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CPS Statements > Healthy Active Living and Sports > Flashcards

Healthy Active Living and Sports Flashcards

1
Q

What is a concussion?

A
  • brain injury
  • complex pathophysiological process affecting the brain induced by biometrical forces and resulting in the rapid onset of short-lived impairment of neurological function that resolves spontaneous
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2
Q

What causes a concussion?

A
  • direct impact to the head, neck or face or to somewhere’s on the body that transmits an impulsive force to the head
  • LOC is not common
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3
Q

What are some signs and symptoms of concussion?

A
  • h/a,
  • N/V
  • dizziness
  • photophobia, phonophobia
  • LOC
  • amnesia
  • loss of balance or coordination
  • decreased playing ability
  • irritability
  • emotional lability
  • sadness, anxiety
  • in appropriate emotions
  • slowed reaction times
  • trouble concentrating
  • difficulty remembering
  • confusion
  • feeling dazed or in a fog
  • drowsiness
  • trouble falling asleep
  • sleeping more or less than usual
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4
Q

When do symptoms of a concussion develop?

A

-usually in minutes to hours but can be up to days following the injury

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5
Q

When do symptoms of a concussion typically resolve?

A

usually 7-10 days but for some it is weeks to months

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6
Q

What is second impact syndrome?

A

-fatal diffuse cerebral swelling

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7
Q

What should you do if you have a concussion?

A
  • stop the activity right away

- see a MD for neurological and cognitive assessment as soon as possible to confirm the dx

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8
Q

What are some factors that might put you at risk for a longer recovery phase following a concussion?

A
  • previous head or facial injury
  • hx fo h/a or migraines in the pt or family
  • mental health issues
  • sleeping difficulties
  • learning disabilities
  • ADHD
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9
Q

What do you tell parents about monitoring immediately after a concussion?

A
  • be closely monitored for 24 to 48 hours for signs of deterioration
  • sleep is important but they should be checked on through the night but not woken up unless concern about deterioration
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10
Q

What imaging do you need for concussion?

A

usually none, unless suspect a structural injury

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11
Q

What is the role of neuropsychological testing in concussion?

A
  • can be helpful for return to play guidelines but not usually feasible
  • may be necessary for athletes who have sustained multiple concussions or who experience prolonged post concussive symptoms to help identify specific deficits and aid with educational planning
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12
Q

What is the Return to Learn protocol for concussion?

A

-different stages and if symptoms worsen at any stage go to the one before

Cognitive rest - decrease and limit cognitive tasks including screen time; no school

increase cognitive tasks - slow increase cognitive tasks at home in 15-20 min increments

Resume modified school attendance - start with half days or only certain classes (avoid gym, music, shop) limit homework assignments to 15-20 min blocks

Increase school attendance - gradually increase to full days as symptoms allow; specific accommodations may be required; tests should be limited to one per day in a quiet area with unlimited time and frequent breaks

Return to play protocol - once symptom free and back in full-time school without accommodations the student can start with graduated return to play

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13
Q

What kind of accommodations are made for students with concussion in school?

A
  • frequent breaks, quiet area, hydration
  • shortened day, only certain classes
  • if photo or phono phobia - sunglasses, ear plus, avoid noisy areas, limit computer work
  • reassurance and support from teachers
  • shorter assignment, decreased workload, more time to complete assignments or tests
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14
Q

Why do we have return to learn protocols?

A

b/c participation in cognitive tasks that exacerbate symptoms may prolong recovery

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15
Q

Do you need to be symptom free to return to school?

A
  • no but may need modifications

- but do need to be in full academics before return to sports

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16
Q

When would you consider referral to a specialist in concussion?

A

-persistent symptoms causing prolonged absence from school (more than a couple of weeks)

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17
Q

What is the Return to Play protocol?

A
  1. No activity - symptom limited physical and cognitive rest until symptom free; stay at this stage until symptom free for several days (ideally 7-10 days)
  2. Light aerobic exercise - walking, swimming or stationary cycling; no resistance training
  3. Sport-specific exercise - skating drills in ice hockey, running drills in soccer, no impact activities
  4. Noncontact training - progression to more complex training drills (eg. passing drills); may start progressive resistance training
  5. Full contact practice - following MD clearance, normal training activities
  6. Return to play - normal
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18
Q

How long should each step in the Return to Play protocol take?

A
  • the first step ideally should be several days (ideal is 7-10 days) before go to step 2
  • all other steps should be a minimum of 24 hours
  • if any symptoms recurs then rest until it resolves (min 24-48 hrs) before trying again starting with the last step at which they were asymptomatic
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19
Q

What should you do with the athlete with multiple concussions?

A
  • controversial
  • may be increased risk for subsequent head injuries and that concussive injuries may be cumulative
  • consider retiring from the sport or moving to a less risky position esp if concussion occurs with less force, results in more severe sx, is more likely b/c of playing style or position, occurs in the setting of comorbid learning disability
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20
Q

Does protective equipment (e.g. helmets) prevent concussion?

A

no but they do protect against other head injuries like fractures, structural damage

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21
Q

What is bodychecking?

A

-defensive tactic where the defensive player physically extends his body toward the puck carrier while moving in an opposite or parallel direction, a deliberate and forceful move not solely determined by the puck carrier

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22
Q

How is bodychecking taught?

A

-there is a 4-step skill development program outline by Hockey Canada

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23
Q

When does hockey Canada mandate that bodychecking be introduced?

A
  • peewee (age 11 and 12 yrs) for boys

- bodychecking is not allowed in girls’ or women’ hockey

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24
Q

What is the most common mechanism of injury in hockey?

A

bodychecking

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25
Q

Is hockey or football more dangerous?

A

-hockey has more fatality, catastrophic spinal cord and brain injuries than football

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26
Q

What risk factors increase risk of injury in hockey?

A
  • injury increases with increasing skill level
  • injuries more likely in games than practices
  • goalie is protective
  • previous hx of injury or concussion
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27
Q

What are the CPS recommendations regarding bodychecking?

A
  • recommend eliminating it from all levels of recreational/non-elite competitive male hockey
  • delay introduction of bodychecking in elite male competitive leagues until players are at least 13 or 14 years old
  • use the Hockey Canada 4-stage skill development program
  • education of coaches, trainers, schools, etc
  • no bodychecking ni womens hockey
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28
Q

What are the risks of sedentary behaviour and increased screen time?

A
  • increased BMI and adiposity
  • replaces physical activity
  • reduces resting metabolism
  • exposes to low nutritive foods through advertising
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29
Q

What factors reduce participation in physical activity?

A
  • inactive role models
  • low SES and low education
  • cost
  • accessibility
  • parental time
  • dislike sports
  • disabled youth
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30
Q

What are the benefits of aerobic physical activity?

A

-decreases obesity, BP, atherosclerosis, sleep disordered breathing, diabetes, NASH, self-esteem, decreases anxiety and depression

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31
Q

What is the role of exercise-videogames?

A

-should not replace physical activity but can replace screen time or sedentary activities

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32
Q

What are the benefits of weight-bearing physical activity?

A

-promotes bone mass acquisition, improved BMD

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33
Q

What are the recommendations for physical activity for infants?

A

should start in early infancy, floor-based play, tummy time, reaching, crawling

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34
Q

What are the recommendations for screen time in kids

A

-no screen time

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35
Q

What are the physical activity guidelines for kids age 5-9 yrs?

A

-screen time 1 hr of physical activity/day; vigorous intensity activities at least 3 days per week, muscle/bone strengthening activities at least 3 days per week

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36
Q

What are the physical activity guidelines for kids 10-12 yrs?

A

screen time 1 hr of physical activity/day; vigorous intensity activities at least 3 days per week, muscle/bone strengthening activities at least 3 days per week

  • pick sports bed on physical maturity
  • can start strength training that is supervised (low weight, high reps)
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37
Q

What should MDs do to help improve physical activity?

A
  • write a prescription for it for both aerobic and strength training
  • promote
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38
Q

What psychosocial factors contribute to obesity?

A
  • depression/anxiety
  • low self-esteem
  • bullying
  • weight bias (tendency to make unfair judgements based on a person’s weight)
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39
Q

What effect does stress have on obesity?

A
  • stressed kids more prone to emotional eating
  • chronic stress –> poor sleep –> fatigue –> no physical activity
  • stress impacts the immune system and can have increased illnesses like URTIs
  • chronic stress can activate HPA axis and sympathetic nervous system –> insulin resistance, adiposity
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40
Q

What are common stressors for kids that may contribute to obesity?

A
  • parental divorce
  • bullying
  • physical/mental maltreatment
  • abuse
  • living in foster care
  • living situation where limit-setting and supervision are lacking
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41
Q

What are the parents’ responsibilities when it comes to childhood obesity?

A
  • be good role models
  • set limits
  • exercise together
  • purchase healthy food
  • ensure that divorce as un-traumatic as possible
  • only kids (without sibs) are at higher risk for obesity
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42
Q

What are some community -level challenges that contribute to obesity?

A
  • cost of nutritious, fresh food is often higher than fast food especially in more remote communities
  • fast food and sugary foods are often advertised during kid’s tv
  • families with limited income and education are more likely to be overweight
  • remote norther communities may have weather that limits physical activity
  • unsafe housig limits access to safe facilities
  • school programming of physical activity
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43
Q

What is a key technique to use when working with families related to obesity?

A

motivational interviewing!

  • pateitn centered goals which elicit intrinsic motivation for change, useful for pts that are less confident about their ability to change behaviours
  • empower parents and patients and give them confidence to make the necessary changes
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44
Q

What are some food specific recommendations you can tell parents regarding childhood obesity?

A
  • avoid casual snacking throughout the day
  • avoid using food as a reward or bribe
  • discourage food pushing (eating all the food prepared for you)
  • avoid exposure to fast foods
  • promote eating as a family
  • avoid skipping breakfast (is linked to obesity)
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45
Q

True or False. It is very important to identify stress in a family when talking about childhood obesity.

A

True.

46
Q

What is the CMA’s position on boxing?

A

-that it be banned in Canada

47
Q

What is the CPS’ position on boxing?

A

That it not be allowed as a sport for kids and adolescents b/c it involves deliberate blows to the head leading to risk of injuries that can be cumulative and possibly fatal.

48
Q

What are the most common injuries in boxing?

A

1) concussion - kids brain more vulnerable to injury and recovery is more prolonged compared to adults
2) open wounds/lacerations/cuts
3) fractures (including facial)

49
Q

What is the most significant injury in boxing?

A
  • brain injury with subdural hematoma the most common cause of death
  • can get neuro and cognitive deficits
  • micro-hemorrhages
  • impaired neurocognitive functioning
  • chronic traumatic encephalopathy
50
Q

Aside from head injuries what are some risks related to boxing and weight restrictions?

A
  • laxative and diuretic use, voluntary dehydration to reach targets
  • this can impair reaction time, endurance, strength, electrolyte imbalance, dehydration, heat exhaustion and heat stroke
51
Q

If someone insists on boxing, what are some medical things to ensure?

A
  • ensure regular medical care
  • preparticipation checks
  • medical care at events
  • regular neurocognitive testings
  • regular ophtho assessments
52
Q

What contributes to decreased vigorous physical activity in kids with JIA?

A
  • muscle atrophy
  • weakness
  • anemia
  • deconditioning
53
Q

What are some benefits of exercise in JIA?

A
  • psychosocial benefits of group activities
  • reduce loss of proteoglycans and cartilage damage
  • optimize BMD
  • lower obesity so less load on the joints
  • improved aerobic fitness
  • better muscle strength and function
  • decreases disease activity
  • improved energy
  • reduces pain and medication use
  • water sports encourages ROM, strength, fitness with less stress on joints
54
Q

What are some risks of JIA with exercise?

A
  • TMJ disease puts them at risk for dental fractures
  • uveitis might increase risk of eye injury
  • cspine arthritis might put at increased risk for spinal cord injury
  • etc
55
Q

What are the recommendations regarding physical activity in kids with JIA?

A
  • can safely participate in sports without disease exacerbation
  • should participate in moderate fitness, flexibility and strengthening exercises
  • can participate in impact activities and competitive sports if disease is well controlled
  • should gradually return to full activity following a flare
  • if have neck arthritis screen for C1-C2 stability
  • wear mouth guards
  • wear eye protection in the sports that need it
56
Q

What are some potential benefits of exercise in patients with hemophilia?

A
  • active kids can have fewer bleeding episodes than sedentary kids
  • prophylactic physio improves periarticular muscle strengtha nd reduces frequency of hemorrhage
  • proprioceptive training may decrease joint damage
  • weight bearing can improve bone health
  • vigorous exercise increases factor VIII
57
Q

What are some risks of exercise in kids with hemophilia?

A
  • they may restrict activity due to parental concern, pain or deconditioning
  • chronic hemophilic arthropathy may lead to impaired neuromuscular function, diminished strength and endurance
  • contact sports can result in life-threatening bleed
58
Q

What are the recommendations regarding sports for patients with hemophilia?

A
  • shoudl receive appropriate factor prophylaxis
  • vigilant assessment of joint and muscle function before sport selection
  • shoudl be carefully assessmd before being allowed to participate in contact sports
  • need written strategies for coach, parent, school to prevent or treat bleeds
  • need protective equipment
  • should undergo physiotherapy
  • require factor replacement, ice, splinting and rest for acute bleeds
  • avoid activity until joint pain or swelling has resolved
59
Q

What is the progression/onset/resolution of exercise-induced bronchospasm in asthma?

A

-occurs 8-15 mins after onset of physical activity and resolves within 60 mins

60
Q

How do you diagnose exercise-induced bronchospasm?

A
  • using exercise challenge PFT

- drop of 10-15% in FEV1 after vigorous exercise for 6-8 mins is diagnostic

61
Q

What are some potential risk of exercise with asthma?

A

-can trigger exercise-induced bronchospasm
-permament bronchial changes may occur in endurance athletes
-certain sports expose individuals to dry, cool air, allergens, etc
-atheletes in running and winter sports have more symptoms
-breathing humid air during swimming may be protective
-

62
Q

What are the recommendations regarding exercise for kids with asthma?

A

-able to participate in any physical activity if their symptoms are well-controlled
d-swimmin is less likely to trigger exercise-induced bronchospasm
-should keep accurate hx of sx, triggers, treatments, etc
-should use LTRI, ICS and/or LABAs for optimal long-term disease control and avoid overuse of ventolin
-should take inhaled beta-2agonist 15-30 mins before exercise
-should not scuba dive if they have asthma symptoms or abnormal PFTs
-if compete nationally or internationally require a therapeutic use exemption with confirmation of asthma to use certain meds

63
Q

What are some potential benefits of exercise in kids with CF?

A
  • high aerobic fitness experience slower deterioration in lung function and greater survival rates
  • enhanced lung mucus clearance can occur during intense exercise
  • can improve strength and endurance of resp muscles
64
Q

What are some potential risks of exercise in kids with CF?

A
  • may cough, causing brief dessert
  • ability to do exercise may be limited by lung disease
  • can get VQ mismatch (intrapulmonary R to L shutting or for pulmonate with CHF)
  • cardiac dysfunction is often noted in pts with advanced CF (FEV1
65
Q

What are the recommendations regarding exercise for kids with CF?

A
  • encourage to participate in physical activity, consult with resp or sports med MD
  • shoudl have individualized exercise program that includes strength training
  • require supervised and or unsupervised home exercises that elevate HR by 70-80% max
  • do not necessarily need to stop activity if they cough
  • AVOID scuba diving
  • if severe CF should have exercise testing
  • shoudl drink flavoured NaCl-containing fluids about thirst levels to prevent hyponatremic dehydration
  • if have CFRD then may need additional carbs during prolonged exercise
  • avoid contact or collision sports if have splenomegaly or liver disease
66
Q

True or false. Trampoline injuries result in admission more than injuries from all other sports.

A

False. Alpine skiing results in more but trampoline injuries are #2.

67
Q

Which kids are most at risk of trampoline injury and what is the nature of the injury?

A
  • usually kids 5-14 yrs
  • home trampolines
  • most injuries occur on mat (not from falling off)
  • fractures are most common (usually upper extremity)
  • many occur with more than one kid on the trampoline at a time
68
Q

What are some serious injuries that can occur as a result of trampolines?

A
  • cspine
  • knee ligamental injury
  • popliteal artery thrombosis
  • ulnar nerve injury
  • vertebral artery dissection
69
Q

What are the CPS recommendations regarding trampoline use?

A
  • should not be used for recreational purposes at home (including cottages) by kids or teens
  • health care professionals should warn parents of the dangers of trampolines
  • enclosures around trampolines are no guarantee against injury
  • should not be part of outdoor playgrounds
  • legislation should require warnings of trampoline dangers to be put on product labels
  • need more research on trampolines in schools, gym clubs, etc
70
Q

What are examples of macronutrients and micronutrients?

A
  • macronutrients = carbs, protein, fat

- micronutrients = vitamins, minerals

71
Q

What are side effects of energy deficits?

A
  • short stature
  • delayed puberty
  • dysfunctional menstruation
  • loss of muscle
  • increased fatigue
  • inury or illness
72
Q

What is the most important fuel source for athletes and why?

A

carbs b/c they give glucose for energy

73
Q

What % of intake should be made up for carbs for 4-18 year olds?

A

45-65% (whole grains, veggies, fruits, milk, yoghurt)

74
Q

What is the role of protein for energy?

A

-not primary energy source for short or mild exercise but as duration increases proteins maintain glucose though gluconeogenesis

75
Q

How % of caloric intake in kids 4-18 yrs should be made up by protein?

A

10-30%

76
Q

What is the role of fats in nutrition?

A
  • fats are necessary for fat soluble vitamins

- provide essential fatty acids, provide insulation

77
Q

What % of total caloric intake should be made up of fats ?

A

25-35% of total intake, saturated fat

78
Q

What micronutrients are especially important for atheletes? How much of each should they be getting?

A

Calcium = 1000mg/day for ages 4-8 yrs, 1300 mg/day for ages 9-18 yrs
Vit D = 600 IU/day but depends on where you live and race
iron = 8mg/day for 9-13 years; 11mg/day for males and 15 mg/day for females age 14-18years

79
Q

What are fluid recommendations for athletes?

A

-2-3 hrs before have 400-600ml of cold water; during take 150-300ml q15-30 mins (of water if

80
Q

What are meal recommendations around exercise?

A
  • recovery foods wihtin 30 minutes and again within 1-2 hours to reload muscle and glycogen (includes protein and carbs)
  • meals 3 hrs prior to event and include carbs, protein, fat
  • pregame snacks or liquid meals 1-2 hours before, during can have fruit, sports drinks or granola bars
81
Q

What are the energy requirements of kids 4-6 yrs, 7-10 yrs, 11-14 yrs and 15-18 years?

A
  • 4-6 yrs: 1800 kcal/day for both sexes
  • 7-10 yrs: 2000 kcal/day for both
  • 11-14 yrs: 2500 kcal/day for males, 2200 kcal/day for females
  • 15-18 yrs: 3000 kcal.day for males, 2200 kcal/day for females
82
Q

What is the main message about low back pain in young athletes?

A

-take it seriously to avoid delays in treatment and diagnosis
-more likely to be from structural injuries like spondylolysis
(disc pathology and muscular strain are uncommon)

83
Q

What % of paediatric athletes complain of low back pain? In what sports is this most common?

A
  • 10-15%

- football, figure skating, gymnastics, soccer

84
Q

What are some risk factors that predispose kids to back injuries in sports?

A
  • muscle imbalances
  • inflexibility
  • structural differences of the spine (growth cartilage and secondary ossification centres susceptible to compression, torsion and distraction injury)
  • cartilaginous end plates and ring apophyses at either end of vertebral bodies may be damaged by repeated flexion of the spine
  • can get intervertebral disc herniation through ring apophysis with repetitive spine flexion
  • at risk for spondylolysis due to ossification of the pars interarticularis may be incomplete
  • improper training or technique
  • excessive training
  • growth spurts (muscles and ligaments cannot keep pace with bone growth causing decreased flexibility and imbalances)
85
Q

What is spondylolysis and how does it present? How do you dx and manage it?

A

= stress fracture of the pars interarticularis caused by repetitive spinal extension and rotation (esp dance, figure skating, gymnastics)

  • presents with insidious onset of extension-related back pain, hamstring flexibility is reduced, can be pain with impact activities (running, jumping).
  • physical exam shows hyperlordosis, paraspinal muscle spasm and hamstring tightness

Dx:
XR - AP and lateral - may identify anatomical variants, developmental defects (like spina bifida); oblique views may show stress rxn of the pars interarticularis
Bone scan - increased uptake if there is a bony lesion
CT - can confirm it and monitor healing

MANAGEMENT

  • avoid painful activities (extension movements)
  • abdominal strengthening
  • hip flexor and hamstring stretches
  • antilordotic exercises
  • above done by physic
  • bracing is controversial (if used do it for 4-8 weeks or until pain free) activity is gradually increased until participating fully in activities in the brace with no pain, then wean the brace over the next few months
  • if no bracing - restrict from activities for 3-6 mo or until pain free and gradually increase activities
  • most return to full activities with a brace and without pain within 6 mo
86
Q

What is posterior element overuse syndrome or ‘hyperlordotic back pain’? How does it present and how is it managed?

A

=constellation of conditions involving the posterior spine, including muscle-tendon units, ligaments and facet joints

-presents with insidious onset of extension-related back pain, similar to spondylylysis but FOCAL tenderness of the lumbar spine, paraspinal muscles may be tender

IX:
typically negative

MANAGEMNT:

  • Ice
  • NSIADS
  • painfree activity is allowed (avoidance of extension movements)
  • physio for specifc strengthening exercises
  • usually 4-8 weeks before return to play
  • bracing may be helpful
87
Q

What is vertebral body apophyseal avulsion fracture? How does it present and how is it managed?

A

= repetitive spinal flexion and extension can injure the ring apophysis, resulting in fractures that may posteriorly displace into the spinal canal along with the intervertebral disc
-can occur in volleyball, gymnastics, weightlifting

  • acute-onset flexion-related lumbar pain, no associated near sx
  • on exam there may be spinal flexion and extension limitation, paraspinal muscle spasm

IX:
lateral lumbar XR - may show ossified fragment in the canal
CT to identify the displaced apophyseal fracture (missed on MRI)

MANAGEMENT

  • rest (3-6 months for symptoms to resolve)
  • heat
  • NSAIDs
  • if near deficits - urgent neurosx for surgical excision of fragment
88
Q

What is disc herniation? How does it present and how is it managed?

A

=rare, disc herniation of lumbar spine

  • acute pain onset, flexion-related and associated with back muscle spasm, hamstring tightness and sometimes bum pain
  • radicular symptoms (msucle weakness, parasthesias) are uncommon
  • exam shows decreased flexion, positive straight leg raise and occasionally decreased reflexes/strength of lower extremities

IX:
-XR can r/o tutors or #
MRI - shows extent of herniation, nerve root impingement (MRI reserved for progressive or refractory symptoms)

MANAGEMENT:

  • conservative
  • NSAIDs
  • physio
  • rest
  • usualyl return in 3-6 months
  • reasons for sx include caudal equine syndrome (loss of bel/bladder function, leg paralysis resulting form nerve compression), progressive near deficit or refractory pain
89
Q

What are red flag symptoms of low back pain?

A
  • occur at night
  • fever
  • neurological abnormalities
  • weight loss
  • malaise
90
Q

What are ways to prevent low back pain in young athletes?

A
  • reduce training during rapid growth
  • emphasis on proper techniques (avoid excessive training)
  • improve RF like imbalances muscles, flexibility with core strengthening and hamstring/hip flexor stretches
91
Q

How does exercise affect the immune system?

A
  • increases neutrophils and lymphocytes (secondary to high adrenaline)
  • ratio of CD4 to CD8 cells decreases
  • salivary immunoglobulin A concentration iis suppressed
  • diminished neutrophil chemotaxis and phagocytosis
  • NK activity increases during receive
  • brief periods of immunosuppression after intense exercise “immunological open window”
  • athlete may not be able to fight off infection after a period of high intensity exercise
92
Q

Are athletes more susceptible to infection?

A
  • relationship btwn amount of exercise and incidence of injection is a J curve
  • moderate exercise level enhances immune function with fewer and shorter duration infections
  • high intensity/elite athletes may be at greater risk of infections, also higher risk after major competition/races (some of this may be related to stress, inadequate recovery, fatigue, etc)
93
Q

What are the risks of exercising during a fever?

A
  • may exacerbate symptoms, prolong length of illness, increase risk of serious complications (like myocarditis)
  • fever impairs ability to regulate body temperature and increases insensible fluid losses
  • fever decreases muscle strength and endurance, increased fatigue
94
Q

Should athletes with an infection play sports?

A
  • use “neck check” - if symptoms just above the neck then can play if if they feel able, start with mild-moderate intensity for 10-15 mins and if symptoms worsen then stop
  • systemic symtpoms (fever, myalgias, diarrhea, elevated resting HR) - refrain from exercising until sx resolved for 7-14 days
95
Q

What are the specific risks of EBV and sports and how should you counsel patients?

A

-biggest risk is splenic rupture
-risk is highest in the first 3 weeks
-exam is unreliable
US is test of choice to determine spleen size
-athletes should be excluded from sports for a MINIMUM of 3 weeks beginning from onset of sx
-after 3 weeks can resume low/impact/noncontact training at 50% if meet these criteria:
1) resolution of symptoms
2) normalization of all lab markers
3) resolution of splenomegaly (ideally confirmed by US)
(if cannot get US then wait an extra week)
4) resolution of any and all complications including fatigue, airway obstruction secondary to tonsils, hepatitis)

if improve in the first week of graded return with no relapse then can fully participate in sports again

96
Q

What are the 3 ankle ligaments that stable the ankle laterally?

A

anterior talofibular ligament (most ocmmon to injure)
calcaneofibular ligament
posterior talofibular ligament

97
Q

How does an ankle sprain typically occur? What can you expect to see on exam?

A
  • inversion of plantar flexed foot
  • anterolateral swelling/bruise, tenderness of ligaments
  • weightbearing differently
98
Q

What is the most common ankle injury in young kids? older kids?

A

young kids - salter harris #

older kids - ankle sprain

99
Q

What are the Ottawa ankle rules and what age are they used for?

A
  • age >10 yrs
  • tells you who to XR

Ankle pain in malleolar zone AND any of:

  • bony tenderness at posterior edge/tip of lateral malleolus
  • bony tenderness at posterior edge/tip of medial malleolus
  • inability to weight bear BOTH immediately and in ER

Pain in midfoot region AND any of:

  • bony tenderness at base of 5th metatarsal
  • bony tenderness at the navicular bone
  • inability to weight bear BOTH immediately and in ER
100
Q

What is the management of an ankle sprain?

A

-PRICE
-protetion (no evidence for immobilization) but functional bracing with early mobilization is key
-use rigid lateral stirrups acutely then when return to sport sue lace up brace x3-6 months
ICE - use for 15 mins 1-3x/day in first 36 hrs
Compression/Elevation -
NSAIDs
Rehab - manage with physic, strengthen muscles and tendons, optimize flexibility and ROM

101
Q

When can you return to play after an ankle injury?

A
  • stepwise once ROM, strength and proprioception are normal and pain resolved
  • usually 1- 6 weeks
  • continue to wear brace x 3-6 months
  • d/c from physic when achieve full return to play but continue with home exercises
102
Q

What is sports readiness?

A

-child’s motor development matches requirement of the sport

103
Q

When do kids have the fundamental skills for participation in organized sport?

A

age 6 yrs

104
Q

What are the focus of sports for kids age 2-5 years and why?

A
  • focus on acquiring fundamental skills like running, jumping,
  • avoid competition
  • limited attention spans
  • balance skills are primitive
105
Q

What is the focus of sports for kids age 6-9 years?

A
  • less rapid growth
  • learning tractional skills (fundamental abilities combined or in vacation)
  • rules should be flexible
  • minimal competition
106
Q

What is the focus of sports for kids age 10-12 yrs?

A
  • boys and girls can compete evenly
  • mastering complex skills (eg. lay up in bball), attention skills are better but still selective
  • can start to learn strategy and tactics
107
Q

What is the focus of sports for kids age 13-15 yrs?

A
  • girls accumulate fat mass at a greater rate

- temporary decrease in coordination, balance and flexibility

108
Q

What is the focus of sports for kids 16-18 yrs?

A
  • mature sports skills

- all sports are appropriate

109
Q

What are the most common injuries in baseball and softball? Which age group has the highest # of injuries?

A
  • shoulder and elbow most common
  • can see catastrophic impact injuries from ball or bat
  • ages 11-14 yrs have the most injuries
110
Q

What is commotio cords?

A
  • direct ball impact over the cardiac silhouette which may cause arrest
  • only occurs in kids
111
Q

What are overuse injuries and what do they cause?

A
  • more common in pitchers
  • excessive traction stress across the growth plate, causing widening or even avulsion injuries
  • can cause chronic pain, joint instability, arthritis, inability to fully straighten the elbow
  • compelte tears of the ulnar collateral ligament
112
Q

Should baseball and softball be recommended?

A

yes are generally safe sports for kids 5-18yrs

  • encourage strengthening exercises
  • proper gear
  • allow 3 months of rest a year to avoid overuse injuries
  • coaches and trainers should have CPR and AED training due to risk of commotio cordis
  • safe baseball diamonds
  • lightening awareness

CPS Statements (14 decks)

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