Osgood-Schlatter Disease - Paediatric CPC

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network

• Lyell McEwin Hospital (08) 8182 9000

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Category 1 (appointment clinically indicated within 30 days)

• increased pain associated with acute knee injury
  
• rapid onset of knee pain with no injury

Category 2 (appointment clinically indicated within 90 days)

• nil

Category 3 (appointment clinically indicated within 365 days)

• symptoms not resolving with conservative management
  
• symptoms persisting for more than 18 months

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

• current and past medical history including past history of same condition, history of other inflammatory conditions
• relevant family history, i.e. orthopaedic, neurologic or rheumatic disease
• any investigations completed, 

Clinical history and examination including key points

• onset and duration of symptoms, including description of
  
  • pain characteristics, including location, character, onset, duration, change with activity or rest, aggravating and alleviating factors, night pain
  • trauma, e.g. acute macrotrauma, repetitive microtrauma, recent/remote
    
  • mechanical symptoms, including locking, catching, clicking, instability, if worse during or after activity
    
  • inflammatory symptoms, e.g. morning stiffness, swelling
    
  • neurological symptoms, e.g. weakness, altered sensation
    
  • gait, e.g. limp, altered weight bearing
    
• treatment prescribed, e.g. analgesics, physiotherapy, and current level of function

Additional information to assist triage categorisation

• x-ray and/or ultrasound, including provider, location and date of imaging, and copy of report
  

Clinical management advice

• Reassure parents the condition is self-limiting symptoms and will resolve with skeletal maturity 98% of the time.
  
• 2% develop a symptomatic ossicle in the patellar tendon which can be removed after skeletal maturity.
  
• Modify activities which increase pain, provide quadriceps stretching exercises.
  
• Treatment of anti-inflammatory response – rest, ice, pain relief.
  
• Appropriate footwear – wear supportive shoes.

Referral requirements for specific sites

• Physiotherapy at Women’s and Children’s Hospital (WCH) do not accept referrals from General Practitioners (GPs) – refer instead to community or private physiotherapy.
  
• Physiotherapy at Flinders Medical Centre (FMC) and Lyell McEwin Hospital (LMH) do accept referrals from GPs for paediatric orthopaedic conditions.
  

Consumer resources

• Women’s and Children’s Hospital – Osgood-Schlatter syndrome in children (PDF 149KB)
  
• Royal Children’s Hospital – Osgood Schlatter disease (PDF 291KB)
• Sydney Children’s Hospital – Osgood Schlatter disease

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• full name, including aliases
• date of birth
• residential and postal address
• telephone contact number/s – home, mobile and alternative
• Medicare number, where eligible
• name of the parent or caregiver, if appropriate
• preferred language and interpreter requirements
• identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

• impact on employment
• impact on education
• impact on home
• impact on activities of daily living
• impact on ability to care for others
• impact on personal frailty or safety
• identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery, where surgery is a likely intervention.
• Choice to be treated as a public or private patient.
• Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.