Common Orthopedic and Sports Related injuries developing child

Question 1

Overuse injuries count as ____ % of sports related pediatric injuries

Answer 1

30-50%

Question 2

Physical exam for overuse injuries

Answer 2

Faulty movement patterns
Length-strength imbalances
Bio-mechanical issues

Question 3

is there adequate research for the young athlete and recovery?

Answer 3

minimal research
adult model of treatment is applied to this population
research is skewed to adult counterpart

Question 4

What areas do have significant research for the young athlete

Answer 4

ACL reconstruction
Meniscal injury
Osteochondritis dissecans

Question 5

When is the age for typical onset of adolescent back pain

Answer 5

13-14

Question 6

What are common predictors of adolescent LBP

Answer 6

pain beliefs
mental health
presence of somatic complaints
anxiety/stress response
females>males

Question 7

What factors did not predict LBP

Answer 7

scoliosis
posture
joint hypermobility/flexibility
back/core muscle strength or endurance
carrying a school bag

Question 8

What are the three main interventions for adolescent LBP

Answer 8

1. utilize CPG when applicable
2. impairment based interventions
3. educational strategies are most critical element of management

Question 9

out of place
misaligned, rotated
your back/spine is weak
any story that creates additional anxiety, pathology, concern

Answer 9

not helpful language education strategies

Question 10

structures of you back/spine is health
strategies for you to manage or control your pain
exercise and movement will help keep you and your spine healthy

Answer 10

helpful language

Question 11

Apophysis

Answer 11

secondary centers of ossification, found where major tendons attach to bone

Question 12

What do apophysis do

Answer 12

provide contour and shape to growing bones without adding length

Question 13

these growth centers are the weakest links in the musculoskeletal chain at given age ranges

Answer 13

apophysitis

Question 14

What are common misdiagnosis of apophysistis

Answer 14

tendonopathy/tendonitis
stress fracture
avulsion fracture

Question 15

Tibial tuberosity

Question 16

What is apophysitis

Answer 16

repetitive stress at growth center leading to inflammation due to mirco-trauma at bone cartilage junction

Question 17

Tibial tuberosity apophysitis

Answer 17

patellar tendon attachment to tibial tuberosity

female 8-13
male 10-15

mimics: patellar tendonopathy
PFPS
Fat pad syndrome

Question 18

Examination of tibial tuberosity apophysitis

Answer 18

pain with resisted quad contraction
pain with passive quad stretching
point tender at tibial tuberosity

Question 19

Patellar apophysitis

Answer 19

inferior pole of patella
9-12 year old
mimics:
-infrapatellar fat pad syndrome
-patellar tendonopathy
-PFPS
-plica sydnrome

Question 20

Examination of patellar apophysitis

Answer 20

pain with resisted quadriceps contraction
pain with passive quad stretching
point tender at distal patella

Question 21

management of patellar and tibial tuberosity apophysitis

Answer 21

activity modification/rest

NO eccentrics NO heavy slow resistance
correct muscle imbalance

Question 22

Clacaneal apophysitis

Answer 22

calcaneal attachement of achilles tendon

8-13 year old
mimics: achilles tendonopathy
retrocalcaneal bursitis
plantar fasciitis

Question 23

diagnosis of calcaneal apophysitis

Answer 23

one leg heel standing
squeeze test
palpation
all 3 have 100% specificity

Question 24

what does imaging show with apophysitis

Answer 24

all of the patients and controls showed increased density of the apophysis
50 % of the pain free controls showed fragmentation versus almost all 90% of children with heal pain

Question 25

management of calcaneal apophysitis

Answer 25

modified activity no eccentrics of heavy slow resistance

Question 26

Little leaguers elbow

Answer 26

most common medial epicondyle attachment of common flexor tendons 10-16 years of age mimics: medial epicondylitis UCL complex injury

Question 27

Symptoms with little leaguers elbow

Answer 27

pain with resisted wrist flexion and gripping may or may not be pain with valgus stress point tender over bony portion of medial epicondyle

Question 28

what is the management of hip and pelvic apophysitis

Answer 28

depends on degree of pain but if painful walking and standing then start with weightbearing on crutches

Question 29

what are avulsion fractures

Answer 29

similar to apophysitis but often acute injury vs overuse degree of displacement and location dictate need for surgical intervention or bracing minimally displaced will be managed similar to apophysitis with more agressive rest

Question 30

What are some concerns associated with ACL surgery

Answer 30

growth plates/epiphyseal plate involvement limb length discrepancy

Question 31

what are some risk of non operative ACL surgery

Answer 31

unable to return to sport secondary injury -meniscal injury -chondral injury -MCL

Question 32

What did the cohort study determine about acl surgery

Answer 32

increased risk of additional tissue injury along with inability to return to previous level of activity

Question 33

transphyseal ACLr

Answer 33

recommended to be reserved for those that are near skeletal maturity

Question 34

nontransphyseal

Answer 34

reserved for skeletally immature 8-12 years

Question 35

What is a tibial spine fracture

Answer 35

avulsion fracture of ACL attachment to intercondylar eminence in skeletally immature

Question 36

Physical examination of tibial spine fracture

Answer 36

often unable to achieve full extension may lack 20-30 degrees of extension due to avulsed bone falling within the joint

Question 37

Imaging need to be done before trying to gain full extension

Answer 37

true

Question 38

tibial spine fixation rehab

Answer 38

determined by fixation technique may be initial weight bearing or ROM precautions

Question 39

Osteochondritis

Answer 39

inflammatory reaction

Question 40

osteochondritis dissecans etiology

Answer 40

controversial ischemia trauma

Question 41

most common areas/ages for osteochondritis

Answer 41

6-19 knee elbow

Question 42

goals for OCD

Answer 42

heal subchondral bone preserve articular cartilage prevent OA