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Sports and Exercise Medicine iBSc > MSK Injuries in Children and Adolescents > Flashcards

MSK Injuries in Children and Adolescents Flashcards

1
Q

Age 12-15 boys

A

Second growth spurt

Excessive stress on musculoskeletal system that isn’t present in mature skeleton

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2
Q

Dominant biological process first 20 years of life

A

Growth

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3
Q

Difference between child and mature adult

A 
Epiphyseal plates
Growth spurts
Bone malleability
Apophysites
Articular cartilage
Muscle development
Frequency and variety fo sport
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4
Q

Epiphysis

A

End of bone

Covered in articular cartilage

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5
Q

Metaphysis

A

Adjacent to epiphyseal plate
Undergoes growth in adolescents
Softer

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6
Q

Diaphysis

A

Shaft of long bone

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7
Q

Epiphyseal plates

A

Developing skeleton
Site of weakness
Susceptible to sheer forces- are of bone weaker

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8
Q

Epiphyseal plates + growth

A

Growth occurs and forms cell matrix

Then calcifies to become skeletal bone

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9
Q

Growth spurts

A

Changes in balance between bone and muscle length
Change in coordination + biomechanics
Effect on energy levels

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10
Q

How do kids grow

A

Bone length changes

Soft tissue adapts to that

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11
Q

Bone malleability

A

Metaphysis of bone is softer
Absorbs greater energy
Bones less brittle- less likely to shatter
Less dense and more porous bone

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12
Q

Bone in adolescents properties

A

Less brittle
Less dense
More porous
Susceptible to diff. form of fractures e.g. greenstick

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13
Q

Apophysite

A

Bony attachment site of a tendon

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14
Q

Pelvic apophysites

A 
Iliac crest
ASIS
AIIS
G. Troc
L. Troc
Ischial Tub
Pubic symph
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15
Q

Iliac crest is attachment site of

A

Gluteals

TFL

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16
Q

ASIS is attachment site of

A

Sartorius

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17
Q

AIIS is attachment site of

A

Rec Fem

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18
Q

G. Troc is attachment site of

A

Glute Med/Min

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19
Q

L. Troc is attachment site of

A

Psoas/Iliacus

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20
Q

Ischial Tub is attachment site of

A

Add magnus
Biceps femoris
Semi tend
Semi memb

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21
Q

Pubic Symph is attachment site of

A

Rectus abdominus via inguinal ligament

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22
Q

Apophysitis

A

Inflammation of tendon attachment onto bone

Mature skeleton- area of weakness in bone itself not the MTU

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23
Q

Articular cartilage is

A

Site of development and remodelling of adolescent bone
Thicker than in adults
Greater ability to remodel

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24
Q

Articular cartilage remodelling

A

Can be damaged more easily
Thicker and less mature
But has a chance to mature

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25
Q

Articular Cartilage layers (top to bottom)

A

Articular surface
Superficial Tangential Zone (10-20%)
Middle Zone (40-60%)
Deep Zone (30%)

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26
Q

Osteochondritis Dessicans (OCD)

A

When blood supply is cut off
Cartilage starts to degenerate
More common in children
Damage can be caused by trauma or overuse

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27
Q

Joint stability

A

Lower in developing skeleton
Less muscle development
More ligament laxity- incomplete cross bridge formation
Less core stability

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28
Q

Inflammatory Conditions

A 
Juvenile RA/SLE
Reactive arthritis
hx
Ex
Bloods 
Urine
Joint aspiration
Management
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29
Q

Cardiovascular changes- compared to fully mature athlete

A 
Lower systolic BP
Lower SV
Increased maximal HR
Lower cardiac output
Increased RR
Less anaerobic power
Screening
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30
Q

Environmental changes

A 
greater body SA to mass
Lower sweating rate
More skin SA to gain/lose heat
Rate of heat acclimatisation lower
Problems in hot and cold environments
More regular drinks breaks, subs waiting inside
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31
Q

Ethics

A 
Autonomy
Beneficence
Confidentiality
Do no harm
Equity
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32
Q

Important conditions

A 
Fractures
Hip + groin complaints
Back pathology
Traction apophysitis
Joint instability
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33
Q

Growth plate fracture

A

Salter-Harris classification
Treatment depends on type
Can be complicated

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34
Q

Growth plate fracture healing

A 
Depends on:
severity
age
which growth plate
type
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35
Q

SALTER stands for

A 
S- straight across
A- above
L- lower
TE- through everything
R- cRush
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36
Q

Salter Harris classification

A 
1-5
All are complicated
Type 5 worst
GP effect--> affects growth
e.g. leg length discrepancy
GP can become inactive
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37
Q

Type 1

A

A complete physeal fracture with or without displacement

38
Q

Type 1 treatment

A

Rarely will have to be put back in place

Normally just need a cast- all things still intact- unless damage to blood supply, should grow normally once healed

39
Q

Type 2

A

A physeal fracture that extends through the metaphysis, producing a chip fracture of the metaphysis, which may be very small

40
Q

Type 2 treatment

A

Most common

Typically have to be put back in place surgically and immobilised to allow growth to continue

41
Q

Type 3

A

A physeal fracture that extends through the epiphysis

42
Q

Type 3 treatment

A

Occurs rarely
Usually lower end of tibia
Surgery sometimes necessary
Outlook/prognosis for growth is good if blood supply to separated bit still intact

43
Q

Type 4

A

A physeal fracture plus epiphyseal and metaphyseal fractures

44
Q

Type 4 treatment

A

Surgery needed to restore bone back and perfectly align growth plate
If not perfect alignment achieved when placed back or during growth, prognosis for growth is poor

45
Q

Type 5

A

A compression fracture of the growth plate

46
Q

Type 5 treatment

A

Uncommon
Occurs when bone is crushed
Prognosis poor
Growth likely to be stunted in that portion only –> biomechanical imbalances

47
Q

Greenstick Fracture

A

One side broken, one side bent- like breaking branch
Reduced
Casted 6 weeks
Usually occur in metaphysis

48
Q

Buckle fracture

A 
'Torus' fracture
Incomplete fracture as one side of bone
Buckles without disrupting other side --> outside intact, inside fractured
5-11 years
FOOSH
Pain that lasts couple of hours, child doesn't want to use arm
Quicker healing time
3 week cast
49
Q

Hip/groin pain

A 
Traumatic
Apophyseal injuries
Avascular necrosis of hip
Perthe's diseases
Slipped upper femoral epiphysis
Most common boys 5-12
4th most common injury affecting footballers
3rd longest absence from sport (after fracture + ACL injury)
50
Q

Hip/groin pain mechanism of injury

A

Torque/twisting with opposing forces
Conjoint tendon pulls up and rotates trunk
Adductor pulls down and rotates upper leg
Opposing forces disruption of muscles at their insertion
Imbalance between weak abdominal muscles in relation to strong leg muscles

51
Q

Perthe’s disease

A

Reduced circulation to femoral head and vitamin deficiencies affecting bone formation and development
Avascular necrosis
During revascularisation bone is soft

52
Q

Perthe’s disease epidemiology

A 
Boys
5-12
Painful hip
Limp
X ray/bone scan/MRI
53
Q

Perthe’s disease x ray reasoning

A

Hip pain + limp + under 18

54
Q

Slipped Upper Femoral Epiphysis (SUFE)

A

Femoral head slips posteriorly

Due to weakness of growth plate- sheer force across GP

55
Q

SUFE Epidemiology

A

During periods of accelerated growth
Antalgic gait/limb
Leg short and externally rotated
Surgery

56
Q

Avascular necrosis of hip

A

Ball/socket joint
Articular cartilage
Damage –> collapse/flattening of femoral head
blood supply is through neck of femur, so is shut off

57
Q

Avascular necrosis of hip causes

A

NOF
Dislocation
ETOH
systemic cortisone

58
Q

Avascular necrosis of hip symptoms

A 
Pain on weightbearing
Pain- lower abdo, groin, testicle
Weakness
running/cutting/side-steps
Sit ups
Coughing/sneezing
59
Q

Avascular necrosis treatment

A

Conservative

Surgical-decompressing femoral head

60
Q

Blood supply age 8-10 head of femur

A

The artery to head of femur (goes through ligament to head of femur/teres) is lost and the medial femoral circumflex takes over

61
Q

Back pain in young athletes

A 
Spondylolysis
Spondylolisthesis
Lumbosacral sprain
Scoliosis
Scheuermann's disease
Osteomyelitis
Congenital abnormalities
Ankylosing spondylitis
Juvenile RA
Malignancy
62
Q

Spondylolysis

A

Defect on pars interarticularis
6% general pop
50% sporting back pain
Repetitive hyperextension

63
Q

Spondylolysis occurs commonly in

A

L4/5 or L5/S1

64
Q

Spondylolysis history

A

Sport related pain
Can also be asymptomatic, and found incidentally on imaging
Football, cricket bowlers, gymnastics, weightlifting
Daily activity related pain
Rest pain

65
Q

Spondylolysis history also ask

A 
Morning stiffness
Multiple joint pain/swelling
Night pain
Neuro symptoms
Systemic symptoms
66
Q

Spondylolysis examination

A 
Observation
SIF
ROM
Pain on lumbar extension, single leg extension or extension combined with rotation
Slump test
67
Q

Spondylolysis investigations

A

X ray- AP, lat, oblique
SPECT
CT
MRI

68
Q

Spondylolysis treaatment

A

Relative rest from extension or aggravating activities
Analgesia
Rehab- core, flexion activities, hamstring stretches, aerobic fitness, sports specific
Bracing

69
Q

Traction Apophysitis’

A

Inflammation of site of tendinous attachment

70
Q

Traction Apophysitis’ examples (overuse injuries)

A 
Osgood Schlatters
Severs
Sinding Larsen Johansson
Little league elbow
Iselins
71
Q

Severs

A

Calcaneum

Achilles tendon

72
Q

Sinding Larsen Johansson

A

Inf. pole patella

Patella tendon

73
Q

Little league elbow

A

Med. epicondyle

Wrist flexors

74
Q

Iselins

A

5th metatarsal

Peroneus brevis

75
Q

Avulsion fractures

A

Bone v soft

Avulsion fracture

76
Q

Osgood Schlatters

A

Inflammation at site of patella tendon attachment at tibial tubercle
In adults –> superior and inferior patella tendinopathy

77
Q

Osgood Schlatters clinical findings

A 
TOP tibial tubercle
Protruded tibial tubercle
Pain on resisted knee extension/squatting
Pain on passive knee flexion
Restricted hams ability
78
Q

Osgood schlatters RFs

A 
Biomechanical issues:
poor quads flexibility
poor hams flexibility
growth spurt
increased Q angle
patella alta
overpronated feet
knee valgum
Relationship between growth and load
79
Q

Severs

A

Inflammation at site of calcaneal growth plate

80
Q

Severs biomechanical factors

A

Overpronation/valgus at ankle

Stiff forefoot

81
Q

Severs clinical finding

A

TOP calcaneal growth plate
Pain and restriction on DF stretch
Pain on resisted PF/calf raise

82
Q

Treatment and rehab of traction apophysitis

A

Rest
Treatment of inflammation
address biomechanical factors
improve movement factors

83
Q

Patellofemoral instability

A

Patella will always dislocate laterally

Joint laxity

84
Q

Patella instability mechanism

A

Patellar alignment maintained by fibrous structures
Lateral pull vs medial pull
Subluxation if partial loss of patella femoral joint congruity
Dislocation is complete loss of joint congruity

85
Q

Patella instability biomechanical RFs

A 
Shallow femoral trochlea
Hypoplastic lateral femoral condyle
Patella shape
Patella alta
Poor VMo strength
86
Q

Patella dislocation

A

One of medial structures fail
Medial patella femoral ligament detached at femoral attachment, then pulled out by ITB
Avulsion fracture at chondro-osseus junction

87
Q

Patella dislocation treatment

A

X ray and orthopaedic review
Brace vs no brace
progressive knee flexion
Main aims of rehab are to strengthen VMO whilst limiting tension of lateral structures

88
Q

Osteochondritis Dissecans S and S

A 
Vague history joint pain
in children normally full ROM
Effusion
Palpation of joint line will be tender
Locking/giving away may be reported
Wilson's sign
89
Q

Osteochondritis dessicans

A

Separation of articular cartilage from subchondral bone

Avascular fragment can result in loose body

90
Q

RFs for OD in knee

A 
Trauma (50%)
Male sex
overuse due to sport
Familial 10% 
ligamentous weakness
genu valgum/varum
meniscal lesions in knee
91
Q

Anthropometric measurements

A

Height and weight measurements- 1 per month
Screen those with significant growth
Assess for growth related pathologies- moree than 1cm/month
Use to manage load

Sports and Exercise Medicine iBSc (13 decks)

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