Common Orthopedic Conditions/Sports Injuries Flashcards
Legg-Calve-Perthes Disease
- Degeneration of femoral head from â blood supply (osteonecrosis of capital femoral epiphysis)
- 2-4 year progression seen mainly in 4-8 yo
- Affects one hip mainly in males
- Limp
- Pain in hip, groin, medial thigh, knee
- ROM into hip Abd and IR
- Trendelenburg
- Leg length discrepancy
- Tends to eventually heal but à degen. arthritis
LCPD PT
Hip ROM measurements in all planes taken and repeated often
Emphasize ROM of hip in all directions especially IR and Abd
Orthosis possible to maintain femoral head in contact with acetabulum
Teach donning/doffing (“A” frame, Toronto brace)
Gait train with orthosis
LCPD Med Mgmt
- Pain management (medications)
- Decrease weight bearing
- Joint protection
- Natural course of revascularization
- If severe with destruction of femoral head à surgical intervention
SCFE
Femoral head slides off the femoral neck due to slipping of femoral epiphysis
- Preadolescence and early teens (think growth spurt) boys > girls
- Limp
- Pain in groin, buttock or thigh (acute onset follows trauma)
- Also associated with obesity and weakness of growth plate
- Trendelenburg
- Dec ROM into hip Abd and IR
- ***If patient is only able to flex the hip if also externally rotating
- VERY characteristic
SCFE Med Mgmt
- Surgical pinning (stabilization) soon after diagnosis
- Once diagnosis made, no weight bearing as it can lead to osteonecrosis
Congenital Dysplasia of Hip (CDH)
Developmental Dysplasia of Hip (DDH)
Acetabulum and femoral head not aligned normally—subluxed or dislocated
Left hip > right hip (intrauterine positioning?)
Girls > boys (maternal hormone?)
Abnormal growth of hip
Dec. ROM
Leg length difference
Uneven skin folds (thigh and gluteal)
Antalgic gait
Higher risk—so screen (if…)
Breech position (HF with KE)
First born especially if large
Torticollis
Metatarsus adductus
Oligohydramnios
Family history
-Cultural differences in carrying infants: In a sling in hip flexion and wide abduction on mom’s hip or back vs swaddled for first few months
Hip dysplasia Med Mgmt
Test for hip instability: at birth and infancy
Barlow (stress test): adduction and compression
Ortolani (reduction): distraction and abduction
Conservative management—bracing (Pavlik)
- If optimal position of femoral head and acetabulum maintained, femoral head and femoral anteversion can remodel
- If bracing not successful, may need traction f/b closed reduction and spica cast
After 2 years old—surgery (open reduction) if needed
Hip Dysplasia PT Intervention
- Improve ROM of HF, HAbd, and IR
- ER to neutral only
- Orthoses
- Pavlik harness
- Infants 0-9 months
- Promotes gradual, dynamic reduction
- Requires reliable caregiving
- Places child in HF, Abd and neutral rotation
- Pavlik harness
If excessive genu valgum:
Anterior knee pain
Patellofemoral instability
Circumduction gait
Difficulty running
*Staple medial femoral growth plate
Flat foot
- “normal” for first 2 years
- Arch not developed yet due to ligamentous laxity
- Fat pad under medial longitudinal arch (up to 5 years)
- Lack of neuromuscular control
- May take several years to develop arch
- Weight bearing allows ligaments to stretch and allow mild subluxation of tarsal bones
- Obesity plays a factor
Clubfoot:
Congenital talipes equinovarus
- Common congenital deformity
- Forefoot adductus
- Hindfoot varus
- Ankle equinus
- Changes in talus, tarsal bones, navicular —— ligament and joint changes—–hypoplastic muscles with shortness of foot and small calf
Other MS Abnormalities with idiopathic clubfoot
Tibial shortening
Internal tibial torsion
Increased hip IR
–If due to merely intrauterine positioning, tend to be more mild and respond well to intervention
Clubfoot PT Intervention
- Correct deformity
- Retain mobility and strength
- Plantigrade positioning with normal load-bearing area
- Serial casting- if flexible
- Correct cavus first, rotating foot from under talus, then correct equinus
- May require achilles lengthening
Scoliosis
- Lateral curvature of spine
- Neuromuscular
- Orthopedic
- Congenital
- Poor posture
- Idiopathic—usually noted around time of adolescent growth spurt (girls > boys)
- Named for:
- direction of convexity
- Type and number of curve (“s” or “c”, single or double)
- Section of vertebral column
- Postural asymmetries:
- One shoulder higher than the other
- Pelvic obliquity
- Leg length difference
- Prominent ribs/rib hump on one side
Scoliosis Medical Management
- Cobb angle
- Brace (20-40°)
- Surgery (>40°)
Blount Disease
- Abnormal development of the tibial epiphyseal plate à altered growth of tibia (bowing)—-irreversible pathologic change
- Tibia vara and torsion
- Delayed ossification of medial epiphysis and metaphysis of proximal tibia
- Boys > girls
- Increases with obesity
Blount disease Medical Management
- Osteotomy to realign tibia
- Disruption of growth plate
- Limb lengthening
Osteonecrosis:
- Group of diseases of kids in which localized tissue death (necrosis) occurs f/b regeneration of healthy bone tissue
- During years of rapid growth, blood supply to epiphyses may be compromised à necrotic bone (typically near joints)
Osgood Schlatter Disease
Non-articular osteochondrosis at tibia
Occurrence more frequent at times of rapid growth
Activity related pain and inflammation at anterior knee
Repetitive traction of patellar tendon on tibial tubercle on apophysis (ossification center)
Tender to the touch at tibial tubercle
OSD PT Intervention:
Tends to be self limiting (related to growth)
Ice, NSAIDs, modify activity
Stretch hamstrings, quads
Scheuermann Disease
- Physeal Osteochondrosis at intervertebral joints (endplates)
- Anterior vertebral body wedging— kyphosis during growth spurt
Discoid Lateral Meniscus
Snapping Knee
Central area of lateral meniscus is filled in rather than “C” shape
Possible limited ROM, locking, quad atrophy, pain, effusion
May require arthroscopic surgery if ”symptomatic”
Sever Disease
Calcaneal apophysitis—heel pain
Overuse syndrome caused by repetitive microtrauma at insertion of Achilles tendon at calcaneal apophysis
Predisposing factors:
-Gastroc/soleus tightness with tension at Achilles
-Cavus or planus foot type à hard heel strike
-Infection, trauma
-obesity
Sever Disease Intervention
- Typically self limiting (closure of growth plate)
- Ice, heel cups, heel lifts, stretching
- Reduce activity if necessary
- Proper foot wear for activity
Sports Injuries
Most common anatomic location is lower extremity (particularly knee and ankle)
>50% of sports injuries are from overuse
ACL injuries
-In skeletally immature athletes, males> females
-In skeletally mature athletes, females>males
Growth Factors (and overuse)
Growing articular cartilage has low resistance to repetitive loading àmicrotrauma to cartilage or underlying growth plate
Growing articular cartilage has low resistance to shear, particularly at elbow, knee, ankle
Apophysitis is common– point of attachment of tendon to bone and represents an ossification center
Increased tension at attachment sites à detachment of the structure at the apophysis (avulsion fracture)
Longitudinal bone growth adds stress: musculotendinous structures tighten and lose flexibility (major at growth spurts)
Biomechanical properties of bone: less cartilaginous and stiffer with growth à decrease in resistance to impactà buckling or bowing
With growth spurt, ligaments stronger than growth plateà fx growth plate (Salter-Harris classification)
Increased tension at attachment sites à detachment of the structure at the apophysis (avulsion fracture)
Snapping Hip
Overuse injury in athletes with a rotational component like gymnastics, dancing, sprinters
Irritation of iliotibial band moving over the greater trochanter with hip movement
OR
Tenosynovitis of the iliopsoas tendon near its femoral insertion
Treat with rest, activity modification, stretching, strengthening, modalities
Hip Pointer
Iliac crest contusion mainly from a driving blow from a helmet
Overlying muscle with subperiosteal hematoma
RICE and padding
Modalities, soft tissue work and stretching may be indicated if not resolved with above
Avulsion Fractures
- Forceful contraction or excessive stretch of muscle originating from involved apophysis (sprinting, jumping, soccer, football, weight lifting)
- Anterior-superior iliac spine
- Origin of sartorius
- Ischium
- Origin of hamstrings
- Lesser trochanteric spine
- Insertion of iliopsoas
- Anterior-inferior iliac spine
- Origin of rectus femoris
- Iliac crest
- Abdominal insertion
Little League Shoulder
Common in young pitchers and catchers
Injury of proximal humeral growth plate secondary to a rotatory torque
Limit throwing and rotational activities
Strengthen parascapular and core muscles
Don’t return to sports until all pain subsided
Little League Elbow
Extreme valgus stress placed on epicondyles during the acceleration of pitching
Separation of of medial condyle with hypertrophy, irregularity, fragmentation, and avulsion
Compressive load in lateral joint between radial head and capitellum àà
–osteochondritis of capitellum
–Avascular necrosis of radial head
RICE to progression to full mobility/strength
May have to alter throwing mechanism
