normal.

Radiographs of the bilateral knees are obtained. What is the diagnosis?
Hint
Two very similar entities should be considered on the basis of physical examination findings.

sd04 · Credits: 4277 My Scrapbook My Reading List 9 Books

not sure but is it osgood-schalatter disease

sd04 · Credits: 4277 My Scrapbook My Reading List 9 Books

sd04 · Credits: 4277 My Scrapbook My Reading List 9 Books

hi! dr aditi the gr8!where r u?how long hv to wait for reply its very intersting one,egr to know wats that?? i can think of
osgood-schlatter n osteogenic sarcome

hardcoremallu · Credits: 14786 My Scrapbook My Reading List 6 Books

tibial apophysitis

draditithegreat · Credits: 1247960 My Scrapbook

sorry sd04 for the delay!!
i ll do it now....

draditithegreat · Credits: 1247960 My Scrapbook

Sinding-Larsen-Johansson disease:

Lateral radiographs demonstrate calcifications inferior to the inferior pole of the patella in the expected location of the patellar tendon, as well as minimal soft-tissue swelling over the calcifications.

These findings indicate Sinding-Larsen-Johansson disease. In 1921 and 1922, Sinding-Larsen and Johansson independently described this syndrome.

It occurs in children and adolescents aged 10-14 years and clinically manifests as tenderness and soft tissue swelling over the inferior pole of the patella.

Radiographs demonstrate osseous fragmentation, as shown here.

Initial reports erroneously described the disorder as an apophysitis or osteochondritis.

The findings have been shown to be traumatic in origin, and the pathogenesis is closely related to that of Osgood-Schlatter disease.

The disease is now believed to be related to a traction phenomenon resulting in tendinitis of the proximal attachment of the patellar tendon.

Tendinitis is followed by calcification or ossification.

Patellar fracture or avulsion can occur but are infrequent.

Osgood-Schlatter disease results in radiographic findings similar to these, but it occurs at the distal insertion of the patellar tendon on the anterior tibial tubercle.

Patients with Sinding-Larsen-Johansson disease present with focal tenderness over the inferior pole of the patella that activity aggravates.

The initial radiographic changes are classic. The calcifications are usually incorporated into the inferior pole of the patella, and the natural course of the condition is 3-12 months.

Follow-up radiographs often show normal findings.

Most patients do not require surgical treatment, and the disease is managed symptomatically.

It may also respond to quadriceps-strengthening exercises.

In rare cases, debridement of the patellar tendon may be necessary if the disease does not respond to nonoperative management.[/url]

sd04 · Credits: 4277 My Scrapbook My Reading List 9 Books

thanx alot dr aditi d gr8!really intersting one

i really wud have missed this in DDx really very confusing.now i will remember this whole my life

cud u plz tell me wich one is more com'nly seen osgood-schlatter or sinding-larsen dis?

mksmks · Credits: 110 My Scrapbook

hi is this patellar tendinitis..

santhoshnellikatte · Credits: 307 My Scrapbook

Thank you.Keep posting such cases Dr Aditi.

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