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"What The Bump?"

March 7, 2018

 

 

"Eww why is your knee like that?" I had no idea. I was just a 6th grader with an eccentric protuberance on my right knee and I was in a lot of pain. I remember crying during our annual Turkey Trot during PE, not sure if it was because I was told to walk the entire thing and ended up finishing last or because it hurt that bad (probably a combination of the two). I had always worn shorts to school and when I played sports but once people knew about that weird bump, I started wearing jeans and sweatpants, or at least started sagging my shorts just a bit. It was embarrassing being that kid who had to sit out during PE and especially being told I would not be allowed to try out for basketball that year. I couldn't take it, whatever this bump was, I wanted it to go away!

 

I told my mom about my knee pain and every time she would try to see it, she would press on the bump causing me to jump away from her and almost kick her. Man was that knee tender! It felt like a combination of being punched really hard and shocked at the same time. Imagine stubbing your toe on a corner and then quadruple that pain level. Every time I hit my knee against something, I held my breath, closed my eyes and let out a loud profanity (6th grade Aaron was only limited to "Fudge"). It hurt... a lot! 

 

My mom didn't know what to do or how to help. Her approach to this was such a stereotypical Asian mom response, "See, I told you to cut down on basketball. Why don't you read a book?" #NBADreamsCrushed 

 

Finally, I asked my dad about it on the drive to Redlands, the next weekend he picked me up. I told him about the bump and explained how it was painful to run, jump, squat, kneel, bend my knee and basically anything that required my right knee.

 

Before he even took a look, he said "...blah, blah, blah... Osgood-Schlatter Disease..."

 

"I HAVE WHAT?!"

 

He said, he would have to look at it to be sure but he suspected Osgood-Schlatter Disease (OSD). He also thought it was a good idea to have someone else look at it. When we got home, my dad examined my knee and knew that it was indeed, OSD.

 

I asked him "Is that bump going to be there forever?"

 

"Yes." He replied as he rolled up his right pant leg and showed me his knee. "I have it too!"

 

Whoa! For a split second I was mad at my dad for giving me this knee! (Technically, he kind of did but not really). However, he reassured me, it's not passed down from father to son, it's not contagious, the pain won't last forever and that I can still maybe become an NBA player. (Thanks Dad!) 

 

Relieved, I started doing some research on it to become an expert! I wondered if other kids had it or if some of my favorite NBA players had it. After my initial internet research, I approached my dad and pitched, "Dad, it says you can remove it surgically, do I have to do that?"

 

"No, it's unnecessary to. It won't bother you that much when you get older." I wasn't too sure about that, it had been hurting for weeks and the pain had not subsided. But, my dad doesn't complain about his knee pain, he still is able to run, jump and squat. Maybe it was just a phase. Turns out he was right.

 

After a few more weeks of over-the-counter ibuprofen, resting, icing and wearing a knee strap, I was able to return to PE and sports without any restrictions. However, my basketball coach said that he still did not feel comfortable with me playing that season. I was bummed out but instead it fueled me.

 

Those couple of months had been the worst physical pain I had had. I learned a lot about sports and physical activity mechanisms, knee and lower extremity anatomy and physiology and gained an interest in sports medicine through that early experience. Ever since those days of crying in pain and embarrassed of my deformity, I was motivated to give a lot of effort and play hard in every sport I did... to the point of a couple broken noses, chin lacerations, ankle sprains, shoulder injuries, etc. But that's for another time. To this day, I still live with it, I have little to no pain (unless I hit my knee on something) and I'm still finding others who also have experienced OSD

 

Below are excerpts from my academic paper "Osgood-Schlatter's Disease In Adolescent Athletes" for a pathophysiology post-baccalaureate course:

 

Osgood-Schlatter disease is a common cause of knee pain among adolescent athletes, between the ages of 7-16. It is recognized as "apophysitis of the tibial tubercle". Apophysitis is the repetitive pulling of muscle on the bone at the insertion site. Pain caused by Osgood-Schlatter's can come and go until growth plates completely ossify or harden. In regards to the condition, "the repeated traction... of the developing ossification center leads to multiple subacute microavulsion fractures and/or tendinous inflammation, resulting in a benign, self-limited disturbance manifested as pain, swelling and tenderness." (Gregory, J., Young, C., 2017, February 13). Osgood-Shlatter Disease. The area just below the knee where the patellar tendon attaches to the shinbone becomes inflamed and results in separation from the proximal head of the tibia. The anatomical location of where OSD occurs is on the right, left and/or bilateral knees, inferior to the patella. The main bones involved are the tibia and patella, specifically on the tibial tubercle. The main muscle and tendons involved are the quadriceps and patella tendon.

 

Osgood-Schlatter's disease is easily recognized in adolescent athletes via the enlarged tubercle which can appear on either the left knee, right knee or bilaterally. On exam, clinicians will be able to reproduce the pain through various tests such as passive and active flexion and rotation. Repetitive, strenuous movements, kneeling, striking the anterior knee or directly on the body prominence can exacerbate the pain. Conservative treatments such as resting, icing, compressing and elevating the knee are some of the more common routes to help decrease the tension for quadriceps on the tubercle.  Other treatment options include corticosteroid injections, hydrocortisone injections and other various options. Physical therapy is also utilized as treatment for symptoms of OSD. Finally, although less common, persistence of a painful ossicle to the point of becoming unbearable can indicate possible surgical treatment.

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