Lecture 4 - The Young Athlete Flashcards
what is the main difference between adult bones and growing bones?
- childrens/growing bones are vulnerable at the growth (epiphyseal plate)
(technically between the growth plate and metaphysis)
why are growing bones vulnerable at the growth plate?
- shear/rotation forces, compression
- weaker than the adjacent capsule/ligaments (2-5x)
- acute fractures can occur (or due to repetitive forces)
what is a type I salter-harris classification?
- compete separation of the epiphysis from the metaphysis without any bone fracture
what is a type II salter-harris classification?
- line of separation extends along the growth plate, then out through a portion of the metaphysis
- produces a triangle-shaped metaphysis fragment
- most common
what is a type III salter-harris classification?
- intra-articular (joints)
- extends from the joints surface to the growth plate
- extends along the plate to the periphery
what is a type IV salter-harris classification?
- 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
what is a type V salter-harris classification?
- uncommon injury
- compression at the growth plate
- a crush injury
what is little league shoulder?
- 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
what is slipped capital epiphysis?
- 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)
how do the ligament attachment sites (apophyses) differ between adult and growing bones?
- 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
what is an avulsion around the pelvis?
- 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
how do the metaphysis and diaphysis differ between adult and children’s bones?
- more resilient in children
- withstand greater deflection without fracture (greenstick)
- common in the wrist
what are the clinical cues of a greenstick fracture?
- tender on palpation (mid-bone)
- swelling or bump
- decreased ROM with pain on weight-bearing
what should you do if you suspect a greenstick fracture?
- send for x-ray
- immobilize (cast)
- regain ROM and strength (rehab, after 3-4 weeks)
what is the main difference in the muscles and tendons surrounding bones between children’s and adults’ bones?
- 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
what is little league elbow?
- apophysitis of the medial epicondyle
- due to cocking and early acceleration
what are the clinical cues of little league elbow?
- 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
what is the management for little league elbow?
- ice, brace/splint, imaging
- rest 4-6 weeks minimum
- rehab/ introduce throwing after 6-8 weeks (non-competitive pitches to start)
what is osgood-schlatter and sinding-larson-johansson?
- 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)
what are the clinical cues of OS/SLJ?
- slow onset tenderness
- tightness in quads/hamstrings
- excessive pronation
- should rest/reduce activity, cryotherapy and stretch/strengthen quads and hamstrings
what is sever’s disease?
- 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
