Approach

Characteristic history and physical examination findings are often sufficient to diagnose OSD. Plain x-rays should be ordered initially if symptoms are unilateral, severe, or persistent, and if there is any history of trauma.[1] More sophisticated imaging modalities such as MRI and ultrasound can be used if an oncological or infectious lesion of bone is suspected; these are rarely necessary.

History

Typical presentation includes:

  • Pain at the tibial tubercle

  • Pain worsened by activity (for example, sport)

  • Pain relieved by rest, ice, and anti-inflammatory medicines.

Bilateral in 20% to 30% cases.[1][4]

Physical examination

Typical examination findings include:

  • Localised swelling

  • Localised tenderness

  • Localised warmth

  • Prominence of the tibial tubercle

  • Pain at the tibial tubercle with resisted knee extension.

Imaging

Plain x-rays should be ordered initially if symptoms are unilateral, severe, or persistent, or if there is any history of trauma.[1] Ultrasound or MRI may be performed if diagnosis is in doubt and exclusion of neoplastic or infectious lesion is required.

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