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Osgood-Schlatter diseaseBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/osgood-schlatter-disease/DS00392
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Osgood-Schlatter disease can cause a painful lump below the kneecap in children and adolescents experiencing growth spurts during puberty. Osgood-Schlatter disease occurs most often in children who participate in sports that involve running, jumping and swift changes of direction — such as soccer, basketball, figure skating and ballet.
While Osgood-Schlatter disease is more common in boys, the gender gap is narrowing as more girls become involved with sports. Osgood-Schlatter disease affects as many as 1 in 5 adolescent athletes.
Age ranges differ by sex because girls experience puberty earlier than do boys. Osgood-Schlatter disease typically occurs in boys ages 13 to 14 and girls ages 11 to 12. The condition usually resolves on its own, once the child's bones stop growing.
Signs and symptoms of Osgood-Schlatter disease include:
- Pain, swelling and tenderness at the bony prominence on the upper shinbone, just below the kneecap
- Knee pain that worsens with activity — especially running, jumping and climbing stairs — and improves with rest
- Tightness of the surrounding muscles, especially the thigh muscles (quadriceps)
The pain varies from person to person. Some have only mild pain while performing certain activities, especially running and jumping. For others, the pain is nearly constant and debilitating. Osgood-Schlatter disease usually occurs in just one knee, but sometimes it develops in both knees. The discomfort can last from weeks to months and may recur until your child has stopped growing.
When to see a doctor
If your child has knee pain, try self-care measures first, such as icing the affected area and temporarily reducing or avoiding activities that trigger your child's symptoms.
Call your child's doctor if the pain:
- Continues or worsens
- Interferes with your child's ability to perform routine daily activities
- Is associated with swelling or redness about the joint
- Is associated with fever
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Each of the long bones in your child's arms and legs has a growth plate, made of cartilage, at each end of the bone. Cartilage isn't as strong as bone, and stress on the growth plate can cause it to become swollen and painful.
During activities that involve a lot of running, jumping and bending — such as soccer, basketball, volleyball and ballet — your child's thigh muscles (quadriceps) pull on the tendon that connects the kneecap to the shinbone.
This repeated stress can cause the tendon to pull away from the shinbone a bit, resulting in the pain and swelling associated with Osgood-Schlatter disease. In some cases, your child's body may try to close that gap with new bone growth, which can result in a bony lump at that spot.
The main risk factors for Osgood-Schlatter disease are age, sex and participation in sports.
Osgood-Schlatter disease occurs during puberty's growth spurts. Age ranges differ by sex because girls experience puberty earlier than do boys. Osgood-Schlatter disease typically occurs in boys ages 13 to 14 and girls ages 11 to 12.
Osgood-Schlatter disease is more common in boys, but the gender gap is narrowing as more girls become involved with sports.
Osgood-Schlatter disease affects about 20 percent of the adolescents who participate in sports, as compared with only 5 percent of adolescents who don't participate in sports. The condition happens most often with sports that involve a lot of running, jumping and swift changes in direction. Examples include:
- Figure skating
Complications of Osgood-Schlatter disease are uncommon. They may include chronic pain or localized swelling, which often can be helped with icing and anti-inflammatory medications. Even after symptoms have resolved, a bony lump may remain on the shinbone in the area of the swelling. This lump may persist to some degree throughout your child's life, but it doesn't usually interfere with knee function.
Preparing for your appointment
If your child has knee pain during or after physical activity and it doesn't improve with ice or rest, make an appointment with your child's doctor. After an initial exam, your doctor may refer you to a doctor who specializes in knee injuries or sports medicine.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Bring to the appointment a written list that includes:
- Detailed descriptions of your child's symptoms
- Information about medical problems your child has had in the past
- Information about medical problems common in your family
- All the medications and dietary supplements your child takes
- Questions you want to ask
Below are some basic questions to ask a doctor who is examining your child for possible Osgood-Schlatter disease. If any additional questions occur to you during your visit, don't hesitate to ask.
- What is the most likely cause of my child's signs and symptoms?
- Are there any other possible causes?
- Are any tests needed to confirm the diagnosis?
- What treatment approach do you recommend?
- Do you expect my child will be able to continue in his or her current sport?
- Does my child need to make any changes to his or her activities, such as playing a different position or training with different exercises? If so, for how long?
- What signs or symptoms would signal a need for my child to take a complete break from athletics?
- What other self-care measures would help my child?
- Should we schedule a follow-up appointment to monitor my child's progress?
- Should my child see a specialist?
What to expect from your doctor
Your child's doctor is likely to ask a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask your child:
- What are your symptoms?
- When did you first notice these symptoms?
- Have your symptoms been getting worse?
- How severe is your pain?
- Does your pain occur before, during or after your workouts — or is it constant?
- Have you noticed any swelling near your kneecap?
- Have you experienced any problems with mobility or stability?
- What is your regular exercise or sports-training routine?
- Have you recently made any changes to your training routine, such as training harder or longer, or using new techniques?
- Are you able to tolerate the pain you experience while playing your sport at your usual intensity?
- Are your symptoms affecting your ability to complete normal, daily tasks, such as walking up stairs?
- Have you tried any at-home treatments so far? If so, has anything helped?
- Have you recently had any injuries that may have caused knee damage?
- Have you been diagnosed with any other medical conditions?
- What medications are you currently taking, including vitamins and supplements?
What you can do in the meantime
In the time leading up to your appointment, try self-care measures at home. Your child should avoid using the affected joint in ways that cause or worsen pain. Stretching and icing the affected area also may help. If your child is uncomfortable, try using over-the-counter pain medications.
Tests and diagnosis
To diagnose Osgood-Schlatter disease, your doctor will conduct a physical examination of your child's knee, looking for tenderness, swelling, pain and redness. He or she will also want to check the range of motion in your child's knee and hip.
X-rays may be taken to look at the bones of the knee and leg and to more closely examine the area where the kneecap tendon attaches to the shinbone.
Treatments and drugs
Osgood-Schlatter disease usually gets better without formal treatment. Symptoms typically disappear after your child's bones stop growing. Until that happens, your doctor may recommend mild pain relievers and physical therapy.
Over-the-counter pain relievers such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) may be helpful.
A physical therapist can teach your child exercises to stretch the thigh's quadriceps and hamstrings, which may help reduce the tension on the spot where the kneecap's tendon attaches to the shinbone. Strengthening exercises for the quadriceps can help stabilize the knee joint.
Lifestyle and home remedies
It may help your child to follow these tips:
- Rest the joint. Limit the time spent doing activities that aggravate the condition, such as kneeling, jumping and running.
- Ice the affected area. This can help with pain and swelling.
- Stretch leg muscles. Stretching the quadriceps, the muscles on the front of the thigh, is especially important.
- Protect the knee. When your child is participating in sports, have him or her wear a pad over the affected knee at the point where the knee may become irritated.
- Try a strap. A patellar tendon strap fits around the leg just below the kneecap. It can help to "tack down" the kneecap's tendon during activities and distribute some of the force away from the shinbone.
- Cross-train. Suggest that your child switch to activities that don't involve jumping or running, such as cycling or swimming, until symptoms subside.
- Moutzouros V, et al. Osteochondroses. In. DeLee JC, et al. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2009. http://www.mdconsult.com/books/page.do?sid=1111724571&eid=4-u1.0-B978-1-4160-3143-7..00022-1--sc2&isbn=978-1-4160-3143-7&type=bookPage§ionEid=4-u1.0-B978-1-4160-3143-7..00022-1--s0125&uniqId=234606866-3. Accessed Feb. 1, 2011.
- Mercier LR. Osgood-Schlatter disease. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/page.do?sid=1111724571&eid=4-u1.0-B978-0-323-05610-6..00024-X--sc0055&isbn=978-0-323-05610-6&type=bookPage§ionEid=4-u1.0-B978-0-323-05610-6..00024-X--sc0055&uniqId=234606866-3. Accessed Feb. 1, 2011.
- Kienstra AJ, et al. Osgood-Schlatter disease. http://www.uptodate.com/home/index.html. Accessed Feb. 1, 2011.
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