Lecture 4 - The Young Athlete Flashcards

1
Q

what is the main difference between adult bones and growing bones?

A
  • childrens/growing bones are vulnerable at the growth (epiphyseal plate)
    (technically between the growth plate and metaphysis)
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2
Q

why are growing bones vulnerable at the growth plate?

A
  • shear/rotation forces, compression
  • weaker than the adjacent capsule/ligaments (2-5x)
  • acute fractures can occur (or due to repetitive forces)
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3
Q

what is a type I salter-harris classification?

A
  • compete separation of the epiphysis from the metaphysis without any bone fracture
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4
Q

what is a type II salter-harris classification?

A
  • line of separation extends along the growth plate, then out through a portion of the metaphysis
  • produces a triangle-shaped metaphysis fragment
  • most common
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5
Q

what is a type III salter-harris classification?

A
  • intra-articular (joints)
  • extends from the joints surface to the growth plate
  • extends along the plate to the periphery
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6
Q

what is a type IV salter-harris classification?

A
  • fracture extends from the joint surface through the epiphysis, across the full thickness of the growth plate and through the metaphysis
  • a complete split
  • this has injury to the growth plate
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7
Q

what is a type V salter-harris classification?

A
  • uncommon injury
  • compression at the growth plate
  • a crush injury
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8
Q

what is little league shoulder?

A
  • stress fracture of the proximal epiphyseal plate of the humerus
  • occurs in children ages 11-16 commonly
  • due to release-tension stress or rotational stress
  • pain in the dominant shoulder due to increase in FITT (too much too soon)
  • treatment is to stop throwing from 4-6 weeks
  • healing occurs uniformly
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9
Q

what is slipped capital epiphysis?

A
  • pressure epiphysis
  • femoral head stays in place while femoral neck slips up
  • occurs in children between ages 12-15 (overweight males and late maturers)
  • may be sudden or gradual
  • athlete will have decreased hip abduction and internal rotation, will have one leg shorter and externally rotated
  • this is a surgical emergency (put a pin in)
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10
Q

how do the ligament attachment sites (apophyses) differ between adult and growing bones?

A
  • bone is weaker than the ligament/tendon in children
  • common for the bone to break off rather than injury to the musculus structure
  • tendons/ligaments are very tight in growing children
  • occurs due to submaximal forces, increases FITT, sports during growth spurts and puberty
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11
Q

what is an avulsion around the pelvis?

A
  • at the ischial tuberosity (or ASIS/AIIS)
  • caused by running, kicking or slipping
  • “pop” or tearing followed by pain (on palpation, passive stretch and resisted flexion)
  • care with ice, crutches and imaging
  • rehab includes core stability, balance, cardio and progressive ROM/strengthening and power
  • recovery time is 3-4 months for IT, 6-8 weeks for ASIS/AIIS
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12
Q

how do the metaphysis and diaphysis differ between adult and children’s bones?

A
  • more resilient in children
  • withstand greater deflection without fracture (greenstick)
  • common in the wrist
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13
Q

what are the clinical cues of a greenstick fracture?

A
  • tender on palpation (mid-bone)
  • swelling or bump
  • decreased ROM with pain on weight-bearing
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14
Q

what should you do if you suspect a greenstick fracture?

A
  • send for x-ray
  • immobilize (cast)
  • regain ROM and strength (rehab, after 3-4 weeks)
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15
Q

what is the main difference in the muscles and tendons surrounding bones between children’s and adults’ bones?

A
  • children’s muscles and tendons grow after the bone has grown
  • muscles and tendons are tighter and weaker
  • injury to the apophysis occurs much more often than muscle/tendon injuries
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16
Q

what is little league elbow?

A
  • apophysitis of the medial epicondyle
  • due to cocking and early acceleration
17
Q

what are the clinical cues of little league elbow?

A
  • medial elbow pain
  • decreased velocity and control
  • tenderness at the site
  • pain with wrist flexion and pronation (attachment)
  • valgus stress of elbow
  • tenderness on other side due to compression
18
Q

what is the management for little league elbow?

A
  • ice, brace/splint, imaging
  • rest 4-6 weeks minimum
  • rehab/ introduce throwing after 6-8 weeks (non-competitive pitches to start)
19
Q

what is osgood-schlatter and sinding-larson-johansson?

A
  • partial avulsion of apophysis due to continuous contraction/stretch of quads
  • common during growth spurts with high-level activity
  • at tibial tuberosity (OS)
  • at inferior pole of patella (SLJ)
20
Q

what are the clinical cues of OS/SLJ?

A
  • slow onset tenderness
  • tightness in quads/hamstrings
  • excessive pronation
  • should rest/reduce activity, cryotherapy and stretch/strengthen quads and hamstrings
21
Q

what is sever’s disease?

A
  • calcaneal apopysitis (achilles insertion)
  • caused by growth spurt most often (shortened gastroc-soleus)
  • tenderness in posterior heel, decreased dorsiflexion ROM
  • use heel raise to reduce pain in recovery, stretch plantar flexors
  • rehab/recovery –> condition settles in 6-12 months