Disease Description (Causes and Symptoms)
- Definition: A condition involving inflammation at the bone-tendon attachment site (apophysitis) caused by repeated traction at the tendon attachment (patellar tendon) of the tibial tubercle (upper part of the shinbone), resulting in protrusion of the area, pain, and swelling.
- Causes and pathophysiology: During growth (mainly ages 10–15), when the growth plates are weak, frequent use of the knees or repeated stress on the knees from running, jumping, kicking, and similar activities causes repeated pulling by the patellar tendon, leading to micro-separation, inflammation, and ossification of the tibial tubercle area, which triggers pain. More common in active boys.
- Main symptoms: Localized pain, tenderness, swelling, and redness of the upper part of the shinbone (tibial tubercle), with possible protrusion (bump) of the tubercle. Pain worsens when climbing stairs, bending the knee, kneeling, or running. Usually affects one side, but 20–30% of cases are bilateral.
Treatment Methods
- Conservative treatment (standard treatment in most cases)
- Activity modification: Limit or reduce the frequency of strenuous activities that cause pain (such as jumping, running, and kicking) (“relative rest”). Avoid only activities that trigger symptoms rather than complete inactivity.
- Physical therapy: Quadriceps and hamstring stretching, strengthening (especially balancing quadriceps strength), myofascial release, and functional rehabilitation programs.
- Symptom management: Ice application, short-term oral analgesic anti-inflammatory medication (under a doctor’s instructions), and a knee-protection pad or patellar tendon strap (for symptom relief).
- Bracing/taping: Apply compression and protection with a knee pad or elastic bandage if necessary.
- Return to activity: Gradually return to activity once there is no pain, while continuing stretching and strength training to prevent recurrence.
- Medication treatment
- Relieve pain with short-term nonsteroidal anti-inflammatory drugs (NSAIDs) or similar medications (as prescribed or recommended by a doctor). Use of topical anti-inflammatory medication may also be considered.
- Surgical treatment
- Usually unnecessary. If a separated bone fragment (ossicle) continues to cause pain or functional impairment even after growth has ended (after skeletal maturity), surgical treatment such as partial excision (removal of the bone fragment) may be considered.
- Precautions (during treatment)
- Long-term complete immobilization (such as prolonged casting) is not recommended (it can cause muscle weakness and joint stiffness).
- If pain is very severe, weight-bearing is impossible, or acute swelling is accompanied by fever, other causes such as infection or fracture need to be ruled out.
- Risk of complications
- The prognosis is generally good, but protrusion of the tubercle (a cosmetic issue), chronic tenderness, or discomfort when kneeling may remain. Rarely, surgery may be required because of an avulsion fracture or persistent symptoms.
Outpatient Visit Checklist (Including Preparation, Records, and Sample Questions)
- Items to prepare and bring
- A list of currently used medications (including pain relievers) and allergy history.
- A record of when symptoms began and factors that worsen or improve them (which exercises or movements cause more pain).
- Amount and type of exercise (including school and club activities) and any recent changes in activity.
- Results of previous tests (such as X-rays, ultrasound, or MRI) or treatment records from other hospitals (if available, bring photographs or a CD).
- Record of pain intensity and frequency (a pain diary if possible).
- Examinations and assessments that may be expected during the outpatient visit
- Physical examination (location of tenderness, pain during knee extension and flexion, and functional testing).
- If necessary, an X-ray to check for separation or calcification of the tibial tubercle, and ultrasound or MRI to assess soft tissue and tendon damage.
- Sample questions for the patient (or caregiver) to check before the outpatient visit
- Is exercise completely impossible because of the pain? Does it hurt only during certain movements?
- Are fever, severe swelling, or skin changes accompanying the pain?
Examples of General Questions to Ask the Doctor
- What are the expected side effects of this medication (or the prescribed treatment)?
- How long should conservative treatment be tried, and what is the prognosis?
- When and at what level can I return to exercise (sports)?
- Are additional imaging tests (such as MRI) necessary?
Examples of Disease-Specific Questions
- Under what circumstances is surgery necessary? What are the expected benefits and risks of surgery?
- Could you explain specifically which areas should be strengthened and stretched first during rehabilitation (the exercise program)?
(Note: This is a common condition with a generally favorable prognosis in growing children and adolescents. Most cases improve with conservative treatment, and symptoms often disappear after skeletal maturity. However, additional evaluation is necessary if symptoms worsen rapidly, weight-bearing is impossible, or abnormal signs of inflammation are present.)