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Osgood Schlatter Chiropractic Treatment | Premier Sports ...https://premiersportsandspine.com/osgood-schlatter/
Osgood Schlatter Disease is an irritation at the insertion of the patellar tendon on the tibia (shin bone). The technical term for Osgood Schlatter Disease is an apophysitis which is inflammation in a growth center in immature bone. Sports Chiropractors in Eden Prairie, MN and Eagan, MN Treatment Options for Osgood Schlatter’s
Generally speaking, activity is recommended to the tolerance of the adolescent athlete. True Osgood Schlatter’s that is not related to altered movement strategies is a self-limiting condition and won’t create any larger long-term injury. Chiropractor Helena
chiropractor-helena.com/conditions/knee-ankle-and-foot-pain/osgood-schlatter-disease-helena/ Prestige Chiropractic - Exciting New Treatment for Osgood-Schlatter Disease
www.youtube.com/watch?v=wiI7yDABXbc Osgood Schlatter shockwave
www.youtube.com/watch?v=O__x_MN8zpY Link: www.shockwavetherapy.education/index.php/tutorials/knee/osgood-schlatter CASE LAW
Bailey v. Colvin
Dist. Court, WD New York, 2017 - Google Scholar … The Clerk of the Court is directed to close this case. ALL OF THE ABOVE IS SO ORDERED. [1] Osgood-Schlatter disease (OSD), also known as apophysitis of the tibial tubercle, or Lannelongue's disease, is an inflammation of the patellar ligament at the tibial tuberosity … Related articlesColon v. Commissioner of Social SecurityDist. Court, D. Puerto Rico, 2020 - Google Scholar … an ossified callous formation, a large calcaneal spur at the plantar tubercle, and decreased …enlarged with surrounding edematous changes raising the concern for posterior tibial tendon injury … Palpation from the occipital region to the C7 vertebral apophysis was not particularly … Related articles ARTICLES
Ultrasonography for detecting enthesitis in juvenile idiopathic arthritisS Jousse‐Joulin, S Breton, C Cangemi… - Arthritis care & …, 2011 - Wiley Online Library
… and can be found not only in SpA, but also in rheumatoid arthritis (10-12 … the proximal patellar ligament insertion, the distal patellar ligament insertion on the tibial tuberosity, the Achilles … surface of the calcaneus, and the plantar fascia insertion on the medial calcaneal tubercle (16 … [PDF] wiley.com, Full View Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.
link.springer.com/article/10.1007/s12178-021-09708-5 Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures.
Distal tibial tubercle transfer is a beneficial procedure for treating patients with painful patella alta.
Functional Outcome After Tibial Tubercle Transfer for the Painful Patella Alta.AL-Sayyad, Mohammed J. MD; Cameron, John C. MD
Author Information Clinical Orthopaedics and Related Research (1976-2007): March 2002 - Volume 396 - Issue - pp 152-162 With this technology, they can perfectly match the implant to the patient's anatomy.
https://www.youtube.com/watch?v=hbcq2ClepL8 |
Musculoskeletal: Osgood-Schlatter Disease
A Chapter in Core Concepts of Pediatrics, 2nd Edition Knee Injuries www.utmb.edu/pedi_ed/CoreV2/Musculoskeletal/Musculoskeletal5.html Population Occurrence Adolescent boys near the end of skeletal growth during athletic activity. typically age 12-15 yo. Fracture Treatment Casting or surgical fixation depending on the degree of displacement. Activity Occurance Common in basketball, football, sprinting, and high jump. Associated Conditions Compartment Syndrome (4%) Meniscal Tears (Type III) Compartment Syndrome Osseofascial compartment pressure rises to a level that decreases perfusion. May lead to irreversible muscle and nerve damage. Tibial Tubercle Mechanism of Injury Concentric contraction of the quadriceps during jumping Eccentric contraction of the quadriceps during forced knee flexion. Tibial Ossification Centers Primary ossification center (proximal tibial physis) Secondary ossification center (tibial tubercle phsysis or apophysis) Prognosis High rate of fracture union and return to sports. Low incidence of leg length discrepancy. Which part of the tibia is injured more? secondary ossification center due to extensor mechanism exerting great force at secondary ossification center. How to classify TTF Ogden Classification Ogden Classification Used to classify tibial fractures. Type I - V. Type Ogden Classification Type I: fracture of the SOC near the insertion of the patellar tendon. Ogden Classification Type II: Fracture porpagates prximal between POC and SOC. Ogden Classification Type III: Coronal Fracture extending posteriorly to cross the POC. Ogden Classification Type IV: Fracture throught the entire proximal tibial physis. Ogden Classification Type V: Periosteal sleeve avulsion of the extensor mechanism from the SOC. Physical Exam: TTF Symptoms 1. Sudden onset of pain 2. inability to immediately ambulate 3. Knee swelling/hemarthrosis w/ Type III Injuries Psyical Exam: TTF Inspection and Palpation 1. Knee Effusion 2. Tenderness at tibial tubercle 3. Evaluate for anterior compartment firmness Physical Exam: TTF ROM and Instability Extensor lag or extensor deficiency in type II or III injuries Physical Exam: TTF Neurovascular Exam Monitor for increasing pain suggestive of compartment syndrome TTF Imaging 1. Radiograph 2. CT 3. MRI TTF Radiograph 1. Recommended view: anterior, posterior, lateral 2. Optional Views: IR to bring tibial tubercle into view + comparison views of contralateral knee (pediatric patients) TTF CT 1. Useful to valuate for intra-articular or posterior extension 2. Arteriogram if concern for popliteal artery injury. TTF MRI 1. Generally not indicated 2. Useful for determining fracture extension in a non-displaced Type II injury or type V injury. TTF Non Operative Treatment Long leg cast in extension for 6 weeks. - Usually type I injuries or those with minimal displacement (<2 mm). - Acceptable displacement after closed reduction/cast application TTF Operative Treatment Open reduction internal fixation w/ arthotomy, arthoscopy, and or soft tissue repair. - Type II to IV Fracture - Soft Tissue Repair for Type V (periosteal sleeve) Fracture TTF ORIF Post Op Care Immobilization and NWB in long cast/brace for 4-6 weeks. TTF ORIF Rehab 1. Progress Extensor Mechanism 2. Return to sports no sooner than 3 months TTF ORIF Pros and Cons 1. Pros: anatomic reduction and stable fixation, excellent healing potential, may allow for earlier ROM. 2. Cons: incision and associated complications, hardware irritation can necessitate implant removal. TTF ORIF + Arthrotomy/Arthroscopy Post Op Care Immobilization in long cast and NWB for 4-6 weeks TTF ORIF + Arthrotomy/Arthroscopy Rehab 1. Progress extensor mechanism 2. Return to sports at 3 months TTF ORIF + Arthrotomy/Arthroscopy Pros and Cons 1. Pros: Addresses intrarticular extension and soft tissue injuries. 2. Cons: Arthrotomy may require longer immobilization and/or rehab. **May take longer to heal due to soft tissue vs. bone TTF Soft Tissue Repair Post Op Care 1. Immobilization w/ 8-10 weeks in long cast. 2. Prolonged immobilization needed due to soft tissue (rather than bone) healing. TTF Soft Tissue Repair Rehab 1. Progresive extensor mechanism strengthening 2. Return to sports no sooner than 3 months. TTF Soft Tissue Repair Pros and Cons Prolonged healing time given to soft tissue healing. TTF Complications 1. Recurvatum Deformity - more common than leg length discrepancy; grown arrest anteriorly and posterior growth continues leading to decrease in tibial slope. 2. Compartment Syndrome - due to injury of anterior tibial recurrent artery 3. Stiffness 4. Bursitits - most common complication after surgery; due to prominence of screws and hardware about the knee, resolved upon hardware removal. 5. Vascular Injury - to popliteal artery as it passes posteriorly over distal metaphyseal fragment. |
Symptoms Pain from the knee (259) is predominantly felt anteriorly, often with localisation to the compartment involved (e.g. anteriorly in patellofemoral disease and anteromedially and anterolaterally in medial and lateral compartment problems, respectively). Pain rarely radiates far from the knee: prominent radiation down the tibia normally implies marked subchondral bone collapse or intraosseous hypertension. The front of the knee represents the L2/3 dermatomes (260, 261) and pain may be referred to this site from an L3 root lesion or from the hip. Referred pain often differs from pain originating in the knee in being (1) less clearly demarcated, (2) frequently accompanied by pain and aching above the knee, and (3) exacerbated by different factors. For example, L3 root pain often begins in the buttock, later affecting the front of the thigh and the knee; it is not usually aggravated by walking but may be exacerbated by coughing. The back of the knee represents the S1/2 dermatomes (261). Posterior knee pain alone suggests a complication of arthropathy (e.g. popliteal cyst, posterior tibial subluxation) or an S2 root lesion; other local causes include hamstring or gastrocnemius enthesopathy, lymphadenopathy, and popliteal aneurysm.
'Locking' is a sudden, usually transient, painful inability to extend the knee. As a symptom, it is important in suggesting a mechanical derangement, e.g. torn meniscus, 'loose' body, or trapping of a fold of the synovium ('plica' syndrome).
'Giving way' describes a feeling of apprehension and loss of confidence in weight bearing on the knee. It predominantly accompanies problems relating to the quadriceps/patellar mechanism or stability. Weakness of the quadriceps, particularly the vastus medialis, or patellofemoral disease, alters vertical 'tracking' of the patella as it moves on the femur and gives rise to this odd feeling of apprehension. Ligamentous instability also alters the mechanics of the knee during weight bearing, so that the patient knows that 'things are not right'.
Patellofemoral abnormalities commonly give rise to two characteristic features in the history:
'Locking' is a sudden, usually transient, painful inability to extend the knee. As a symptom, it is important in suggesting a mechanical derangement, e.g. torn meniscus, 'loose' body, or trapping of a fold of the synovium ('plica' syndrome).
'Giving way' describes a feeling of apprehension and loss of confidence in weight bearing on the knee. It predominantly accompanies problems relating to the quadriceps/patellar mechanism or stability. Weakness of the quadriceps, particularly the vastus medialis, or patellofemoral disease, alters vertical 'tracking' of the patella as it moves on the femur and gives rise to this odd feeling of apprehension. Ligamentous instability also alters the mechanics of the knee during weight bearing, so that the patient knows that 'things are not right'.
Patellofemoral abnormalities commonly give rise to two characteristic features in the history:
- Anterior knee pain, which is much worse going up and down (particularly down) stairs or negotiating an incline than walking on the flat. This is because of the maximal stress through that compartment when weight bearing on a flexed knee.
- Progressive anterior knee pain/aching that develops during prolonged sitting with the knee flexed. The patient typically gets up, stretches the legs, and the aching disappears, only to return after 20min or so of again sitting with knees bent.
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Additional tests for mechanical derangement
If the history (e.g. 'locking') or examination suggests that the problem is primarily mechanical, further tests for mechanical derangement may be of use. The 'pivot shift' manouvre (MacIntosh test) Another test for anterolateral rotary instability, this manoeuvre is used to demonstrate a dynamic subluxation where the tibia slips laterally and anteriorly on the femur. The patient is positioned supine, with the hip flexed (20°) and relaxed in slight medial rotation, and the knee slightly flexed (5°). The examiner medially rotates the lower tibia with one hand, the other hand pushing the upper tibia anteriorly on the femur while maintaining a valgus stress (293). As the knee is then flexed to 30-40° the tibia will suddenly reduce backwards with a 'clunk'. The reduction is due to the iliotibial band moving from an extensor to a flexor function, pulling the tibia back to its normal position. Normally, the knee's centre of rotation changes constantly through its range of motion as a result of the shape of the femoral condyles, ligamentous restraint, and muscle pull. A positive pivot shift test usually suggests damage to the anterior cruciate, the posterolateral capsule, or the lateral collateral ligament. From Strain to Pain Mechanical Diagnosis & Treatment of the Spine: A Look at the Mckenzie Method www.youtube.com/watch?v=KRiBYHtpfqM |