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Speciality Medicine II > Lecture 3-Youth Sports in the USA > Flashcards

Lecture 3-Youth Sports in the USA Flashcards

1
Q

1987 Children’s Rights in Sport
* Children must be granted what?
* What cannot happen before 13 and 11?
* No publication of what?
* Children in Norwegian schools don’t get graded until when?

A
  • Children “must be granted opportunities to participate in planning and execution of their own sport activities.”
  • No national championships before 13
  • No Regional Championships before 11
  • No publication of rankings or scores
  • Children in Norwegian schools don’t get graded until 13 and this follows that concept
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2
Q

Currently in the USA:
* Travel teams as early as what?
* What are things that can happen to kids to help them in sports? (3)
* What is the issue?

A
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3
Q

What is the Overuse Injury “epidemic”?

A

“ …children are pigeonholed into one sport fairly early on, which means that they have little variation in terms of the muscles and joints employed and skills practiced, which can lead to fatigue and a much higher rate of injury”

Bc doing the same thing over and over again-> change your body for sport

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4
Q

All things in life come with risk
* American Orthopedic Society for Sports Medicine defines an overuse injury as what?
* Nearly 50% of all pediatric injuries are caused by what?

A
  • American Orthopedic Society for Sports Medicine defines an overuse injury as an injury caused by repetitive microtrauma to the tendons, muscles, and joints
  • Nearly 50% of all pediatric injuries are caused by overuse
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5
Q

Kids are not little adults
* What can happen at any age?
* When you are dealing with Pediatric overuse injuries you have what?
* What is different in kids than adults
* Children have what?

A
  • Overuse injuries can happen at any age
  • When you are dealing with Pediatric overuse injuries you have better tissue
  • Pediatric bones are different than adult bones. They are more porous.
  • Children have growth plates, Apophyses and more pliable tendons.
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6
Q

Growth Plate=
* The tibia has what?

A

Growth Plate = Physis
* The Tibia has a proximal and distal growth plate

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7
Q

Not all bones have what?

A

Not all bones have 2 growth plates
* 2-5: distal
* 1 is proximal

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8
Q
A
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9
Q

Apophysis
* What is it?
* This is an insertion point fot what?
* These areas can become what?
* What can it also become?

A
  • A growth center in a pediatric bone that is attached to a larger bone
  • This is an insertion point for a tendon
  • These areas can become inflamed: Apophysitis
  • The Apophysis can also become avulsed
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10
Q

Intra-articular Issues:
* What can tear?
* This leads to movement of what?
* Causes can include what?

A
  • The labrum of the hip can tear (rare)
  • This leads to movement of the torn segment and can cause pain, inflammation, and locking
  • Causes include dislocation of the hip, femoroacetabular impingement, and joint degeneration
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11
Q

How can you check for intra-articular issues?

A
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12
Q

What are the different types of hip avulsions?

A
  • Illiac Crest
  • Anterior Superior Illiac Spine
  • Anterior Inferior IlliacSpine
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13
Q

Traumatic hip pain: Illiac crest avulsion
* This is the insertion point for what?
* Patient might describe what?

A
  • This is the insertion point of the abdominal muscles (Obliques )
  • Patient might describe a “pop” when flexing their trunk
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14
Q

What is going on here?

A

Normally there is apophysis on both sides but the right side is pulled off

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15
Q

Traumatic Hip Pain: ASIS avulsions
* ASIS avulsions occur inwho?
* Mechanism is a result from what?
* Caused bywhat?
* Occurs duringwhat?

A
  • ASIS avulsions occur inyoung athletes through the growth plate
  • Mechanism is a result from indirect trauma
  • Caused by sudden and forceful contraction of sartorius and tensor fasciae latae
  • Occurs during hip extension (sprinting or swinging a baseball bat)
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16
Q

Where is the tensor fascia lata and sartorius?

A
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17
Q

What is going on here?

A

ASIS avusion

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18
Q

AIIS Avusion
* Usually happens in what sports?
* gender?
* May present as what?
* Typically occurs due to what?

A
  • Usually happens in sports involving kicking
  • Males more often than females
  • May present as a nagging pain that is being played through
  • Typically occurs due to eccentric contraction of the rectus femoris as hip extends and knee is flexed
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19
Q

What is eccentric vs concentric vs isometic contraction? Which one is must vulnerable?

A
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20
Q

What is the insertion point of the AIIS?

A
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21
Q

What is going on here?

A

AIIS avusion

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22
Q

What is the txt of AIIS ( and ASIS?)? When do you do them?

A

Nonoperative
* rest and protected weight bearing with crutches
* nonsurgical management consisting of rest and protected weight bearing yields satisfactory outcomes

Operative
* indications for surgery include
* fractures withdisplacement of > 3 cm
* painful nonunions

23
Q

Knee Pain Pitfalls
* Knee pain can actually be what?
* Children do not possess what?
* Muscle spasm in the lower extremity can create what?
* Always beware of what?

A
  • Knee pain can actually be hip pain in disguise
  • Children do not possess the body awareness that most adults do
  • Muscle spasm in the lower extremity can create pain distal to the anatomical position that is initially painful
  • Always beware of SCFE !!!!!!
24
Q

What is going on here?

A

SCFE
* Get kid in wheelchair then to the ER

25
Q

Knee Effusion (Traumatic+other)
* What are the different events? (6)

A

1) Fracture
2) ACL Tear
3) Meniscus Tear
4) Dislocation of the Patella
5) Infection
6) Rheumatologic Issue

26
Q
  • The most important part of the exam is what?
  • What should you have your patient do?
  • Unfortunately you will likely need to do what?
A
  • The most important part of the exam is to accurately identify the area that is painful
  • Point where it hurts with one finger
  • Unfortunately you will likely need to reproduce the pain to find the correct diagnosis
27
Q

Iliotibial Band Syndrome
* What type of injury?
* Caused by what?
* Often seen in who?
* Also known as what?

A
  • IT Band syndrome is a overuse injury
  • Caused by rubbing between the iliotibial band and the lateral f emoral condyle
  • Often seen in distance runners and cyclist
  • Also known as “runner’s knee”
28
Q

IT Band Syndrome
* Tightness of what? Abnormal what? What does it cause?

A

Tightness of the Tensor Fasciae Latae and abnormal tracking of the IT band causing pain at the lateral condyle

29
Q

IT Band Syndrome
* What is the txt?

A
  • Rest for at least a week
  • Ice immediately after activity
  • NSAID’s for acute pain
  • Stretching- pigon pose
  • Physical Therapy
  • Surgery is only needed for refractory cases
30
Q

Patellar Tendonitis/Sinding-Larsen-Johansson
* What is it? What is it referred to as?
* Common in who? Why?
* More common in what age group?
* Weakness of what?

A
  • Common overuse condition sometimes referred to as “jumper’s knee”
  • common injumping athletes due toforceful eccentric contraction of the extensor mechanism(basketball and volleyball)
  • more common in adolescents/young adults
  • weakness of the quadriceps muscles are thought to contribute to this problem
31
Q

Patellar Tendonitis
* Pain where?
* Pain more often occurs after what?
* Pain with what?
* What might get swollen?

A
  • Pain at the inferior portion of the patella
  • Pain more often occurs after the activity than during activity
  • Pain with prolonged knee flexion (movie theater sign)
  • Tendon may get swollen
32
Q

Osgood Schlatter’s disease
* What type of injury?
* Caused by what?
* What is it due to?
* Common in who?

A
  • An overuse injury
  • caused by a microfracture of the immature tibial apophysis
  • due to stress imposed by the extensor mechanism
  • Common in jumpers or sprinters
33
Q

Osgood Schlatter’s disease
* What will it show on exam?

A
34
Q

Osgood Schlatter’s disease
* What may it show on x-ray?

A

often it shows nothing though

35
Q

Osgood Schlatter’s disease
* What is the txt?

A
  • ICE
  • Let pain be your guide
  • Chopat strap
36
Q

What is going on here when a patient says this area hurts?

A

Patellofemoral Syndrome (PFS)

37
Q

Chondromalacia /Patellofemoral Syndrome
* What is it?
* Pain with what?
* What imaging is negative?
* Historically hurts to do what?
* Who is at higher risk?

A
  • Inflammation behind the patella
  • Pain with compression of the patella
  • X-rays are negative
  • Historically hurts to walk up steps
  • Females with a wide Q angle in running activities
38
Q

What is the q angle?

A
  • The first line is drawn from the anterior superior iliac spine (ASIS) of the pelvis, which is the bony prominence on the front of the pelvis, down to the center of the patella (kneecap).
  • The second line is drawn from the center of the patella down to the tibial tuberosity, which is the bony bump on the shinbone (tibia) just below the knee.
39
Q

What is normal patellar mvt?

A
40
Q

What is the j sign?

A
41
Q

Chondromalacia /Patellofemoral Syndrome
* Who often gets this from prolonged crouching?

A

Baseball catchers and offensive lineman get this from prolonged crouching

42
Q

PFS Treatment
* Imaging?
* Decrease what?
* Increase the strength of what?
* What can be used?

A
  • X-Ray-NO NEED
  • Decrease the activity that is causing the problem
  • Increase the strength on the medial muscles (vastus medialis) to get the patella to ride more medially
  • Bracing to attempt to keep the patella medial
43
Q

What are the 6 Growth Centers?

A
  • Capitellum
  • Radial Head
  • Internal Epicondyle (medial)
  • Trochlea
  • Olecranon
  • External Epicondyle (lateral)

CORTIE

44
Q
A
45
Q

Little League Elbow
* Why does this happen?
* Adults will do what?
* What is the txt?

A
  • Because Pediatric athletes have open growth plates, they will develop an Epicondylitis
  • Adults will tear the Ulnar Collateral Ligament
  • Treatment for this is Tommy John Surgery
46
Q

Little League Elbow
* Patients will complain of what?
* Acute pain raises the question of what?
* The family may report what?

A
  • The patient will complain of a gradual progression of medial elbow pain
  • Acute pain raises the question of a true avulsion
  • The family may report that the patient has lost velocity
47
Q

What hx questions do you need to ask for little league elbow? (4)

A
  • Look for a new increase in volume
  • Did the field change?
  • This includes practice sessions and guest pitching
  • Inquire about the position played when patient is not pitching
48
Q

What does the PE show for little league elbow?

A
  • Patient will be tender directly over the medial epicondyle
  • Increased pain with valgus stress
  • Patient should not have redness or loss of range of motion in the elbow (infection or somthing else)
49
Q

X-rays- little league elbow
* How do you dx it?
* X-rays are typically taken why?
* What is often imaged?
* 85% of patients with Little League Elbow will have what?

A
  • The diagnosis of little league elbow is clinical
  • X-rays are typically taken to rule out significant avulsion or other pathology
  • When X-rays are obtained the contralateral elbow is often imaged
  • 85% of patients with Little League Elbow will have normal X-rays
50
Q

Treatment of LLE?

A
  • REST !!!!!
  • The initial rest period lasts 4-6 weeks
  • After rest the patient should go through a gradual return to pitching protocol
  • Depending on the athlete, this return to pitching protocol should include physical therapy and slow motion video analysis
51
Q

Stress Reaction / Stress Fracture
* Can occur where?
* When we think of a fracture we think of an acute event but this fracture occurs how?
* The presentation is what?
* These typically start out as what?

A
  • Stress fractures can occur in most bones
  • When we think of a fracture we think of an acute event but this fracture occurs over an extended period
  • The presentation is insidious
  • These typically start out as stress reactions which then can progress to stress fractures
52
Q

Shin splints
* This is actually what?
* Typically seen in who?
* Patient presents with what?

A
  • This is actually a stress reaction that we tolerate
  • Typically seen in runners or in sports that include a lot of running
  • Patients presents with pain on the middle third of the tibia along the lateral side of tibia (aka the center on shin)
53
Q

There are many factors that can lead to stress fractures, what are they? (4)

A
  • Overtraining
  • Improper mechanics
  • Poor Nutrition
  • Poor bone mineralization
54
Q

Take Homes
* not enough what?
* Too many kids are what?
* What is important?
* What is the goal?
* Kids are different than who

A
  • Not enough Kids are playing sports
  • Too many kids are playing sports too often
  • Variety and Cross training are important
  • The goal of youth sports is to create adults who work hard, know how to be a teammate and are committed to the benefits of exercise.
  • Kids are different than adults and have different injury patterns

Speciality Medicine II (11 decks)

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