Rheumatology 2

Question 1

Your new patient is a young man who complains of a painful knee that started to hurt for no apparent reason.

a)	List THREE rheumatological/orthopaedic conditions that could be 			causing this pain. 							(20%)

Answer 1

OSgood Schlatters
Synovial Chondromatosis
osteochondrosis

Question 2

b) For TWO of these identified conditions note the questions you would ask together with the responses that will enable you to differentiate between them. (knee pain for no reason) (80%)

Answer 2

OSgood Schlatters - Risk factors include overuse, especially sports which involve running or jumping.[2] The underlying mechanism is repeated tension on the growth plate of the upper tibia.[2] It also occurs frequently in male pole vaulters aged 14-22.[10]

Osgood–Schlatter disease causes pain in the front lower part of the knee.[6] This is usually at the ligament-bone junction of the patellar ligament and the tibial tuberosity.[7

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.[citation needed] 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 initially mild and intermittent. 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 people.[9

Synovial Chondromatosis - Patients usually complain of pain in one joint, which persists for months, or even years, does not ease with exercise, steroid injection or heat treatment, shows nothing on X-ray, but shows a definite restriction of movement
Treatment is frequently by means of removal of the loose bodies and of a partial or full synovectomy (removal of the synovium)
The disease generally affects only one of the larger weight bearing joints (hip, ankle, knee) – although the elbow, and wrist can also be affected. Rarely involves the temporal mandibular joint.[.