Differentials
Rotator cuff tear
SIGNS / SYMPTOMS
Shoulder pain; more common in patients >40 years of age; focal weakness on examination.
INVESTIGATIONS
Positive MRI findings.
Osgood-Schlatter disease
SIGNS / SYMPTOMS
Common cause of knee pain in active youth: boys ages 13 to 14 years old; girls ages 10 to 11 years old. Focal tenderness, swelling, and bump formation over the tibial tubercle.
INVESTIGATIONS
X-ray: may be normal; often demonstrates enlarged tibial tubercle, sometimes with fragmentation of the apophysis.
Sinding-Larsen-Johansson disease
SIGNS / SYMPTOMS
Knee pain; typically affects younger patients (that is, preteen or early teenage) during periods of rapid bone growth. Affects boys more than girls. Focal tenderness to palpation in the inferior pole of the patella on examination.
INVESTIGATIONS
X-ray: may be normal or may demonstrate calcification at the inferior pole of the patella.
Retrocalcaneal bursitis
SIGNS / SYMPTOMS
Posterior heel pain anterior to the Achilles tendon, just superior to its insertion. Dorsiflexion aggravates the pain. Positive 2-finger squeeze test on examination. [Figure caption and citation for the preceding image starts]: Medial and lateral pressure applied anterior and superior to the Achilles insertion elicits painFrom the personal collection of James Wang, PhD [Citation ends].
INVESTIGATIONS
Diagnosis is clinical.
Subcutaneous tendo-Achilles bursitis (Haglund deformity or "pump bump")
SIGNS / SYMPTOMS
Pain in the superficial bursa between the Achilles tendon and skin, usually caused by ill-fitting shoes with rigid heel backs. Prominence on the lateral aspect of the posterosuperior calcaneus is tender to touch on examination.
INVESTIGATIONS
Diagnosis is clinical.
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