Osteochondroses

Question 1

Name some articular osteochondroses.

Answer 1

Perthes, Kohler’s, Frieberg’s

Question 2

Name some non-articular osteochondroses.

Answer 2

Osgood-Schlatters, Sinnig-Larsen-Johansson lesion, Sever’s, Iselin’s lesion

Question 3

Name some physical osteochondroses.

Answer 3

Sheuermann’s Kyphosis, Blount’s disease

Question 4

What is a Kohler’s lesion and how is it caused?

Answer 4

Avascular necrosis of the navicular caused by repeated micro-trauma disturbing blood flow to the navicular.

The navicular is prone to avascular necrosis as it is the last bone to ossify and is subject to compression forces from surrounding bones.

Question 5

How is a Kohler’s lesion diagnosed?

Answer 5

x-ray and clinical examination

Question 6

What are the symptoms for a Kohler’s lesion?

Answer 6

• pain localised to the navicular
• pain with tib post contraction
• widened/flattened/irregular shaped navicular bone

Question 7

Does Kohler’s affect boys or girls more?

Answer 7

Boys>girls, 4:1

Question 8

What age is Kohler’s most common?

Answer 8

2-9 y.o.

Question 9

How is Kohler’s treated?

Answer 9

• activity modification
• orthoses
• short leg cast 6-8 weeks

Question 10

What is Frieberg’s lesion and how is it caused?

Answer 10

Avascular necrosis of the metatarsal head (usually 2nd met head, sometimes 3rd). Caused by repeated micro-trauma interrupts blood supply to the epiphyseal plate.

Question 11

What are the symptoms for a Frieberg’s lesion?

Answer 11

• pain on WBing through the forefoot

- longer second ray? - push off through second rather than first

Question 12

Is Frieberg’s more common in girls or boys?

Answer 12

F>M, often 12-15 y.o. dancers

Question 13

How is Frieberg’s diagnosed?

Answer 13

xray, bone scan, MRI, clinical examination

Question 14

What are DDX for Frieberg’s?

Answer 14

stress #, march #, synovitis, neuroma, RA

Question 15

What are DDX for Kohler’s?

Answer 15

accessory navicular, #, trauma

Question 16

What is the treatment for Frieberg’s?

Answer 16

• activity modification
• off-loading
• footwear modifications
• short leg cast
• surgery
• aspirin

Question 17

What is Osgood-Schlatter’s and how is it caused?

Answer 17

Pain, tenderness and inflammation at the tibial tuberosity caused my micro-avulsions from tensile forces of quads on the developing secondary ossification centre (proximal tibial apophysis), causing formation of extra bone.

Question 18

What are the clinical signs of Osgood-Schlatter’s?

Answer 18

• symptomatic with exercise but alleviated with rest
• query muscle strength imbalance or excessive activity load
• common in sports requiring running and jumping

Question 19

What is the age of onset for Osgood-Schlatters?

Answer 19

Boys: 12-15 y.o.
Girls: 10-12 y.o.

Question 20

What are the DDX for Osgood-Schlatters?

Answer 20

Osteochondrosis dissecans, RA, meniscus injury

Question 21

What is the treatment for Osgood Schlatters?

Answer 21

Spontaneous resolution is common (months to years)

• activity modification
• NSAIDs
• improving muscle imbalance through stretching and strengthening of hamstrings and quads
• surgical excision of tibial tuberosity

Question 22

What is a Sinding-Larsen-Johansson lesion?

Answer 22

Pain at the inferior pole of the patella at the superior attachment of the patella tendon

Question 23

What is the treatment for a Sinding-Larsen-Johansson lesion?

Answer 23

• activity modification (directed through pain)
• Still need to do some form of activity, but must stop at onset of pain
• quads tightness may play a role

Question 24

What is a Sever’s lesion?

Answer 24

Traction apophysitis of the insertion of the Achilles tendon to the calcaneus.

Question 25

What are the symptoms of Sever's?

Answer 25

- localised pain around the achilles insertion site | - commonly arise around beginning of sporting seasons

Question 26

Is Sever's more common in girls or boys?

Answer 26

Boys>girls generally 10-12 y.o.

Question 27

How is a Sever's lesion diagnosed?

Answer 27

- squeeze test (squeeze post heel, should elicit pain)

Question 28

What are the DDX for Sever's?

Answer 28

Retrocalcaneal bursitis, achilles tendinopathy, bone tumour, medial calcanea nerve entrapment, tarsal tunnel syndrome, RA

Question 29

How is Sever's treated?

Answer 29

Usually self-limiting unless the calcaneal ossification centre is ruptured - activity modification - shoe wear modification - heel raises - calf stretches/strengthening

Question 30

What is an Iselin's lesion?

Answer 30

traction apophysitis of the tuberosity of the 5th metatarsal

Question 31

What are the clinical signs of Iselin's lesion?

Answer 31

- pain with eversion (as PL tendon pulls) | - localised pain and swelling

Question 32

How is an Iselin's lesion diagnosed?

Answer 32

xray

Question 33

What are the DDX for Iselin's lesion?

Answer 33

styloid #, os vesaleanum (accessory bone in the PL tendon), RA

Question 34

What treatment is required for Iselin's lesion?

Answer 34

- offloading - orthoses - lateral wedging