Osteochondroses are a class of diseases characterized by death of bone followed by full regeneration. There are a wide variety of diseases classified under this definition and symptoms primarily depend on the bone involved. Physicians can usually make a diagnosis of osteochondrosis can by a careful history and examination. Most types of osteochondrosis cause symptoms of pain that gradually subside over time. Some kinds, however, may lead to more serious complications and potentially require surgery.
Cause
In children, bone growth occurs at sites known as epiphyses. The various kinds of osteochondrosis lead to damage or death of these cells due to a loss of blood supply. This is termed as "ischemic necrosis." While the reasons for the loss of blood supply are unclear, in many cases it is thought to be due to trauma, overuse or abnormal growth of these sites in the bone. If the site involved occurs along the edges of joints, fragments of bone may be released into the joint space; this condition is known as osteochondritis dessicans.
Symptoms
Osteochondrosis causes a variety of symptoms, depending on the region of the body affected. Osgood-Schlatter disease is commonly seen in obese males between the ages of 10 to 15. It affects the tibia, a bone of the lower leg, causing swelling in this region and pain in the knee. Freiberg's disease is a type of osteochondrosis affecting the second toe. It commonly occurs in girls aged between 12 to 15 and can cause pain while walking. Legg-Calve-Perthes disease is a common osteochondrosis seen in boys between 6 to 9 years of age; the disease affects the hip, causing difficulty walking. Perthes disease is sometimes associated with long-term deformity. Osteochondritis dessicans can cause pain in the knee or the elbow. In the knee, it can cause pain, locking of the joint and a sensation of giving way. When it involves the elbow, it can cause long-lasting disability. Sever's disease occurs in the heels of young boys and can cause pain while running.
Diagnosis
Before coming to a diagnosis of osteochondrosis, doctors should consider more serious causes of joint pain, such as infections and inflammatory conditions. X-rays of the bone or joint involved may be taken but may be normal in many cases. Magnetic resonance imaging may be needed in some cases to more firmly find the diagnosis; this is especially important in Legg-Calve-Perthes disease. Nuclear medicine scans, using isotopes to scan bones, are occasionally used as well.
Treatment and Prognosis
In most cases, the prognosis of most osteochondroses is good. The pain typically subsides over several months. Treatment is usually directed at relieving the pain. Rest during symptoms and ice-packs are usually effective. If this does not work, the child can be given analgesics such as ibuprofen or acetaminophen. Some osteochondroses can cause deformities in the involved joint. This is especially important in Legg-Calve-Perthes disease where deformity can occur, shortening the affected leg. For such children, surgical treatment may be needed.
References
- "Nelson Textbook of Pediatrics"; Dr. Robert M. Kliegman, et al.; 2008
- Orthoseek: Osteochondrosis
- PubMed Health: Osgood-Schlatter Disease; November 12, 2010.
- "American Family Physician"; Osteochondrosis: common causes of pain in growing bones.; A. Atanda Junior et al.; February 2011
- Patient.co.uk: Osteochondroses
