What kind of MD/DO to see for adult OSD?

[LucidResq]

Hello all. I'm hoping you can all help me.

I'm a 20 year old female with bilat. Osgood-Schlatters since I was about 9-10. I wasn't diagnosed until about 4 years ago, when during a sports medicine class lesson on knee disorders, I realized what those bumps were that no doctor over years could figure out. I told my new PCP and it was an "AHA!" moment. Over the years my pain and deformation had been diagnosed as everything from tendinitis to lupus (yikes!).

PCP referred me to a sports medicine doc who did x-rays and the full exam. He referred me to a physical therapist, told me to keep up the RICE + ibuprofen, and gave me an Rx for Voltaren Gel (a topical steroid).

The physical therapist set up a pretty intense regime for me. I was in that office about 3 times a week at least. She said I also had patellofemoral dysfunction. I was supposed to use this special tape 24/7 on each knee to help redirect my patellas. Unfortunately I had a gnarly skin allergic reaction to it and couldn't keep up with that. Due to a generally unpleasant experience at this practice, I dropped out of physical therapy (I know, I know).

I tried wearing a patella strap regularly, especially during exercise. It was more uncomfortable than helpful.

So here I am, several years later, the bumps are getting larger, and the pain is getting worse. It isn't constant, but close enough. I have 6-7/10 pain several days a week every week, and have to take 1200+ mg of ibuprofen over the course of the day probably 3-5 days every week. The ibuprofen does very little, same with ice, rest, elevation, and Voltaren.

I am studying nursing and currently work at a hospital and an MDs office. I am on my feet all day. The knee pain is often excruciating. It genuinely terrifies me that I may not be able to pursue the career I am passionate about because of the debilitating pain.

I'd like to give physical therapy another go, but my insurance necessitates I see an MD/DO first for a referral. I'm wondering what kind of specialist would be best for this kind of problem? Sports Medicine? Ortho Surgeon?

I'm also wondering if I should consider seeing a pediatric specialist since they're more likely to see this problem and I'm still only 20.

Thanks for your help in advance.

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[LucidResq]

Just to clarify: this is not pain when kneeling, walking up stairs, simply during activity or when the bump is struck. This pain occurs for hours on end on a regular basis, even if I haven't been particularly active. It does seem to be more intense and more likely if I've been at work since I'm on my feet all day. The bumps are not tender to palpation.

[gcoe]

Hi LucidResq

As you have probably read Osgood-Schlatter Disease is a traction problem of the growing superior tibial epiphysis ( growth plate for the bone to increase in length and size) and is related to the pull of the quadriceps muscle on the tendon that inserts into the tibia tubercle. the tibial tubercle is tractioned forwards, sometimes completely separating from the growth plate. often following one-off or repeated episodes of trauma to the tubercle. This forward traction is what causes the large bump you see on the shin bone just below the knee joint.

As you may have read the condition is self limiting. By your age the tibial tubercle and associated epihpysis (growing catilage plate) has fused into solid bone. The damage is done in your early to mid teens and then fusion occurs. Once the bone fuses the pain related to OS is resolved. End of story. Therefore the pain you are experiencing now is more likely due to changed mechanics of the knee cap articulating with the femur (Patello-femoral joint) as your physio describes.

You seem to be suffering an inordinate amount of pain - however patello femoral joint problems can produce a lot of pain and your physio is probably right in identifying this as the cause of your current pain.


With treatment, taping is just one option. If you have had problems with skin allergies don't despair. Usually building up the strength of the quadriceps muscle and dealing with any muscles imbalances in the leg is warranted and really does help matters. this doesn't occur straight away but persistent strengthening using weight machines usually helps matters after several weeks.

In the long term this should not interfere with your work duties and I would strongly recommend that you don't give into it. You have found a great profession to work in so persist! some times some ergonomic advice can help. For example having a high stool that you can use when you aren't on the move but need to be standing, having super comfortable shoes with appropriate shock absorption, and if possible rotating through duties so you can intersperse static standing with other activities.

Patello-femoral pain (if that is what is causing your pain) can be concerning and difficult but you can often be helped by appropriate physiotherapy to the knee muscles.In the case of patello femoral pain and dysfunction the patella is really part of the quadriceps muscle and is therefore can be modified by the behaviour of the quadriceps muscle. Another structure to consider in the assessment of your pain is the "fat pad" that lies just below the patella and is deep to the patellar tendon. This structure is prone to abnormal pressure and is very sensitive to pain. all these things can be disrupted by the change in mechanics due to OS.

Make sure the physio has made a thorough assessment of your pain and has discussed with you treatment options.

A final thing to consider - OS is usually a pretty straight forward thing to diagnose. Clinically it is an obvious pattern to see and a plain xray should confirm it. I don't understand why there was so much problem with getting the diagnosis right. However such delayed diagnosis and when serious diseases are misdiagnosed this can have a negative bearing on your experience now. So when it comes to pain all this can impact negatively on your experience of pain. It is really bad psychology. Please don't get me wrong. I am not suggesting your pain is psychological but such delay in diagnosis of a relatively simple condition is not good for you and can affect your experience of pain.