Considerations for the Youth Athlete Flashcards
At what age do children have limited fundamental motor skills and balance system integration?
2-5
At what age do children have Visual system still developing (difficulty tracking and judging moving objects)?
2-5
At what ages do children have short attention spans?
2-5
At what age do children learn by exploitation, experimentation, and mimicking?
2-5
What are some good things to do with 2-5 year olds?
Fundamental skill development with little instruction
Emphasize unorganized and organized play rather than competition/rules
At which age do kids start showing Integration of transitional skills (throwing accuracy/scale)?
6-9
At which age do children have more automatic balance and posture?
6-9
At which age do kids have short attention spans and limited rapid decision making?
6-9
At which age are there small gender differences?
6-9
What are some things to modify in games with 6-9 year olds?
Promote success and participation
Simple sports with flexible rules
Short instruction time and more free practice
At what age do kids have the ability to master complex motor skills?
10-12
At which age do kids have selective attention?
10-12
At what age are kids able to understand strategies and rules for organized sports?
10-12
Which modifications are good to make for kids ages 10-12?
Promote sports participation, skill development, and sport strategy
Begin more complex sports (football, basketball, hockey)
At what age is there a distinct gender split?
12-16
At which age do kids reach their maximum height, weight, and muscle growth ?
12-16
At which ages should sports become more specialized?
12-16
What are 3 ways of tracking growth?
Radiographic evidence
Tanner staging
Peak height velocity
Which sex has a higher BMR and aerobic capacity?
Males
When is a female’s peak flexibility?
15
How do you measure flexibility?
Beighton scale
VO2 max (increases/decreases) with age
Increases
True or false; kids have a higher stroke volume
False
True or false; kids have a higher heart rate
True
True or false; kids have a higher tidal volume
False
True or false; kids have a higher respiratory rate
True
True or false; kids have less efferent energy source
True- they utilize fat more than glycogen or glucose
True or false; kids have an exponentially more intense response to endurance training
False; blunted response
True or false; kids have a decreased ability to generate aerobic energy
False; they rely on oxidative system and have decreased ability to generate anaerobic energy
At high temperatures, kids sweat (more/less)
Less
Kids can acclimatize (faster/slower) to new environments
Slower
Kids have (more/less) surface area to mass ratio
More
True or false; in kids, muscle often fails long before bone
False; bone is the weak link
Do bones ossify distal to proximal or proximal to distal?
Distal to proximal
What is a torus fracture?
Buckle fracture
Caused by compression
Usually on distal radius
Treated with 3 weeks of closed reduction
What is a green stick fracture?
Tensile forces cause cracking
Treated with closed reduction with cast 3-8 weeks
Treated with open reduction with percutaneous pinning
What is plastic deformation ?
Bones bowing rather than breaking under tensile forces
Treated with reduction with a slow unbending of the bone, or controlled completion of the fracture
What is an avulsion fracture?
Tension/ligament pulls off a piece of the bone
What is a spiral fracture?
Twisting injury
High suspicion of abuse
Common in preschool children who fall short distances onto an extended leg
Cast it above an below the joint
What is a stress fracture?
Overuse injury to the bone , it cant withstand loads
Females >males
Where are some common sites for stress fractures in kids?
Pars
Tibia
Femur
Metatarsals
Your patient is a gymnast complaining of pain at L4-5. Upon examination, you find:
Pain with extension and unilateral standing extension test
Bony tenderness
HS mm spasm
Step off with with anterior slippage
What could be the diagnosis?
A pars interarticularis defect
Which Salter-Harris classification involves a separation through the physis, usually through areas of hypertrophic and degenerating cartilage cell columns?
Type 1
Which Salter-Harris classification involves a fracture through a portion of the physis that extends through the metaphyses?
Type 2
Which Salter-Harris classification involves a fracture through a portion of the physis that extends through the epiphysis and into the joint?
Type 3
Which Salter-Harris classification involves a fracture across the metaphysis, physis, and epiphysis?
Type 4
Which Salter-Harris classification involves a crush injury to the physis?
Type 5
Which Salter-Harris classifications are treated conservatively?
Types 1 and 2
Concussion should be suspected in the presence of what signs?
Symptoms- headache
Physical symptoms- unsteadiness
Impaired brain function- confusion
Abnormal behavior- change in personality
What are the 4 categories of common concussion symptoms?
Physical, cognitive, emotional, sleep
The Child Scat 3, King Devik Test, and ImPACT all test for what?
Concussion
What is traction apophysitis?
repetitive forces of pull at the sites of tendon-bone
interface
What are the causes of apophysistis?
◦ Bone growth exceeds muscle-tendon length
◦ Sports increases force generation of attached mm
◦ Abnormal mechanics
◦ Inefficient technique
Pt is a 14 year old who just started playing high school football complaining of gradual onset of pain without a specific history of injury. He experiences pain on palpation, contraction, and activity. He experiences a decrease in pain with rest.
Imaging reveals a widening at growth centers.
What is his diagnosis?
Apophysitis
What treatments are appropriate for someone with apophysitis?
◦ Education
◦ Protect apophysis/bracing helpful
◦ Correct underlying flexibility and strength deficits
◦ Movement/Technique training
What is Osgood-Schlatter disease?
Tibial tuberosity apophysitis due to pull of the quadriceps/patella tendon
Pt is a 13 year old girl in track and field complaining of pain over the tibial tuberosity. You observe swelling and quad and hamstring tightness.
What is her diagnosis?
Osgood-schlatter disease
How do you treat Osgood-Schlatter disease?
Monitor overall load Modalities and NSAIDs for pain control Patella tendon taping/strapping Stretching of quads/HS/HF/PF’s Strength to LE (pain free) NM control/Mechanics training
What is Sever’s disease?
Calcaneal Traction apophysitis
What is the most common pediatric overuse injury?
Sever’s disease
Pt is an 8 year old boy complaining of bilateral pain in his posterior heels what gets worse with running and jumping. Upon examination, (+) squeeze test, heel cord tightness and weak ankle dorsiflexors.
What is his diagnosis?
Sever’s disease
How do you treat Sever’s disease?
Relative/Active rest
◦ Severe cases: may require intermittent use of CAM boot
Modalities and NSAID’s Role for heel cups, pads or OTC orthotics Heel cord stretching Ankle and LE strengthening Movement coordination
Pt is an adolescent female complaining of dull, diffuse, achy anterior knee pain that gets worse with prolonged sitting, squatting, and stair negotiation. Upon examination you observe her patella is very mobile.
What is her diagnosis?
Patella femoral pain syndrome
What is juvenile osteochondritis dissecans?
Subchondral bone delamination and localized necrosis
What is a discoid meniscus?
Anatomical variant in meniscus shape where the meniscus covers most of the tibial plateau
What are the timelines for post surgical patella dislocation rehab?
◦ PWB (1 week) in extension
◦ ROM: 90 degrees by weeks 2/3; 130 by week 4/5
◦ CKC muscle function
◦ OKC strength at 8 weeks
Gradual Return to unrestricted sports at 24 weeks
What age is most at risk of developmental hip dysplasia/ dislocation?
0-2
Which gender is more at risk of developmental hip dysplasia/dislocation?
Females
What age is most at risk of legg calve perthes disease?
3-10
Which gender is most at risk of legg calve perthes disease?
Males
Which gender and age are most at risk for a slipped capital femoral epiphysis?
Males 13-15
Pt is a 13 year old male complaining of pain with slippage. He states he is beginning to limp. He is tall and thin. Upon examination, he has no fixed flexion deformity, but he is hyperextended and positioned in external rotation.
What is his diagnosis?
SCFE
Pt is a 6 year old male of average size. He is not experiencing pain, but has started limping for a few days. Upon examination, he has a fixed flexion deformity.
What is his diagnosis?
Legg calve perthes disease
How would you treat legg calve perthes disease following surgery or with a non surgical approach?
PWB for 4-6 weeks
◦ FWB after evidence of callus
Strengthen hip abd/ext
ROM- IR and flexion
Non surgical
◦ Bilateral Hip Spica Cast
What are the components of Little League Elbow?
◦ Medial epicondle apophysitis/avulsion
◦ Panner’s Disease
◦ Osteochondritis Dissecans (OCD) of the Capitellum
◦ UCL Sprains/tears
Pt presents with:
◦ Gradual, pain associated with throwing
◦ TTP to lateral prox humerus (most common finding)
◦ Pain/weakness with resistive testing (ER > IR)
◦ Radiographs: widening of the proximal humeral physis
What are the possible diagnoses?
Little League (Thrower’s) Shoulder
- Proximal Humeral Physeal Stress Injury (epiphysiolysis)
- Proximal humeral apophysitis (more rare)
What is the most common elbow pain in adolescents?
Osteochondritis dissecans of the capitellum (OCD)
How do you treat medial epicondyle apophysitis?
Sling immobilization
Progressive return
How do you treat osteochondritis dissecans of the capitellum?
Immobilization until asymptomatic
What is panner’s disease?
Necrosis of the ossification center of the capitellum followed by regeneration and recalcification
What is the most common cause of elbow pain in children 7-10?
Panner’s disease
How do you treat a UCL sprain/ grade 1 or 2 tear?
Short immobilization
Progressive return
___% of throwing energy comes from the legs and tunk
50
