Adolescent Athlete Injuries Flashcards
List questions you should include with adolescent athletes
- did the condition start insidiously or did they have a trauma?
- how long have they had the symptoms?
- where are your symptoms?
- how do you describe your symptoms?
- do the symptoms radiate?
- aggravating/relieving factors?
- how irritable is it?
- is there anything you can longer do?
- has this injury changed anything you do?
Patient History Common Questions?
- Patient history of common condition
- have you had any similar injuries or issues in the past?
- how long did the episode last?
- have you seen any other medical professional?
- are you taking any meds?
- Past med/surgery history
- how is their general health?
- do they have any allergies?
List specific disorders in adolescent athletes
- Distal Radial Epiphyseal Injuries
- Little League Elbow
- Medial Epicondyle Apophysitis
- Lateral Elbow Pain
- Panner’s disease
- fratures
- Little Leaguer’s Shoulder
- Osgood-Schlatter Disease
- ACL injuries
- Chronic Exertional Compartment Syndrome
- Sever’s disease
describe Distal Radial Epiphyseal Injuries
gradual onset of wrist pain which is worsened by weight-bearing activities
more common in male and female gymnasts
S/S of Distal Radial Epiphyseal Injuries
- ROM → WNL
- tenderness over dorsal radial growth plate, and possibly the volar radial physis
- no tenderness over snuff box
- X-ray usually show widening of the epiphysis
- could potentially use a tuning fork
describe treatment for distal radial epiphyseal injuries
- rest
- elimination of stressful activities
- possibly immobilization
describe little league elbow
commonly used to describe pain and injuries to the medial elbow during overhead throwing
little leagues elbow can include what other conditions?
- Epicondyle apophysitis
- Epicondyle Avulsion Fractures
- Growth plate disturbances
- Ulnar Collateral Ligament Injuries
- less likely injuries:
- MCL injury
- common flexor tendon pathology
- ulnar nerve pathology
what is the cause of little league elbow?
high levels of torque generated during the last cocking phase and early acceleration phase
list S/S of Medial Epicondyle Apophysitis
- Medial elbow pain
- Medial elbow swelling
- Decreased throwing distance
- Point tender over medial epicondyle
- Medial epicondyle hypertrophy
describe treatment for Medial Epicondyle Apophysitis
- 4-6 weeks rest
- immobilization not commonly required
- avoidance of aggravating activities (pitching, throwing, etc.)
- correction of biomechanics
- ORIF if avulsion injury is present
describe Panner’s disease
aka Osteochondrosis Dissecans of the Capitellum
condition in which bone underneath the cartilage of a joint dies due to the lack of blood flow, the bone and cartilage can break loose causing pain and limiting motion
incidence and history of Panner’s disease
- children under 10
- usually dominate arm
- History
- insidious onset, diffuse lateral elbow pain
- can also be due to repetitive trauma
- can have “locking” in elbow
other differential diagnoses that can present as lateral elbow pain in children
other than Panner’s disease
- traumatic fracture
- avulsion fracture
what is little leaguer’s shoulder?
injury to the proximal humeral epiphysis that occurs due to:
distraction or torsion
- during ball release a distracting force acts across the physis may reach up to ½ body weight. throwing causes sig rotational stress at proximal humerus
- fatigue fracture
- localized inflammatory reaction
describe Little Leaguer’s shoulder
- usually occurs in 11-14 yo
- due to high levels of torque generated during the last cocking phase and early acceleration phase of throwing
what can Little Leaguer’s shoulder include?
- osteochondritis
- epiphysiolysis of the proximal humeral epiphysis
- physeal widening of the proximal humerus
- avulsion fractures
- fracture to the glenoid rim
the long head of the biceps is a _________ during ball release
decelerator
treatment for little leaguer’s shoulder
- cessation of throwing until
- patient has pain free ROM
- radiographs are normal
- pitching mechanics analysis
- pt then can begin gradual return to throwing and increased based on return to throwing protocol
describe Osgood-Schlatter’s disease
aka Tibial Tubercle Apophysitis
boy’s > girls
symptoms of Osgood-Schlatter’s disease
- duration of symptoms can vary and be up to 28 months
- gradual onset of pain, tenderness, swelling and prominence of tibial tuberosity
- pain worse with jumping and/or running
treatment for Osgood-Schlatter’s disease
- activity modification for 4-6 weeks
- modification of overall sports activity
- ice
- immobilization (less common)
- stretching
- strengthening
treatment algorithm in skeletally immature children
- surgical reconstruction → may damage growth plate but can protect damage to meniscus
- primary active rehab w/o surgical reconstruction
- favorable functional outcomes
- ⅓ to ½ show changes and impairments with sports activities
- Physeal-sparing ACL reconstruction
- ACL avulsion can be treated with surgical fixation without disrupting the growth plate
incidence of Chronic Exertional Compartment Syndrome
83% of those diagnosed are athletes or military
- 54% athletic, 29% military
- 1 in 2000 military service members
- 17% of those military members who undergo surgery will be medically discharged
- 51% anterior compartment
- frequently seen in endurance athletes
differential diagnosis for Chronic Exertional Compartment Syndrome
- stress fracture
- DVT
- peripheral nerve entrapment
what is Sever’s Disease?
AKA Apophysitis of the posterior calcaneus
heel pain where the Achilles tendon inserts into the posterior calcaneus
- heel pain associated w/adolescents who have an unfused apophysis
- males 75% of cases, 61% bilateral
- pain increases with DF
the diagnosis of Sever’s disease is based on what?
- sport involvement
- timing of growth spurt
- physical exam
- decreased flexibility
- radiographs
Treatment of Sever’s Disease
- heel cord stretching
- discontinuation of sport
- heel cup/lift
- orthotics
- immobilization (if needed)
