Alan - 12 year old boy

Alan - 12 year old boy

1. X-rays reveal: Multiple Small opacities in the region of the right tibial tuberosity .

   • The history and clinical findings suggest Osgood Schlatter Disease

2. PC: Crying from pain in the right knee

   • ANATOMY OF THE LEG:
     • Bones
       • Femur
       • TIbia
       • Fibula
       • CONNECTIVE TISSUES
         • Adipose
         • Dense CT
         • Loose CT
         • Blood
         • Cartilage
       • TYPES OF BONES
         • Long bones
           • Structure
             • Diaphysis
             • Epiphysis
             • Metaphysis
             • Compact bone
             • Spongy bone
             • Periosteum
             • Endosteum
           • Femur, Tibia, ulna and radius
         • Short bones
           • Carpal bones of the hand
         • Flat bones
           • Skull, sternum and scapula
         • Irregular bones
           • Vertebra and ethmoid
         • Sesamoid bones
           • Bones embedded in tendons
       • BONE OSSIFICATION
         • Endochondral Ossification
           • Growing cartilage is systematically replaced by bone
         • Endomembranous ossification
           • Woven bone arises directly from the surrounding mesenchymal tissues
       • COMPOSITION OF BONE
         • ORGANIC COMPONENT
           • - Type 1 collagen - Glycoproteins -Phospholipids -Phosphoproteins --Osteoclacin -Osteonectin
           • CELL TYPES
             • Osteocytes Osteoclasts Osteoblasts Osteogenic
         • INORGANIC COMPONENT
           • Hydroxyapaptite (calcium phosphate salts) - Carbonate -Fluoride -Magnesium -Citrate
       • Illium
       • Ischium
       • Pubis
     • Joints
       • Synarthroses
         • Fibrous
         • Cartilaginous
       • Synovial
         • Variable range of motion
         • Dense fibrous capsule
         • Synovial membrane
         • Reinforced by ligaments and muscles/tendons
         • Articular cartilage

3. Upon Examination: Painful when running or lifting and worsening with heavy training. He is limping and their is tenderness on the anterior surface of the upper and of right tibia.

   • Musculoskeletal Histroy Protocol
     • Where does it hurt?
       • Look at the joint below and above!
     • Pain history: SOCRATES
       • Instability
       • Stiffness
       • Changes in sensation
       • Function
     • Compare with the joint on the other side
     • Look
       • Scars./Sinus/Redness
       • Wasting
       • Bone prominence
       • Deformity
     • Feel
       • Swelling/ Lumps
       • Tenderness
       • Warmth
     • Move
       • Restricted
       • Excessive
       • Crepitus

4. Management: Referral to a specialist, modification of soccer and weight training. As well as refraining from game play until improved.

   • MUSCLES
     • Thigh
       • Anterior Compartment
         • Flexors of hip: Illiopsoas Pectineus Sartorius
         • Extensors of knee: Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius
       • Medial Compartment
         • Adductors of the thigh: Adductor longus Adductor brevis Adductor Magnus Obturator Externus
       • Posterior Compartment
         • Flexors of the leg and extensors of thigh.: Semitendinosus Semimembranosus Biceps femoris
     • Leg
       • Anterior Compartment. Extensors of foot and ankle (dorsiflexion) + extension of toes.
         • Tibialis anterior. Extensor hallucis longus. Extensor digitorum longus. Fibularis tertius
       • Lateral Group Evert the foot and weakly plantarflex
         • Fibularis longus Fibularis Brevis
       • Posterior group. Flexors of the foot and toes
         • Gastrocnemius, Soleus Flexor hallicus longus Flexor digitorum longus Tibialis posterior Plantaris, Popliteus

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