History and Physical Examination

The presentation and findings of patients with osteochondrosis depend on the site of involvement and on the stage to which the syndrome has progressed.

Pain that is localized to the affected site is usually present in the initial stages (eg, pain during kneeling in patients with Osgood-Schlatter disease or referred pain to the knee in those with Perthes disease). However, clinicians should remember that patients are asymptomatic more often than not and that they typically present late, after the onset of disability. Nonspecific bone and joint pains that occur in children during growth spurts are often overlooked, and many of these may reflect osteochondroses.

Findings commonly found alone or in combination include the following:

Localized tenderness
Limited movement of adjacent joints
Swelling
Gait disturbance (when the disease affects the lower limbs)
Reactive effusion in an adjacent joint (sometimes observed)

Growth disturbance and secondary deformities are late presentations in specific entities, such as Blount disease (shortening and tibia vara), Scheuermann disease (kyphosis), and Perthes disease (shortening and coxa vara, magna, or brevis).

Of greatest importance is that systemic symptoms of inflammation (eg, fever, malaise, weight loss, local redness, and raised temperature) should alert physicians to search for causes other than an osteochondrosis.

Differential Diagnoses

Resnick D. Osteochondroses. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia: WB Saunders; 2002. Vol 4: 3686-741.
The osteochondroses. Clin Orthop Relat Res. 1981 Jul-Aug. (158):1-98. [QxMD MEDLINE Link].
Backes JR, Durbin TC, Bentley JC, Klingele KE. Multifocal juvenile osteochondritis dissecans of the knee: a case series. J Pediatr Orthop. 2014 Jun. 34 (4):453-8. [QxMD MEDLINE Link].
Bertone AL, Bramlage LR, McIlwraith CW, Malemud CJ. Comparison of proteoglycan and collagen in articular cartilage of horses with naturally developing osteochondrosis and healing osteochondral fragments of experimentally induced fractures. Am J Vet Res. 2005 Nov. 66 (11):1881-90. [QxMD MEDLINE Link].
Monfort J, Garcia-Giralt N, López-Armada MJ, Monllau JC, Bonilla A, Benito P, et al. Decreased metalloproteinase production as a response to mechanical pressure in human cartilage: a mechanism for homeostatic regulation. Arthritis Res Ther. 2006. 8 (5):R149. [QxMD MEDLINE Link]. [Full Text].
Erdil M, Imren Y, Bilsel K, Erzincanli A, Bülbül M, Tuncay I. Joint debridement and metatarsal remodeling in Freiberg's infraction. J Am Podiatr Med Assoc. 2013 May-Jun. 103 (3):185-90. [QxMD MEDLINE Link].
Muramatsu K, Hashimoto T, Tominaga Y, Taguchi T, Kido K. Operative treatment for scaphoid osteonecrosis (Preiser disease): salvage or excision? Report on two cases and a review of the literature. Ann Plast Surg. 2014 Nov. 73 (5):516-9. [QxMD MEDLINE Link].
Sabharwal S. Blount disease: an update. Orthop Clin North Am. 2015 Jan. 46 (1):37-47. [QxMD MEDLINE Link].
Crofton PM, Macfarlane C, Wardhaugh B, Ranke MB, Elmlinger MW, Kelnar CJ, et al. Children with acute Perthes' disease have asymmetrical lower leg growth and abnormal collagen turnover. Acta Orthop. 2005 Dec. 76 (6):841-7. [QxMD MEDLINE Link].
Mirams M, Ayodele BA, Tatarczuch L, Henson FM, Pagel CN, Mackie EJ. Identification of novel osteochondrosis--Associated genes. J Orthop Res. 2016 Mar. 34 (3):404-11. [QxMD MEDLINE Link].
Damborg F, Engell V, Andersen M, Kyvik KO, Thomsen K. Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins. J Bone Joint Surg Am. 2006 Oct. 88 (10):2133-6. [QxMD MEDLINE Link].
Aksoy MC, Aksoy DY, Haznedaroglu IC, Sayinalp N, Kirazli S, Alpaslan M. Enhanced tissue factor pathway inhibitor response as a defense mechanism against ongoing local microvascular events of Legg-Calve-Perthes disease. Pediatr Hematol Oncol. 2005 Jul-Aug. 22 (5):391-9. [QxMD MEDLINE Link].
Mehta JS, Conybeare ME, Hinves BL, Winter JB. Protein C levels in patients with Legg-Calve-Perthes disease: is it a true deficiency?. J Pediatr Orthop. 2006 Mar-Apr. 26 (2):200-3. [QxMD MEDLINE Link].
Balasa VV, Gruppo RA, Glueck CJ, Wang P, Roy DR, Wall EJ, et al. Legg-Calve-Perthes disease and thrombophilia. J Bone Joint Surg Am. 2004 Dec. 86 (12):2642-7. [QxMD MEDLINE Link].
López-Franco M, González-Morán G, De Lucas JC Jr, Llamas P, de Velasco JF, Vivancos JC, et al. Legg-perthes disease and heritable thrombophilia. J Pediatr Orthop. 2005 Jul-Aug. 25 (4):456-9. [QxMD MEDLINE Link].
Gee E, Davies M, Firth E, Jeffcott L, Fennessy P, Mogg T. Osteochondrosis and copper: histology of articular cartilage from foals out of copper supplemented and non-supplemented dams. Vet J. 2007 Jan. 173 (1):109-17. [QxMD MEDLINE Link].
Demirag B, Ozturk C, Yazici Z, Sarisozen B. The pathophysiology of Osgood-Schlatter disease: a magnetic resonance investigation. J Pediatr Orthop B. 2004 Nov. 13 (6):379-82. [QxMD MEDLINE Link].
Visuri T, Pihlajamäki HK, Mattila VM, Kiuru M. Elongated patellae at the final stage of Osgood-Schlatter disease: a radiographic study. Knee. 2007 Jun. 14 (3):198-203. [QxMD MEDLINE Link].
Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr. 2007 Feb. 19 (1):44-50. [QxMD MEDLINE Link].
Westhoff B, Krauspe R, Kalke AE, Hermsen D, Kowall B, Willers R, et al. Urinary excretion of deoxypyridinoline in Perthes' disease: a prospective, controlled comparative study in 83 children. J Bone Joint Surg Br. 2006 Jul. 88 (7):967-71. [QxMD MEDLINE Link].
Davis DL, Chen L, Young ST. Evaluation of epiphyses in the skeletally immature knee using magnetic resonance imaging: a pilot study to analyze parameters for anterior cruciate ligament reconstruction. Am J Sports Med. 2013 Jul. 41 (7):1579-85. [QxMD MEDLINE Link].
West EY, Jaramillo D. Imaging of osteochondrosis. Pediatr Radiol. 2019 Nov. 49 (12):1610-1616. [QxMD MEDLINE Link].
Rothschild BM, Wayne Lambert H. Distinguishing between congenital phenomena and traumatic experiences: Osteochondrosis versus osteochondritis. J Orthop. 2021 Jan-Feb. 23:185-190. [QxMD MEDLINE Link].
Kim HK, Morgan-Bagley S, Kostenuik P. RANKL inhibition: a novel strategy to decrease femoral head deformity after ischemic osteonecrosis. J Bone Miner Res. 2006 Dec. 21 (12):1946-54. [QxMD MEDLINE Link].
Behrbalk E, Uri O, Parks RM, Grevitt MP, Rickert M, Boszczyk BM. Posterior-only correction of Scheuermann kyphosis using pedicle screws: economical optimization through screw density reduction. Eur Spine J. 2014 Oct. 23 (10):2203-10. [QxMD MEDLINE Link].
Miyamoto W, Takao M, Miki S, Kawano H. Midterm clinical results of osteochondral autograft transplantation for advanced stage Freiberg disease. Int Orthop. 2016 May. 40 (5):959-64. [QxMD MEDLINE Link].
Ishimatsu T, Yoshimura I, Kanazawa K, Hagio T, Yamamoto T. Return to sporting activity after osteochondral autograft transplantation for Freiberg disease in young athletes. Arch Orthop Trauma Surg. 2017 Jul. 137 (7):959-965. [QxMD MEDLINE Link].

Media Gallery

Osteochondrosis of the lesser trochanter of the left femur (Monde-Felix disease). Image shows fragmentation.
Perthes disease. Anteroposterior view of the pelvis and both hips. Image shows pathology involving the right hip joint. Also depicted is flattening, fragmentation, and sequestrum formation affecting the capital epiphysis of the femur, with metaphyseal cyst formation and osteopenia. Of note, no subluxation of the hip joint is observed.
Osteochondrosis of the base of the fifth metatarsal bone (Iselin disease). Image shows fragmentation.
MRI in the same patient as in image above shows altered marrow signal intensity in the apophysis of the fifth metatarsal base. This finding is suggestive of Iselin disease.
Perthes disease. Lateral view of the same patient as in image above shows flattening of the epiphysis, as well as sclerosis with deformation of the femoral head.

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Table 1. Eponyms for Osteochondroses

Table 1. Eponyms for Osteochondroses

Center	Location	Eponym
Primary	Carpal scaphoid	Preiser disease^[7]
	Lunate	Kienböck disease
	Medial cuneiform	Buschke disease
	Patella	Köhler disease
	Talus	Mouchet disease
	Tarsal scaphoid	Köhler disease
	Vertebral body	Calvé disease (Legg-Calve-Perthes disease)
Secondary	Vertebral epiphysis	Scheuermann disease and Scheuermann kyphosis
	Iliac crest	Buchman disease
	Symphysis pubis	Pierson disease
	Ischiopubic junction	Van Neck disease or phenomenon
	Ischial tuberosity	Valtancoli disease
	Calcaneal apophysis	Sever disease or phenomenon
	Accessory tarsal navicular or os tibiale externum	Haglund disease
	Second metatarsal	Freiberg disease (or Freiberg infraction)
	Fifth metatarsal base	Iselin disease
	Talus	Diaz disease
	Distal tibial epiphysis	Lewin disease
	Proximal tibial epiphysis	Blount disease^[8]
	Tuberosity of the tibia	Osgood-Schlatter disease
	Secondary patellar center	Sinding-Larsen-Johansson syndrome (Sinding-Larsen disease, jumper’s knee)
	Lesser trochanter of the femur	Monde-Felix disease
	Greater trochanter of the femur	Mandl or Buchman disease
	Capital epiphysis of the femur	Legg-Calve-Perthes disease
	Phalanges	Thiemann syndrome
	Metacarpal heads	Mauclaire disease
	Proximal epiphysis of the radius	Schaefer disease
	Distal epiphysis of the ulna	Burns disease
	Medial humeral condyle	Froelich disease
	Lateral humeral condyle	Froelich disease
	Capitellum of the humerus	Panner disease (see Little League Elbow Syndrome)
	Humeral head	Hass disease
	Clavicle	Friedrich disease

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Author

Manish Kumar Varshney, MBBS, MRCS Assistant Professor, Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, India

Disclosure: Nothing to disclose.

Coauthor(s)

Shah Alam Khan, MBBS, MS, MRCS(Edin), MCh(Orth), FRCS Associate Professor, Department of Orthopedics, All India Institute of Medical Sciences, India

Disclosure: Nothing to disclose.

Ashok Kumar, MBBS Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, India

Disclosure: Nothing to disclose.

Prashanth Inna, MBBS, MS, DNB Consultant in Pediatric Orthopedic Surgery, Manipal Hospitals of Bangalore and Dr Malathi Manipal Hospitals, India

Prashanth Inna, MBBS, MS, DNB is a member of the following medical societies: Medical Council of India, Indian Orthopedic Association, National Academy of Medical Sciences (India)

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ian D Dickey, MD, FRCSC, LMCC Orthopedic Surgeon, Colorado Limb Consultants, Denver Clinic for Extremities at Risk; Medical Director, Denver Sarah Cannon Sarcoma Network; Staff Surgeon, Department of Orthopedics, Presbyterian/St Luke’s Hospital; Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine

Ian D Dickey, MD, FRCSC, LMCC is a member of the following medical societies: Canadian Orthopaedic Association, Maine Society of Orthopaedic Surgeons, Mayo Clinic Alumni Association, Musculoskeletal Tumor Society, New England Orthopedic Society, Royal College of Surgeons of Canada

Disclosure: Received consulting fee from Stryker Orthopaedics for consulting; Received honoraria from Cadence for speaking and teaching; Received grant/research funds from Wright Medical for research; Received honoraria from Angiotech for speaking and teaching; Received honoraria from Ferring for speaking and teaching.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic Society

Disclosure: Nothing to disclose.

Osteochondroses Clinical Presentation

History and Physical Examination

References

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