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American Family Physician May 2019Apophysitis and osteochondrosis are common causes of pain in growing bones but have differing etiologies and required management. Apophysitis results from a traction... (Review)
Review
Apophysitis and osteochondrosis are common causes of pain in growing bones but have differing etiologies and required management. Apophysitis results from a traction injury to the cartilage and bony attachment of tendons in children and adolescents. Most often it is an overuse injury in children who are growing and have tight or inflexible muscle tendon units. Although apophysitis occurs in upper and lower extremities, it occurs more often in the lower extremities, with common locations including the patellar tendon attachment at the patella or tibia (i.e., Larsen-Johansson and Osgood-Schlatter diseases), the calcaneus (i.e., Sever disease), and multiple locations around the hip, including the anterior inferior iliac spine. Other locations include the medial epicondyle, which is common in patients who throw or participate in racket sports, and more rarely at the base of the fifth metatarsal (i.e., Iselin disease). Radiography can be helpful in evaluating for other pathologies but is usually not necessary. Treatment includes stretching the affected muscle groups, relative rest, offloading the affected tendon, icing after activity, and limited use of nonsteroidal anti-inflammatory drugs. Osteochondrosis presents less commonly and refers to degenerative changes in the epiphyseal ossification centers of growing bones. Unlike apophysitis, the etiology of osteochondrosis is unknown. Multiple possible etiologies have been explored, including genetic causes, hormonal imbalances, mechanical factors, repetitive trauma, and vascular abnormalities. Other locations of osteochondrosis include the second metatarsal head (i.e., Freiberg disease), the navicular bone (i.e., Köhler bone disease), the femoral head (i.e., Legg-Calvé-Perthes disease), and the capitellum (i.e., Panner disease). Radiography results may be normal initially; magnetic resonance imaging is more sensitive to early changes. Osteochondrosis generally resolves with relative rest, but close monitoring is needed to ensure resolution. Surgery is rarely needed for either apophysitis or osteochondrosis.
Topics: Adolescent; Athletic Injuries; Bone Development; Calcaneus; Child; Cumulative Trauma Disorders; Female; Humans; Male; Osteochondrosis
PubMed: 31083875
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Feb 2015Increased intensity of sports activities combined with a decrease in daily physical activity is making overuse injuries in children more common. These injuries are... (Review)
Review
Increased intensity of sports activities combined with a decrease in daily physical activity is making overuse injuries in children more common. These injuries are located mainly in the epiphyseal cartilage. The broad term for these injuries is osteochondrosis, rather than osteochondritis, which more specifically refers to inflammatory conditions of bone and cartilage. The osteochondrosis may be epiphyseal, physeal, or apophyseal, depending on the affected site. The condition can either be in the primary deformans form or the dissecans form. While there is no consensus on the etiology of osteochondrosis, multiple factors seem to be involved: vascular, traumatic, or even microtraumatic factors. Most overuse injuries involve the lower limbs, especially the knees, ankle and feet. The most typical are Osgood-Schlatter disease and Sever's disease; in both conditions, the tendons remain relatively short during the pubescent grown spurt. The main treatment for these injuries is temporary suspension of athletic activities, combined with physical therapy in many cases. Surgery may be performed if conservative treatment fails. It is best, however, to try to prevent these injuries by analyzing and correcting problems with sports equipment, lifestyle habits, training intensity and the child's level of physical activity, and by avoiding premature specialization. Pain in children during sports should not be considered normal. It is a warning sign of overtraining, which may require the activity to be modified, reduced or even discontinued.
Topics: Adolescent; Athletic Injuries; Child; Child, Preschool; Cumulative Trauma Disorders; Growth Plate; Humans; Life Style; Lower Extremity; Orthopedic Procedures; Osteochondrosis; Physical Therapy Modalities; Prevalence; Radiography; Salter-Harris Fractures; Sports
PubMed: 25555804
DOI: 10.1016/j.otsr.2014.06.030 -
Orthopaedics & Traumatology, Surgery &... Feb 2019Blount disease is an asymmetrical disorder of proximal tibial growth that produces a three-dimensional deformity. Tibia vara is the main component of the deformity.... (Review)
Review
Blount disease is an asymmetrical disorder of proximal tibial growth that produces a three-dimensional deformity. Tibia vara is the main component of the deformity. Blount disease exists as two clinical variants, infantile or early-onset, and adolescent or late-onset, defined based on whether the first manifestations develop before or after 10 years of age. The pathophysiological mechanisms are unclear. In the Americas and Caribbean, Blount disease chiefly affects black obese children. Without treatment, the prognosis is often severe, particularly in the infantile form due to the development of medial tibial epiphysiodesis at about 6 to 8 years of age. In other parts of the world, the associations with black ethnicity and obesity are less obvious and the prognosis is often less severe. A consensus exists about the optimal treatment in two situations: before 4 years of age, progressive Blount disease should be corrected, preferably by a simple osteotomy; and once medial tibial epiphysiodesis has developed, both a complementary epiphysiodesis and gradual external fixator correction of the other alignment abnormalities, rotational deformity, and limb length are required. After 4 years of age, the outcome in the individual patient is difficult to predict. Magnetic resonance imaging supplies information on the morphology and vascularisation of the growth regions, thereby helping to guide treatment decisions. In the adolescent form, morbid obesity limits the treatment options. Untreated Blount disease in adults is rarely encountered. A more common occurrence is the presence of residual abnormalities at skeletal maturity in patients treated for Blount disease in childhood. Premature osteoarthritis may develop. In this situation, osteotomy may delay the need for total knee arthroplasty.
Topics: Age of Onset; Bone Diseases, Developmental; Child; Disease Progression; External Fixators; Fibula; Humans; Osteochondrosis; Osteotomy; Pediatric Obesity; Prognosis; Remission, Spontaneous; Risk Factors; Tibia
PubMed: 29481866
DOI: 10.1016/j.otsr.2018.01.009 -
Physical Therapy in Sport : Official... May 2021Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with locally painful alterations around the tibial tuberosity apophysis. Up to 10% of...
OBJECTIVES
Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with locally painful alterations around the tibial tuberosity apophysis. Up to 10% of adolescents are affected by OSD. Treatment is predominantly conservative. The aims of this systematic review are to comprehensively identify conservative treatment options for OSD, compare their effectiveness in selected outcomes, and describe potential research gaps.
METHODS
A systematic literature search was conducted using CENTRAL, CINAHL, EMBASE, MEDLINE, and PEDro databases. In addition, ongoing and unpublished clinical studies, dissertations, and other grey literature on OSD were searched. We also systematically retrieved review articles for extraction of treatment recommendations.
RESULTS
Of 767 identified studies, thirteen were included, comprising only two randomised controlled trials (RCTs). The included studies were published from 1948 to 2019 and included 747 patients with 937 affected knees. Study quality was poor to moderate. In addition to the studies, 15 review articles were included, among which the most prevalent treatment recommendations were compiled.
CONCLUSION
Certain therapeutic approaches, such as stretching, have apparent efficacy, but no RCT comparing specific exercises with sham or usual-care treatment exists. Carefully controlled studies on well-described treatment approaches are needed to establish which conservative treatment options are most effective for patients with OSD.
Topics: Adolescent; Adult; Child; Conservative Treatment; Exercise; Exercise Therapy; Female; Humans; Knee; Knee Joint; Male; Muscle Stretching Exercises; Osteochondrosis; Pain; Randomized Controlled Trials as Topic; Review Literature as Topic; Sports; Tibia; Treatment Outcome; Young Adult
PubMed: 33744766
DOI: 10.1016/j.ptsp.2021.03.002 -
Radiologia Apr 2016Spondylodiscitis is an infection of the spine that has been known since ancient times. Its incidence is rising, due to the increases in life expectancy and debilitating...
Spondylodiscitis is an infection of the spine that has been known since ancient times. Its incidence is rising, due to the increases in life expectancy and debilitating conditions. Its age distribution is bimodal, affecting persons younger than 20 years of age or persons aged 50-70 years. According to its origin, it is classified as pyogenic, granulomatous or parasitic, though the first form is the most common, usually caused by Staphylococcus aureus or Escherichia coli. The clinical presentation is insidious, resulting in a delayed diagnosis, particularly in tuberculous spondylodiscitis. The initial onset usually involves inflammatory back pain, though the disease may course with fever, asthenia and neurological deficit, these being the most severe complications. Diagnosis is based on clinical, radiological, laboratory, microbiological and histopathological data. Magnetic resonance imaging is the technique of choice for the diagnosis of spondylodiscitis. The differential diagnosis involves, among other conditions, intervertebral erosive osteochondrosis, tumour, axial spondyloarthropathy, haemodialysis spondyloarthropathy, Modic type 1 endplate changes and Charcot's axial neuroarthropathy. Treatment is based on eliminating the infection with antibiotics, preventing spinal instability with vertebral fixation, and ample debridement of infected tissue to obtain samples for analysis.
Topics: Diagnosis, Differential; Discitis; Humans
PubMed: 26869521
DOI: 10.1016/j.rx.2015.12.005 -
The New England Journal of Medicine Mar 2018
Topics: Adolescent; Humans; Male; Osteochondrosis; Pain; Radiography; Tibia
PubMed: 29539285
DOI: 10.1056/NEJMicm1711831 -
Medicine Dec 2021The purpose of this case study was to identify factors of bilateral etiopathogenesis of Osgood-Schlatter disease (OSD) and those supporting the effectiveness of the...
RATIONALE
The purpose of this case study was to identify factors of bilateral etiopathogenesis of Osgood-Schlatter disease (OSD) and those supporting the effectiveness of the therapeutic process in a 12-year-old elite female Olympic karateka.
PATIENT CONCERNS
The present case study concerns OSD female karateka who started her sport-specific training at the age of 4 years.
DIAGNOSES
The results of subjective palpation by the orthopedic surgeon and objective medical examination using ultrasonography, wall slide test, magnetic resonance imaging, and body height and weight measurements were collected.
INTERVENTIONS
The therapeutic intervention for the athlete's knee joints lasted 20 months (5 stages). Physical therapy, kinesiotherapy, and pharmacological treatment were administered, and physical activity was gradually introduced.
OUTCOMES
The developmental trajectory was uniform for body height and labile for body weight. OSD was diagnosed after the second growth spurt, and significant progression was reported during the subsequent height and weight gains and increased volume and intensity of sports training. The rate and dynamics of changes in the distance from the patellar ligament to the tibial apophysis were irregular, with dominance in the right knee with the highest rate of change (-3.3 mm) and twice the regression of the rate of change (-2.5 mm). The analyzed distance never exceeded the baseline value (5.5 mm), which was the case in the left knee. Return to sports competition was possible from the second month of therapy, in which kinesiotherapy and static stretching were the most effective. A relatively correct distance of the patellar ligament from the tibial apophysis was recorded at the time of stabilization of the body height and weight gain. No pathological changes were observed following OSD, and full recovery was observed.
LESSONS
In the case discussed in this study, growth spurt, the specificity of the sport practiced, and early specialization including high-volume and high-intensity training should be considered as factors causing OSD and its progression. Kinesiotherapeutic management and static stretching are crucial for the treatment of OSD. Quick return to sports competition was possible due to early therapeutic intervention, which could also lead to the absence of pathological changes in the tibial tubercle and the absence of recurrence of OSD.
Topics: Athletic Injuries; Child; Conservative Treatment; Disease Management; Exercise Therapy; Female; Humans; Knee Injuries; Knee Joint; Osteochondrosis; Patellar Ligament; Tibia; Ultrasonography
PubMed: 34918694
DOI: 10.1097/MD.0000000000028257 -
Journal of Orthopaedic Surgery (Hong... 2020
Topics: Adolescent; Bone Diseases, Developmental; Humans; Osteochondrosis; Tibia
PubMed: 31898473
DOI: 10.1177/2309499019889902