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Join date : 2013-12-26

PostSubject: AMC Clinical exam preparation   Sat Dec 28, 2013 1:33 pm

amc clinical exam

You are working as a locum GP. The next patient is a 12 year old girl, Natalia, brought in by her father, Mr. Johnson.
Natalia is quite a healthy girl, very much involved in athletics and started to complain about a painful right knee over the last 2 to 3 weeks.
She is meant to be in the high jump final but the parents are concerned to have her knee checked out.

Your tasks are to:
1. take a focused further history
2. examine the patient (you’ll have to tell the examiner what you want to examine and how you do it)
explain your most likely diagnosis to Natalia and her father and outline your management

Natalia has always been healthy and a keen sports person involved in netball and in the high jump.
For the last 2 to 3 weeks she has been training for the school final in the high jump almost on a daily basis and started to complain about a painful right knee during and after the jumps. She felt the pain was getting worse when she tried to kneel on it or when she was going up stairs.
She does not recall any injury to the area, it was never hot and she did not have a fever or other symptoms.

PHx, FHx and SHx: unremarkable


Natalia looks quite well, vital signs are normal.
There is a lump with some soft tissue swelling below her right knee cap which her father thought was a “surfer’s Knee” which he suffered from as a young lad. The tibial tuberosity area is mildly tender but NOT hot or warm.
No sensory loss. Motor power is normal except for 4/5 strength in right quadriceps because of pain over the tibial tubercle.

• X-ray: the lateral view shows thickening of the patellar tendon and irregular ossification of the tibial tuberosity associated with localised soft tissue swelling at this region
• U/S: Ultrasound may reveal a normal tubercle and signal changes consistent with thickening (more echogenic) in the patellar tendon and hypoechoic area of the adjacent soft tissue.
A traction apophysitis due to repetitive traction stresses at the insertion of the patellar tendon into the tibial tubercle

Osgood-Schlatter syndrome usually resolves by itself within 12 months or so. However, the knee joint may remain uncomfortable for around two to three years until the growth spurt finishes. Treatment options may include:
• Frequent use of icepacks to reduce the swelling
• Sufficient rest to ease the symptoms
• Avoiding activities that worsen the pain
• Stretching and strengthening exercises for the quadriceps, hamstring and calf muscles before physical activities
• Physiotherapy
• Medications including painkillers and anti-inflammatory drugs
• Very rarely, surgery (but only in extreme cases and only once the growth spurt has ended).

Things to remember
• Osgood-Schlatter syndrome is a knee condition that affects teenagers.
• During a growth spurt, it is thought that the tendon attaching the quadriceps muscle to the knee joint fails to keep up with the lengthening bone and pulls tight, creating a strain on the growing bone (tibial tuberosity).
• Osgood-Schlatter syndrome usually resolves by itself once growth has finished. This may take up to two to three years.
• This often seems to occur during a sudden growth spurt. It is thought that the tendon attaching the quadriceps muscles to the knee joint fails to keep up with the lengthening bone, and pulls tight.

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