Differentials
Rotator cuff tear
SIGNS / SYMPTOMS
Shoulder pain; more common in patients >40 years of age. Focal weakness on examination.
INVESTIGATIONS
Positive MRI findings.
Osgood-Schlatter's disease
SIGNS / SYMPTOMS
Common cause of knee pain in active youth: boys aged 13 to 14 years old; girls aged 10 to 11 years old. Focal tenderness, swelling, and bump formation over the tibial tubercle.
INVESTIGATIONS
X-ray: may be normal; often demonstrates enlarged tibial tubercle, sometimes with fragmentation of the apophysis.
Sinding-Larsen-Johansson disease
SIGNS / SYMPTOMS
Knee pain; typically affects younger patients (that is, pre-teen or early teenage) during periods of rapid bone growth. Affects boys more than girls. Focal tenderness to palpation in the inferior pole of the patella on examination.
INVESTIGATIONS
X-ray: may be normal or may demonstrate calcification at the inferior pole of the patella.
Retrocalcaneal bursitis
SIGNS / SYMPTOMS
Posterior heel pain anterior to the Achilles' tendon, just superior to its insertion. Dorsiflexion aggravates the pain. Positive 2-finger squeeze test on examination. [Figure caption and citation for the preceding image starts]: Medial and lateral pressure applied anterior and superior to the Achilles' insertion elicits painFrom the personal collection of James Wang, PhD [Citation ends].
INVESTIGATIONS
Diagnosis is clinical.
Subcutaneous tendo-Achilles' bursitis (Haglund's deformity or 'pump bump')
SIGNS / SYMPTOMS
Pain in the superficial bursa between the Achilles' tendon and skin, usually caused by ill-fitting shoes with rigid heel backs. Prominence on the lateral aspect of the posterosuperior calcaneus is tender to touch on examination.
INVESTIGATIONS
Diagnosis is clinical.
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