10. The Baseball
‘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
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