NR 602 -DDX for Medial Apophysitis

NR 602 -DDX for Medial Apophysitis

NR 602 -DDX for Medial Apophysitis Sample

The three differential diagnoses I would suspect are medial apophysitis, osteochondritis dissecans or lateral epicondylitis.

Medial apophysitis, also known as little leaguer’s elbow, occurs when repetitive throwing creates an excessively strong pull on the tendons and ligaments of the elbow (Saltzman, Chalmers, Mascarenhas, Cole, & Romeo, 2014). …

In children, the muscles and ligaments are stronger than the growth plates so this increased stress causes the growth plate to get irritated, inflamed and in some cases separated from the rest of the elbow (Saltzman et al., 2014). Repeated pulling can tear ligaments and tendons away from the bone and can disrupt normal bone growth. The diagnosis is typically confirmed with a thorough medical history, physical examination, and x-ray of the elbow or a MRI.

Medial apophysitis can start as soreness, …

In the future, medial apophysitis may be prevented by strengthening muscles of the arm, shoulder, back, trunk, and hip. Additionally, it can be prevented by resting more frequently (not playing year-round), limiting the number of throws in practice and games each week, and using proper technique (Padaki & Ahmad, 2018).

Medial apophysitis would by …

Lateral epicondylitis, also called tennis elbow, is an inflammation or damage to the area of an epicondyle of bone. These are tendons that are bands of tough tissue that connect the muscles of your lower arm to the bone (Saeed, Saeed, & Tariq, 2018). Lateral epicondylitis is a condition associated with repetitive forearm and elbow activities. Symptoms include pain and tenderness in the bony knob on the outside of your elbow and may radiate into the upper or lower arm. Pain is present when doing things with your hands such as lifting an object, gripping onto something, opening a door, shaking hands, raising your hand, or straightening your wrist (Saeed, Saeed, & Tariq, 2018).

To confirm the diagnosis of tennis elbow, …

The diagnosis of lateral epicondylitis is very close …

Osteochondritis Dissecans (OCD), occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply (Kumar, Bhatnagar, & Lodhi, 2018). It occurs most often in children and adolescents and most commonly affects the knee, but also occurs in elbows, ankles and other joints. In many cases of OCD in children, the affected bone and cartilage heal on their own, especially if a child is still growing. However, in grown children and young adults, OCD can have more severe effects resulting the lesions of separating from the surrounding bone and cartilage and can detach and float around inside the joint (Kumar, Bhatnagar, & Lodhi, 2018).

The cause of osteochondritis dissecans is unknown but is suspected…

OCD lesions in children and young teens will heal on their own, especially when the body still has a great deal of growing to do. …

I think this diagnosis is less likely as the patient was already having pain with a simple activity such as writing and with OCD, pain is induced by vigorous physical activity. Also, the patient did not complain of popping or locking of the joint or decreased range of motion.  Lastly, the patient’s x-ray was normal, in which an x-ray for osteochondritis dissecans is used to evaluate the size and location of the lesion (Hammoud, Sgromolo, & Atanda, 2015). OCD is more common among the young adolescent of 12-17 years of age (Hammoud, Sgromolo, & Atanda, 2015).

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References:

D’Angelo, K., Kim, P., & Murnaghan, M. L. (2014). Juvenile osteochondritis dissecans in a 13-year-old male athlete: A case report. Journal of the Canadian Chiropractic Association, 58(4), 384–394. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=awh&AN=100644118&site=eds-live&scope=site (Links to an external site.)Links to an external site.

Dhakal, S., Acharya, T., Gautam, S., Upadhyay, N., & Dhakal, S. (2015). Diagnosis and management pattern of lateral epicondylitis in a tertiary care center. Journal of Nepal Medical Association, 53(200). https://doi-org.chamberlainuniversity.idm.oclc.org/10.31729/jnma.2736

Gabusi, E., Manferdini, C., Paolella, F., Gambari, L., Kon, E., Filardo, G., … Lisignoli, G. (2018). Clinical and biological signature of osteochondritis dissecans in a cross-sectional study. BioMed Research International, 2018, 1–9. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1155/2018/5458704 (Links to an external site.)Links to an external site.

Giuseffi, S. A., & Field, L. D. (2014). Osteochondritis dissecans of the elbow. Operative Techniques in Sports Medicine, 22, 148–155. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1053/j.otsm.2014.02.012

Hammoud, S., Sgromolo, N., & Atanda, A., Jr. (2015). The approach to elbow pain in the pediatric and adolescent throwing athlete. Physician and Sportsmedicine, 42(1), 52–68. https://doi-org.chamberlainuniversity.idm.oclc.org/10.3810/psm.2014.02.2048 (Links to an external site.)Links to an external site.

Kumar, V., Bhatnagar, N., & Lodhi, J. S. (2018). Grade I osteochondritis dissecans in a young professional athlete. Indian Journal of Orthopaedics, 52(4), 344–352. https://doi-org.chamberlainuniversity.idm.oclc.org/10.4103/ortho.IJOrthopass:[_]322_17 (Links to an external site.)Links to an external site.

Ökmen, B. M., Eröksüz, R., Altan, L., & Aksoy, M. K. (2017). Efficacy of peloid therapy in patients with chronic lateral epicondylitis: a randomized, controlled, single blind study. International Journal Of Biometeorology, 61(11), 1965–1972. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1007/s00484-017-1386-1

Padaki, A. S., & Ahmad, C. S. (2018). Can we reduce the epidemic of elbow injuries in youth throwers? Journal of Orthopaedic & Sports Physical Therapy, 48(5), 354–358. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=129423111&site=eds-live&scope=site

Pengel, K. B. (2014). Common overuse injuries in the young athlete. PEDIATRIC ANNALS, 43(12), e297–e308. doi: 10.3928/00904481-20141124-09

Saeed, U. B., Saeed, T. B., & Tariq, S. (2018). Tennis elbow; Comparison of platelet rich plasma with steroid injection in treatment. Professional Medical Journal, 25(2), 196–200. https://doi-org.chamberlainuniversity.idm.oclc.org/10.29309/TPMJ/18.4410

Saltzman, B. M., Chalmers, P. N., Mascarenhas, R., Cole, B. J., & Romeo, A. A. (2014). Upper extremity physeal injury in young baseball pitchers. The Physician And Sportsmedicine, 42(3), 100–111. https://doi-org.chamberlainuniversity.idm.oclc.org/10.3810/psm.2014.09.2081