Osteocondritis Flashcards
What is perthes disease (RF, SX)
avascular necrosis of femoral epiphesis -interuprtion of blood supply - often followed by revascularisation and re-ossification -premature fusion of plates and OA
RF - boys 4-8y.o
bilateral 20%
comonly mistaken for transiet synovitis
Sx- insidious presentation (asympto)
Limp, knee/hip pain (one or both sides), limb shortening
Roll test = supine pt, roll affected hip itnernally and xtrenally -guard/spasm
Ix and Mx of perthes disease
Ix -
Xray -often first try but the disease doesnt always show -might need MRI
“Increased densitity of femoral head” -> fragmentel/iregular/flatenel femoral head
Roll test = supine pt, roll affected hip itnernally and xtrenally -guard/spasm
Mx-
analgesia for pain
<6 -observation + mobilisation and monitoring as healing is good at this age +splints
> 6-surgery
What is osgood schlatter disease?
Inflammation of cartilage of patellar tendon insertion at knee
usually in physically active 10-15 y/o (growth spurt related)
bilateral up to 50% of times
Sx -
Knee pain after exercise -relvied by rest
Localised tendernsss and SWELLING over tibial tuberosity
Hamstring tightness
Ix and Mx of Osgood schlatter disease
Clinical diagnosis
xray could be required following the Ottawa knee rules (cant weight bear, cant bend knee, tenderness at fibula, isolated patella tenderness, old)
xr shows -fragmentation of tibial tubercule + tissue swelling
Mx –
Analgesia (paracetamol/NSAID), ice, protective knee pads, stretching
Reassure - resolve over time but can presist until end of spurt
Advise stopping/reducing physical activity (insentiy, frequency or duration)-change type to limit jump/run
can reincrease later
quad exercises
What are the ottawa knee rules
According to the Ottawa knee rule, knee X-ray is only required after a knee injury for people with any of these findings:
Inability to weight bear both immediately and during the consultation for four steps (inability to transfer weight twice onto each lower limb regardless of limping).
Inability to flex the knee to 90 degrees.
Tenderness of the head of the fibula.
Isolated tenderness of the patella (no bone tenderness of the knee other than the patella).
Age 55 years or older.
What is osteochondritis dissecans (Sx, Mx)
reduced blood to articvular cartilage and subchondral bone -> avascualr necrosis -> activity related joint pain
sx- pain after exercise
catching/locking and giving way -important
mx -rest and physio
what is chondromalacia patellae (RF,. Sx, mx)
Anterior knee pain from degeneration fo articular catilage of patella
young adults from overuse of physical activity
sx- anterior knee pain
pain worse when running, stair, getting up from chair
painless passive movement but pain after repeated extension + GRATING sensation
mx - physio
