MSK Injuries in Children and Adolescents Flashcards
Age 12-15 boys
Second growth spurt
Excessive stress on musculoskeletal system that isn’t present in mature skeleton
Dominant biological process first 20 years of life
Growth
Difference between child and mature adult
Epiphyseal plates Growth spurts Bone malleability Apophysites Articular cartilage Muscle development Frequency and variety fo sport
Epiphysis
End of bone
Covered in articular cartilage
Metaphysis
Adjacent to epiphyseal plate
Undergoes growth in adolescents
Softer
Diaphysis
Shaft of long bone
Epiphyseal plates
Developing skeleton
Site of weakness
Susceptible to sheer forces- are of bone weaker
Epiphyseal plates + growth
Growth occurs and forms cell matrix
Then calcifies to become skeletal bone
Growth spurts
Changes in balance between bone and muscle length
Change in coordination + biomechanics
Effect on energy levels
How do kids grow
Bone length changes
Soft tissue adapts to that
Bone malleability
Metaphysis of bone is softer
Absorbs greater energy
Bones less brittle- less likely to shatter
Less dense and more porous bone
Bone in adolescents properties
Less brittle
Less dense
More porous
Susceptible to diff. form of fractures e.g. greenstick
Apophysite
Bony attachment site of a tendon
Pelvic apophysites
Iliac crest ASIS AIIS G. Troc L. Troc Ischial Tub Pubic symph
Iliac crest is attachment site of
Gluteals
TFL
ASIS is attachment site of
Sartorius
AIIS is attachment site of
Rec Fem
G. Troc is attachment site of
Glute Med/Min
L. Troc is attachment site of
Psoas/Iliacus
Ischial Tub is attachment site of
Add magnus
Biceps femoris
Semi tend
Semi memb
Pubic Symph is attachment site of
Rectus abdominus via inguinal ligament
Apophysitis
Inflammation of tendon attachment onto bone
Mature skeleton- area of weakness in bone itself not the MTU
Articular cartilage is
Site of development and remodelling of adolescent bone
Thicker than in adults
Greater ability to remodel
Articular cartilage remodelling
Can be damaged more easily
Thicker and less mature
But has a chance to mature
Articular Cartilage layers (top to bottom)
Articular surface
Superficial Tangential Zone (10-20%)
Middle Zone (40-60%)
Deep Zone (30%)
Osteochondritis Dessicans (OCD)
When blood supply is cut off
Cartilage starts to degenerate
More common in children
Damage can be caused by trauma or overuse
Joint stability
Lower in developing skeleton
Less muscle development
More ligament laxity- incomplete cross bridge formation
Less core stability
Inflammatory Conditions
Juvenile RA/SLE Reactive arthritis hx Ex Bloods Urine Joint aspiration Management
Cardiovascular changes- compared to fully mature athlete
Lower systolic BP Lower SV Increased maximal HR Lower cardiac output Increased RR Less anaerobic power Screening
Environmental changes
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
Ethics
Autonomy Beneficence Confidentiality Do no harm Equity
Important conditions
Fractures Hip + groin complaints Back pathology Traction apophysitis Joint instability
Growth plate fracture
Salter-Harris classification
Treatment depends on type
Can be complicated
Growth plate fracture healing
Depends on: severity age which growth plate type
SALTER stands for
S- straight across A- above L- lower TE- through everything R- cRush
Salter Harris classification
1-5 All are complicated Type 5 worst GP effect--> affects growth e.g. leg length discrepancy GP can become inactive