Common Orthopedic and Sports Related injuries developing child Flashcards
Overuse injuries count as ____ % of sports related pediatric injuries
30-50%
Physical exam for overuse injuries
Faulty movement patterns
Length-strength imbalances
Bio-mechanical issues
is there adequate research for the young athlete and recovery?
minimal research
adult model of treatment is applied to this population
research is skewed to adult counterpart
What areas do have significant research for the young athlete
ACL reconstruction
Meniscal injury
Osteochondritis dissecans
When is the age for typical onset of adolescent back pain
13-14
What are common predictors of adolescent LBP
pain beliefs
mental health
presence of somatic complaints
anxiety/stress response
females>males
What factors did not predict LBP
scoliosis
posture
joint hypermobility/flexibility
back/core muscle strength or endurance
carrying a school bag
What are the three main interventions for adolescent LBP
- utilize CPG when applicable
- impairment based interventions
- educational strategies are most critical element of management
out of place
misaligned, rotated
your back/spine is weak
any story that creates additional anxiety, pathology, concern
not helpful language education strategies
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
helpful language
Apophysis
secondary centers of ossification, found where major tendons attach to bone
What do apophysis do
provide contour and shape to growing bones without adding length
these growth centers are the weakest links in the musculoskeletal chain at given age ranges
apophysitis
What are common misdiagnosis of apophysistis
tendonopathy/tendonitis
stress fracture
avulsion fracture
Tibial tuberosity
What is apophysitis
repetitive stress at growth center leading to inflammation due to mirco-trauma at bone cartilage junction
Tibial tuberosity apophysitis
patellar tendon attachment to tibial tuberosity
female 8-13
male 10-15
mimics: patellar tendonopathy
PFPS
Fat pad syndrome
Examination of tibial tuberosity apophysitis
pain with resisted quad contraction
pain with passive quad stretching
point tender at tibial tuberosity
Patellar apophysitis
inferior pole of patella
9-12 year old
mimics:
-infrapatellar fat pad syndrome
-patellar tendonopathy
-PFPS
-plica sydnrome
Examination of patellar apophysitis
pain with resisted quadriceps contraction
pain with passive quad stretching
point tender at distal patella
management of patellar and tibial tuberosity apophysitis
activity modification/rest
NO eccentrics NO heavy slow resistance
correct muscle imbalance
Clacaneal apophysitis
calcaneal attachement of achilles tendon
8-13 year old
mimics: achilles tendonopathy
retrocalcaneal bursitis
plantar fasciitis
diagnosis of calcaneal apophysitis
one leg heel standing
squeeze test
palpation
all 3 have 100% specificity
what does imaging show with apophysitis
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
management of calcaneal apophysitis
modified activity
no eccentrics of heavy slow resistance
Little leaguers elbow
most common medial epicondyle attachment of common flexor tendons
10-16 years of age
mimics:
medial epicondylitis
UCL complex injury
Symptoms with little leaguers elbow
pain with resisted wrist flexion and gripping
may or may not be pain with valgus stress
point tender over bony portion of medial epicondyle
what is the management of hip and pelvic apophysitis
depends on degree of pain but if painful walking and standing then start with weightbearing on crutches
what are avulsion fractures
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
What are some concerns associated with ACL surgery
growth plates/epiphyseal plate involvement
limb length discrepancy
what are some risk of non operative ACL surgery
unable to return to sport
secondary injury
-meniscal injury
-chondral injury
-MCL
What did the cohort study determine about acl surgery
increased risk of additional tissue injury along with inability to return to previous level of activity
transphyseal ACLr
recommended to be reserved for those that are near skeletal maturity
nontransphyseal
reserved for skeletally immature 8-12 years
What is a tibial spine fracture
avulsion fracture of ACL attachment to intercondylar eminence in skeletally immature
Physical examination of tibial spine fracture
often unable to achieve full extension may lack 20-30 degrees of extension due to avulsed bone falling within the joint
Imaging need to be done before trying to gain full extension
true
tibial spine fixation rehab
determined by fixation technique
may be initial weight bearing or ROM precautions
Osteochondritis
inflammatory reaction
osteochondritis dissecans etiology
controversial
ischemia
trauma
most common areas/ages for osteochondritis
6-19
knee elbow
goals for OCD
heal subchondral bone
preserve articular cartilage
prevent OA
