10. The Baseball

 

‘Come on, Ozzy, you can do it!’ I shouted from the sidelines.

I didn’t even know Ozzy until that weekend. He was Katie’s nephew and also the cutest blondie 9-year-old boy I had ever seen. Katie had asked me if I wanted to join her in her nephew’s baseball game and well, you know I am a sports fan.

And of course, Peter and Jax tagged along. It was a sunny day in Brooklyn and it was practically a miracle that all of us were off duty at the same time.

‘So who is your nephew again?’ Jax asked and Katie pointed to the young shortstop. ‘Oh my God he is so cute!’

‘He is, isn’t he?’ She smiled. ‘My brother did a really good job there.’

‘Where is he, by the way?’ Peter asked.

‘He couldn’t make it. He had to work a shift at the hospital. He is an ICU nurse.’

‘Really? At Brooklyn Hospital?’ I asked and Katie nodded. ‘How come we haven’t met him yet?’ I asked.

‘I don’t know, maybe you did. He is the bald nurse on the third floor.’ She laughed. ‘But he is usually on night shifts. Today he is covering for a friend.’

Ozzy was doing pretty well on the game. He had alredy gotten a single and a double in the 4th inning. We kept cheering him on so much that I think Katie regretted inviting us to the game a little bit. 

On his last at bat, he did it. He hit a home run and the crowd went crazy. Ozzy was so happy, he was smiling all the way around the bases to home plate. But when he stepped on home plate, his face grimaced with pain and he put his hand on his left knee. He went to the bench with a limp.

‘Damn it.’ Said Kate.

‘What is wrong with him?’ Jax asked.

‘I don’t know, my brother says that he’s been complaining of knee pain for a while now. At first he thought it was growing pains, but it’s becoming worse and it’s only in the left knee.’

‘That’s weird.’ Peter completed.

‘Well, I have three PGY-2s here to diagnose him.’ Kate turned to us and laughed. We were silent so she pushed us. ‘Come on, ask me what you want to know, we can examine him after the game.’

‘Well, where is the pain exactly?’ I started.

‘It is the front of his knee.’

‘How long has the pain been going?’

‘I am not sure, 2 months maybe.’

‘Does it get worse with movement?’ Peter followed.

‘Yes, he complains especially when he is practicing.’

‘Any history of trauma or fractures?’

‘None.’

‘Does he have signs of joint effusion?’

‘Hum…’ She thought about it for a moment. ‘I don’t think so, at least not visibly.’

‘What about systemic symptoms like fever?’

‘Nop.’

‘So it’s a 9-year-old boy with a history of progressive anterior knee pain that gets worse with movement without systemic symptoms or history of trauma. Is that correct?’ I asked.

‘Yes, that seems accurate. Let’s go get Ozzy so you can take a look at his knee.’

When we got there he was happy and licking an ice cream cone he won because of the home run. He appeared to have forgotten all about the knee pain.

‘Congratulations, Ozzie!’ Kate caressed his hair and we all congratulated him so much he blushed. ‘Now do you mind if your antie’s friends take a look at your knee?’ He nodded.

I pushed Jax to examine his knee. First of all because orthopedics is not my best specialty, and second, he was a kid. Jax would probably do much better than me in talking to him. And boy wasn’t I right, Ozzy was having the time of his life while Jax examined him.

When he finished he turned to us.

‘I think he has Osgood-Schlatter disease.’ 

We were all silent because none of us remembered that name. Jax smiled.

‘It is a weird name, I know. You probably don’t remember it because it usually happens in kids. It is an apophysitis of the anterior aspect of the tibial tuberosity. Look.’ He pointed to Ozzy's tibia. ‘This is why his tibial tubercle looks enlarged on the left side.’

He was right. Even without palpating it I could see there was a nodule there.

‘Wow, Dr. Jackson.’ I teased. ‘Who knew you could still make such a rare diagnosis.’ He shrugged.

‘Ozzy has Osgood.’ Peter laughed. ‘I am never gonna forget that.’

A few weeks later Kate showed me Ozzy’s x-ray and, sure enough, Jax was right. His tibial tubercle was clearly fragmented.

'Genius Jax.’ I smiled.

…

Want to know more about Osgood-Schlatter Disease?

https://www.ncbi.nlm.nih.gov/books/NBK441995/

Want to read a real case of Osgood-Schlatter Disease?

https://casereports.bmj.com/content/casereports/2013/bcr-2012-007614.full.pdf

Clinical Board

 

MC: most common; physioth: physiotherapy.