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athletic injuries 2036 > lecture 4 - the young athlete > Flashcards

lecture 4 - the young athlete Flashcards

1
Q

long bone growth occurs at each end, around the —- (growth) plates

A

epiphyseal

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2
Q

growth plates where tendons attach to bones are —

A

apophysis

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3
Q

the epiphyseal plate is – times more weaker than the surrounding bone

A

2-5

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4
Q

– to – of all childhood fractures are growth plate fractures

A

15% to 30%

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5
Q

avulsion

A

when the bone is pulled off, the tendon or ligament is stronger than the attachment to the bone and it actually pulls the bone off

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6
Q

anatomical differences between adult and growing bones (increased vulnerability of the growth (epiphyseal) plate. more specifically, it is the junction between growth plate and metaphysis

A
  • typically due to sheer/ rotation force and compression. most resistant to tension
  • physis 2-5 times weaker than adjacent capsule or ligamentous structure
  • periosteum is a major support through this area
  • injury can be acute or from repetitive forces
  • common acute fractures
    -distal radius, humeurs (proximal and distal) distal tib, fib, femure
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7
Q

salter - harris classification

A
  • type 1
  • type 2
  • type 3
  • type 4
  • type 5
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8
Q

type 1 salter-harris classification

A

complete seperation of the epiphysis from the metaphysic without any bone fracture (through the growth plate)

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9
Q

type 2 salter - harris classification

A

line of seperation extends along the growth plate, then out through a portion of the metaphysic, producing a triangular shaped metaphseal fragment

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10
Q

type 3 salter- harris classification

A
  • is intra- articular and extends from the joint surface to the growth plate and extends along the plate to its periphery (starts in the joint)
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11
Q

type 4 salter- harris classification

A

the fracture extends from the joint surface through the epiphysis, across the full thickness of the growth plate and through a portion of the metaphysis, producing a complete split. (starts in joint but goes right through the growth plate)

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12
Q

type 5 salter - harris classification

A

is a relatively uncommon injury, where there is a compression

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13
Q

Little league shoulder

A
  • stress facture of the proximal epiphyseal plate of the humerus (11 - 16 years old)
  • release - tension stress vs rotational stress
  • pain in dominant shoulder of athlete (tennis and volleyball, too) (any overhead type athletes)
    • during and after throwing
    • decreased speed and control
    • recent increase in FITT
  • treatment is abstinence from throwing for 4-6 weeks
  • healing occurs uniformly
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14
Q

slipped capital epiphysis (pressure epiphysis)

A
  • femoral head maintains position - femoral neck slips up
  • occurs in children between 12 and 15
    • overweight males
    • late maturers
  • slip may be sudden or gradual
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15
Q

clinical cues for slipped capital epiphysis

A
  • decreased hip abduction and internal rotation
  • shortening and external rotation of leg
  • surgical emergency
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16
Q

anatomical differences between adult and growing bones - tendon/ligament attachment sites (apophyses) are weak cartilaginous plates that are predisposed to avulsion injuries

A
  • repetitive submaximal forces
  • increased FITT
  • growth patterns
    • decrease in tensile strength around puberty
  • more muscle-tendon tightness during growth spurts
  • most will have similar etiology
17
Q

avulsions around the pelvis

A

common site
- ischial tuberosity > ASIS/AIIS

MOI
- running, kicking or a slip

Clinical clues
- athlete usually reports “pop” or tearing followed by pain at site
- or poorly locailized groin pain for AIIS
- pain on palpation over structure
- ASIS will displace inferior over the AIIS
- pain with passive stretch and resisted flexion of muscles

18
Q

management for avulsions around the pelvis

A
  • immediate
    • ice
    • support with protected gait
    • refer for imaging

early rehab
- early core stability
- static balance
- maintain cardio - UBE
- progressive ROM and strengthening as able

late rehab
- progress functional strength and power (think about temporal parameters)

19
Q

anatomical differences between adult and growing bones - metaphysis/ diaphysis in children is more resilient when compared to mature bones

A
  • withstands greater deflection without fracture
  • children have greenstick type fractures
    • incomplete fracture (like trying to break a green tree branch)
    • usually the fracture is on the side that is opposite to the bending force
    • common wrist injury but can be anywhere
20
Q

clinical clues for metaphysis/diaphysis in children.

A
  • may not have “typical” pain
  • tender on palpation mid shaft
  • swelling or mat have “bump” due to bend in bone
  • may have decreased ROM or pain with weight bearing
21
Q

management and rehabilitation following: for metaphysis/diaphysis in children

A

management
- refer for xray
- standard immobilization
- heals quickly 3-4 weeks

rehabilitation following:
- regain ROM
- Regain strength
- gateway for rehab
1. palliate pain
2. regain motion
3. regain strength

22
Q

anatomical differences between adult and growing bones - during rapid growth phases, bone lengthens before muscles and tendons are able to stretch

A
  • injury to the apophysis (AKA traction epiphysis), known as Apophysitis
  • this is an over-use injury due to repetitive motion during periods of rapid growth
  • minimal muscle - tendon injuries in this age group
23
Q

little league elbow

A
  • classic little league elbow refers to an apophysitis of the medical epicondlyle
    • results of forces during cocking and early acceleration (may also cause an avulsion injury)
24
Q

clinical clues for little league elbow

A
  • medial elbow pain - or + decreased velocity and control
  • tender over medial epicondyle
  • pain with resisted wrist flexion and pronation
    (because the flexors and pronator attach at a common site on the median epicondyle, lateral side extend and supinate)
  • valgus stress on elbow - painful
  • may have tenderness on lateral side (because the medial flexor ball that stabilizes, then your arm will have more movement and there will probably be more friction too.
25
Q

management, early rehab and late rehab of little league elbow

A

management immediate
- ice
- support or protected with brace or splint
- refer for imaging

early rehab
- complete local rest for a minimum of 4-6 weeks
- maintain lower extremity and core

late rehab
- throwing programs starts 6-8 weeks
- start long toss
- non-competitive pitches with emphasis on form
- stop 2-3 days with any pain

26
Q

osgood - Schlatter/ sinding - larsen - Johansson

A
  • continuous contraction or stretch of quadriceps may cause softening or partial avulsion of apophysis
  • most common during growth spurts and with high level of activity (running and jumping)
  • OS at tibial tuberosity
  • SLJ at inferior of patella
27
Q

clinical clues and tightness of OS and SLJ

A

clinical clues
- slow onset tenderness
- tibial tuberosity in OS (girls 8-13 and boys 10-15 Y.O)
- inferior patella in SLJ (children 10-15)

tightness of surrounding muscles
- quadriceps
- hamstrings

  • excessive pronation
  • may have a bump or pronounces Tibial Tuberosity
28
Q

management for OS/ SLJ

A
  • Self limiting conditions
  • settles with bony fusion
  • OS may be left with a prominence or tibal tubercle
  • activity medication (no need to rest completely)
  • cryotherapy
  • address imbalances
    • stretch/strengthen (quadriceps and hamstrings)
29
Q

sever’s disease

A

-calcaneal apophyitis is a traction apophyitis of the insertion of the achilles
- usually seen in boys between 8 - 12 years of age
- 2nd most common site, secondary to OS
- usually with increase in activty or during Growth spurt
- seen in children with shortened gastrocnemius - soleus muscle complex

30
Q

clinical clues for severs disease

A
  • tenderness over the posterior aspect of thier heel
  • decreased dorsiflexion ROM
  • over pronation (could be possible for people who are over pronatotors)
31
Q

management for severs disease

A
  • similar principles as OS and SJL

early rehab
- inset heel to decrease pain in early rehab
- stretch of plantar flexors
progress to:
- strengthen plantar flexors and dynamic stabilizers when pain free
- correct/ manage over-pronation
- condition settle in 6-12 months (max 2 years)

32
Q

traumatic plate injuries (bottom line)

A
  • if we see appropriate mechanism of injury
  • if pain on palpation of growth plate
  • if replication of stress causes increase in plate pain
    (pain will not get better with rest because it is avulved)
  • if it requires immediate medical attention
33
Q

chronic growth injuries (bottom line)

A
  • pain with activity (especially after increase in FITT
  • pain subsides with rest
  • deformity
  • swelling
  • pain on palpation

athletic injuries 2036 (20 decks)

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