By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SON’S KNEE PAIN PROBABLY COMMON OSD, BUT VISIT TO DOCTOR WISE

Question: My son is active in sports, and I recently noticed a big bump below his knee.  It causes him some pain after playing basketball but the pain goes away with rest.  I’ve called the doctor and made an appointment with her. While I wait and worry, I’m afraid he might have bone cancer. What should I do?

Answer: Any time there is an unexplained lump, you should be concerned. You were wise to schedule a visit to his doctor to assess the bump and the pain. While it could be a cancer, it most likely is not. More likely it is a problem called Osgood-Schlatter's Disease.

Osgood-Schlatter's Disease is a very common problem in physically active young people around puberty or the early teenage years. It is more common in males, but females can have this problem, too. It is one of the most common causes of knee pain in young athletes. The primary symptom is pain right below the knee, at the top of the shin bone -- what we doctors call the “tibia.” It can affect one or both knees.

OSD is caused by the powerful thigh muscles -- the quadriceps -- pulling on the patellar tendon where it attaches to the tibia. OSD is frequently associated with growth spurts common in the early teenage years. At this stage of growth, the muscles are “stronger” than the bones, since the bony growth plates have not closed yet. The primary symptom, pain, becomes worse during sports that require running and jumping, and going up or down stairs can also cause pain.

When your son visits the doctor, she will take a history of when the pain occurs, if it’s worse at rest or with activity, and what relieves the pain. She may also get an X-ray to rule out hidden fractures, developmental problems with the joint or a tumor. In some instances, the doctor may want to have an X-ray of the hip, as well, to be sure the cause is not in that joint.

Once OSD is diagnosed, your son’s doctor will probably recommend ibuprofen for the pain and may advise him to cut down or eliminate activities that place a great deal of strain on the knee. After activity, using ice and elevation can also ease the discomfort. Knee sleeves that pad the front of the knee (tibial tubercle) like wrestling gel pads can be helpful during activities. Cortisone injections are never indicated for this problem as they can weaken the patellar tendon.

A child usually outgrows OSD in 12 to 24 months, as the bones mature. Usually there is full resolution, but a bump can remain on the front of the knee for life. This is usually of more concern to girls. And, while I just mentioned that there is full resolution, over 60 percent of adults who had OSD still experience some pain when they kneel because of the residual bump.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.