A tuberositas tibiae avulsion, which primarily affects children and adolescents, is a partial or complete tearing of the shin bone bump. If the joint surface is also affected, the joint surface is involved. Then there is talk of an avulsion fracture.
What is tuberosity tibiae avulsion?
In relation to children and adolescents, this diagnosis is a total or partial tear of the shinbone bump, Latin tuberositas tibiae, in connection with a current sporting event or experience that puts strain on the joint. If the articular surface is involved, it is called an avulsion fracture. For introduction to latex allergy, please visit sciencedict.com.
The term ending “Avulsion” stands for a violent demolition. In young domestic dogs, the term is used interchangeably with “apophyseal necrosis of the tibia tibiae” in reference to aseptic disease of the affected bone. The formation of necrosis and subsequent detachment of the tibial bump can be observed, which is referred to as tuberosity tibiae avulsion.
It is similar to Osgood-Schlatter disease in humans. Even if the designation is identical, it should be avoided because of some differences related to the dog.
Causes
In humans, spontaneous or long-term sporting activities are the most common cause. The joint is not or no longer able to cope with the load, overloading occurs and ultimately joint damage. An existing joint arthrosis can also be responsible as a triggering symptom.
The same applies to existing metabolic diseases such as gout and arthrosis. Diabetes mellitus and chronic inflammation such as polyarthritis are also known triggers. Certain sports such as volleyball and basketball, but also tennis and badminton put a strain on the entire joint and muscle mechanism.
This also applies to weightlifting, soccer, road biking, weightlifting and bodybuilding. As an extrinsic (from outside) occurring factor, a high hopping frequency is primarily responsible. Heavy and unfamiliar stresses follow. A training floor that is too hard increases the risk of injury.
One of the intrinsic (from within) injury factors is age. Statistically, the symptoms increase from the age of 15. If there is a leg length discrepancy, the shorter leg is less affected than the longer one.
Symptoms, Ailments & Signs
The pain is load-dependent but does not only occur when running (running training). In fact, any movement that places severe to severe tension on the thigh muscles can cause further pain ranging from mild to severe.
In the initial stage, the pain occurs at the beginning and at the end of a load. As the injury progresses, the pain is constant. And not only during physical exertion, but also during everyday activities such as climbing stairs, driving a car or getting up after sitting for a long time.
The angle at which the joint is located is also decisive for the intensity of the pain. Chronic development is not uncommon. Stress peaks with stronger to severe pain then often alternate with symptom-free times. Active extension against resistance is also painful. A bilateral injury of this type occurs in only 20 to 30 percent.
Diagnosis & course of disease
Sonography ( ultrasound ), MRI (magnetic resonance imaging) or projection radiography provide information about the current condition of the affected joint. It is quite typical that there is no complete detachment of the shin pouch.
In contrast to Osgood-Schlatter disease, bony fragments do not occur at the base of the patellar ligament. According to Pfeil et al, three types can be classified:
- Type I shows less than 2mm displacement of the tibial bump. In addition, there is a minimized apophyseal area.
- In type II, the apophyseal fracture shows a displacement of more than 2 mm.
- If there is type III, the apophysis is already far displaced and the kneecap is elevated. There is also step formation in the knee joint.
According to Watson-Jones, the three types are classified as follows: Type I represents an avulsion of the apophysis, but without damage to the tibial epiphysis. In type II, the cephalad epiphysis is elevated and incomplete. Type III shows that the proximal base of the epiphysis is displaced into the joint with the fracture line.
Complications
The Tuberositas tibiae avulsion primarily leads to very severe pain in those affected. This pain occurs mainly when running or walking, but can also show up in the form of pain at rest. This also leads to sleeping problems and possibly to irritability in the person concerned.
The pain caused by the tuberosity tibiae avulsion often spreads to the neighboring regions. Physical activities or sporting activities are therefore no longer easily possible for the patient. The patient’s joints are also permanently damaged by the complaint, which can lead to restrictions in movement. If the tuberositas tibiae avulsion occurs in a child, the disease will lead to a significantly delayed development and thus also to disorders and symptoms in the adulthood of the patient.
Treatment of tuberosity tibiae avulsion is not associated with complications and, as a rule, can take place with the help of medication. The symptoms are thereby alleviated, but those affected are dependent on long-term use of these drugs. Various exercises can also have a positive effect on the course of the disease. Tuberositas tibiae avulsion usually does not negatively affect or reduce the patient’s life expectancy.
When should you go to the doctor?
Since tuberositas tibiae avulsion cannot heal itself, the affected person must consult a doctor to prevent further deterioration and further complications. The sooner a doctor is consulted, the better the further course of the disease. A doctor should be consulted for tuberositas tibiae avulsion if the affected person suffers from slight pain in the thighs.
This pain occurs for a recognizable reason and usually does not go away on its own. They can also appear in the form of rest pain and therefore also have a negative effect on the patient’s sleep. The pain can also get worse with a higher load. The disease can be diagnosed by a general practitioner. Further treatment is then usually carried out by a specialist. As a rule, this does not lead to a reduction in life expectancy, although the further course of the disease itself depends heavily on the exact severity of the tuberosity tibiae avulsion.
Treatment & Therapy
Type I initially allows conservative treatment in the form of immobilization and cooling with ice, ice spray and anti-inflammatory ointments and medication. Stabilizing knee bandages and injection treatments without cortisone (which would lead to a risk of tendon rupture) can also follow. Kinesiotape often leads to effective relief. If the tendon is completely torn off, an operation is unavoidable.
If the disease is already more advanced and has reached type II or even type III, an osteosynthetic treatment is necessary. Physiotherapy exercises to optimize the flexibility of the hip-flexing muscles and to strengthen the hip-extending muscles are important.
Exercise in the form of brisk walking or a moderate jog is advisable for long-term improvement. Long distances, steep climbs and downhill stretches should only be tackled with extreme caution because they put too much strain on the affected joint. Movement in the water, on the other hand, is particularly suitable.
Prevention
Avoid overpronation and negative hip extension. Shoes with pronation protection are recommended. Beginners should slowly learn how to “run correctly” under the guidance of sports therapists and optimize it step by step.
Joints, like all muscles, should not be trained without a warm-up phase. When training outdoors on cold days, warming ointments and protective clothing can protect against injuries because they protect against hypothermia.
Aftercare
After the successful treatment of a tuberosity tibiae avulsion, good and comprehensive follow-up care is important to avoid long-term consequences. The aim should be, on the one hand, to prevent the recurrence of a tibial tubercle avulsion and, on the other hand, to permanently restore full mobility of the knee joint and leg. In order to achieve the latter, the treatment of the tuberosity tibiae avulsion must be followed by intensive physiotherapy, in which the knee joint and leg are slowly strengthened again and returned to normal resilience and mobility.
Until this physiotherapeutic treatment is completed, you should largely avoid sport in order not to put excessive strain on the affected leg or legs. In order to prevent the recurrence of a tuberosity tibiae avulsion, regular check-ups by the orthopedist should also be carried out. In addition to an external examination, imaging methods (X-rays) are also used for this purpose. If necessary, the orthopedist can prescribe additional knee bandages for sports, especially for the leg that is not (yet) affected, which stabilize and relieve the knee joint and thus prevent the symptoms of a tuberosity tibiae avulsion from recurring.
You can do that yourself
Type I tuberosity tibiae avulsion can be treated conservatively with cooling and immobilization. Patients must also take anti-inflammatory drugs. Suitable self-help measures are cooling, rest and, if necessary, the use of natural painkillers and anti-inflammatory drugs.
Due to the mobility restrictions, a walking aid is required. In severe cases, a wheelchair must be used. The patient should also be supported in everyday life. Physical activities, especially those involving the lower limbs, must be avoided. The doctor will also recommend comprehensive physiotherapy. The healing process can be supported by gentle massages, warm baths and possibly also by alternative practices from Chinese medicine. Here, too, the doctor must give his consent, since complications can occur under certain circumstances.
In the case of severe clinical pictures, an osteosynthetic treatment is necessary. Patients should contact a specialist at an early stage, especially if severe pain or restricted movement occurs. Sporting activity may be resumed after the treatment is complete. The exact steps must be discussed with the specialist and a physiotherapist. Further self-help measures are generally not applicable to tuberosity tibiae avulsion.
