Approach

Characteristic history and physical examination findings are often sufficient to diagnose OSD. Plain radiographs 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 oncologic 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, sports)

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

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

Physical examination

Typical examination findings include:

  • Localized swelling

  • Localized tenderness

  • Localized warmth

  • Prominence of the tibial tubercle

  • Pain at the tibial tubercle with resisted knee extension.

Imaging

Plain radiographs 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. Do not order MRI scans for children until plain radiographic examinations have been completed.[13]​

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