CPS Pediatric Sport and Exercise Medicine

Question 1

What kind of diet is best for young athletes?

Answer 1

Well balanced diet

Question 2

What is the most important fuel source for athletes?

Answer 2

Carbohydrates

Question 3

List the Ottawa Ankle rules

Answer 3

An ankle x ray is needed in a child over the age of 10 only if there is pain in the malleolar zone and any of the following:

1. Bone tenderness at the posterior edge or tip of the lateral malleolus
2. Bone tenderness at the posterior edge or tip of the medial malleolus
3. Inability to ambulate both following the injury and in the emergency department

Question 4

List the Ottawa Foot rules

Answer 4

A foot x ray series is needed in a child over the age of 10 only if there is pain int he midfoot zone and any of the following:

1. Bone tenderness at the base of the 5th metatarsal
2. Bone tenderness at the navicular bone
3. Inability to weight bear both immediately and in the emergency department

Question 5

Describe PRICE management for ankle injury

Answer 5

Protection
Rest
Ice
Compression
Elevation

Question 6

Which is the most commonly injured ankle ligament?

Answer 6

ATFL

Question 7

Contrast bracing vs. taping for ankle injury

Answer 7

Taping commonly used but bracing more effective and less expensive

Question 8

List four sports that are high risk for back injury

Answer 8

• Football
• Figure skating
• Gymnastics
• Soccer

Question 9

Describe four risk factors for back injuries in athletes

Answer 9

• Muscle imbalance
• Inflexibility
• Structural differences of the spine
• Improper training

Question 10

List three features of the clinical presentation of spondylolysis

Answer 10

• Extension related back pain
• Reduced hamstring flexibility
• Pain with impact activities

Question 11

List three physical examination findings seen with spondylolysis

Answer 11

• Hyperlordosis
• Paraspinal muscle spasm
• Hamstring tightness

Question 12

List three sports with increased risk for spondylolysis

Answer 12

• Dance
• Figure skating
• Gymnastics

Question 13

List three management recommendations for spondylolysis

Answer 13

• Avoid painful activities (extension)
• Physiotherapy focused on abdominal strengthening, hip flexor and hamstring stretches
• Custom thoracolumbar orthoses to limit spinal extension
• Expect return to plan in 4-8 weeks with brace, 3-6 months without

Question 14

What is the typical clinical presentation for posterior element overuse injury?

Answer 14

• Insidious onset extension related back pain (similar to spondylolysis)

Question 15

How to differentiate between spondylolysis and posterior element overuse syndrome?

Answer 15

• Spondylosis is associated with paraspinal muscle spasm and tight hamstrings
• Spondylolysis is associated with findings on imaging that are consistent with a fracture in the scottie dogs neck

Question 16

What is the typical presentation for vertebral body apophyseal avulsion fracture?

Answer 16

• Acute onset flexion related lumbar pain similar to disc herniation
• No associated neurological symptoms

Question 17

List physical examination findings in vertebral body apophyseal avulsion fracture

Answer 17

• Spinal flexion and extension limitation

- Paraspinal muscle spasm

Question 18

List three management strategies for vertebral body apophyseal avulsion fracture

Answer 18

• Rest for 3-6 months to allow for resolution
• Heat
• NSAIDs

Question 19

List the clinical presentation of acute disc herniation

Answer 19

• Acute onset pain
• Flexion related and associated with back muscle spasm
• Hamstring tightness, buttock pain
• Radicular symptoms

Question 20

List 3 physical examination findings seen with disc herniation

Answer 20

• Decreased flexion
• Positive straight leg raise
• Occasionally decreased reflexes/ strength of the lower extremities

Question 21

List three indications for surgery in disc herniation

Answer 21

• Cauda equina syndrome
• Progressive neurological deficit
• Refractory pain

Question 22

List 5 red flag symptoms that should prompt further investigation for back pain

Answer 22

• Fever
• Night pain
• Neurological abnormalities
• Weight loss
• Malaise

Question 23

For how long does an athlete with splenomegaly from infectious mononucleosis need to be excluded from play?

Answer 23

• Needs to be excluded for minimum period of three weeks from the time of onset of symptoms or diagnosis
• Needs to be able to tolerate low impact non contact training for one week and if this goes well then may return to contact play