Pediatric Injuries + Hip Injuries Flashcards
What percentage of pediatric injuries are soft tissue injuries?
95
Acute soft tissue injuries are most common in the ages of _____ to ______
10 to 18
What causes growing pains?
Soft tissues lag behind in their growth relative to the rapid growth of the skeletal system.
What are the 3 locations where growth cartilage is found in pediatric patients?
- epiphyseal growth plates
- apophyses
- epiphyses
The same force that would produce a soft tissue injury in an adult would produce a ______________ injury in a child
Growth plate/apophyseal injury in a child
When to epiphyseal plate injuries have severe implications?
- when the blood flow is disrupted (causes growth deformity, limb length discrepency, abnormal limb angulation)
What is an apophyseal avulsion?
Sudden forces causing the apophyses to become seperated from bone
Osgood schlatter’s disease results in hard fibrocartilagenous tissue being deposited at the tibial tuberosity . This is due to repetitive strain or traction on the ____________ _____________
Quadriceps tendon
What are some of the signs and symptoms of osgood schlatter’s?
- pain over tibial tubercle
- swelling over patellar tendon
- pain with activity
- bilateral
- males 10-15
Females 8-13
What does the treatment for osgood schlatter’s disease include?
-rest
- restore strength and flexibility to lower extremity muscles (to address range of motion deficits)
- ultrasound sometimes I guess
Calcaneal apophysitis is also known as _______ ________
Severs disease
What classifies calcaneal apophysitis/severs disease?
Inflammation at the insertion of the achilles tendon, plantar fascia, short muscles of the foot
What are some of the signs and symptoms of calcaneal apophysitis?
Localized pain over the calcneal apophysis via squeeze test
- decreased pain with rest
- most common between ages 7-10
- tip toes is painful
-pain with weight bearing acitivies
- no story
Treatment for calcaneal apophysitis includes:
Heel lifts
Ice and rest
Casting
Orthotics
Proper athletic shoes
Stretching calves
Stretching lower extremity muscles
Restore strength and flexbility
What is sliding larsen johansen disease?
-pain at the proximal end of the patellar tendon
- pain at distal pole of patella
- prominance
- pain with activity (especially those that use the quads)
- common in children aged 8-13
- involves bilateral movement
- X rays show irregularity of the inferior pole of the patella
What is the treatment for sliding larsen johansen disease?
Same as osgood schlatters
What are the 4 types of bone injuries?
Fracture, dislocation, subluxation
What is osteochondritis dissecans?
Chunks of cartilage seperate from bone forming a loose body that feels like having a pebble in your shoe. ‘
The area of bone underneath where the cartilage was dislodged may undergo asvascular necrosis and ischemia (comes up black)
Describe leg calve perthes disease. What causes it? What might happen?
Avascular necrosis of the proximal femoral epiphysis (at the head of the femur)
- due to repetitive compression
- avascular necrosis occurs, which may spread to other bone and tissue
-
What are some of the signs and symptoms of leg calve perthes disease? Age/sex most common?
Pain in groin, anterior thigh, and knee
Antalgic (limp) gait pattern
Decreased hip abduction, extension, external rotation
Most common in males aged 4-8
What does the treatment for leg calve perthes disease?
Immobilization in abducted position in a non weight bearing position, immobilization could last 1-2 years
Surgery to prevent deformation of the femoral head
In regards to pediatric bone injuries, what is plastic deformation?
The bone bends rather than break due to it being less mineralized, as growth continues the angle could get worse. Difficult to detect and permament deformity and loss of function
Torus fracture?
Longitudinal force along shaft of bone causing damage on the distal end of bone?
What is a Green stick fracture?
- tension results in bone bending but the fracture is not complete. May need to reduce it then x ray again
What is a basic equation for growing pains?
Tensile force on one side + growing pains on another side = growing pains
What are some steps that can be taken to reduce the occurence of paediatric injuries?
- pre participation medical examinations
- appropriate supervision
- correction of training error and technique
- use of appropriate footweear and equipt
- use of appropriate type and size of playing surface
- insure adequate rehab injuries
- be aware of associated disease states
What muscle shuts down in the case of hip injuries?
Gluteus medius
Where does nerve innervation for the hip and thigh come from?
Lumbosacral plexus, branches of lower extremity
The hip joint is made for _________, the shoulder joint is made for _________
Stability, mobility
What is the cause of a ‘hip pointer’ injury?
Blow to the iliac crest, or a forceful contraction of the muscles attaching to the area
Which muscles are involved in a hip pointer injury?
Sartorius, rectus femoris, abdiminal muscles
Describe a grade 1 hip pointer:
-normal gait pattern and posture
- slight pain on palpation
- little to no swelling, full ROM of lumbar spine and hip
Describe a grade 2 hip pointer
-antalgic gait pattern and shortened swing phase
- lands in flexed and side flexed (takes tenson off the affected muscles)
- pain on palpation’
- visible swelling and brusing
-AROM in lumbar spine and hip flexion is decreased/painful
-pain and weakness with resistance testing
Positive thomas test is indicative of a ____ _________ injury
Hip pointer
Describe a grade 3 hip pointer
Pain with coughing, sneezing, laughing,
Severe pain, swelling, bruising
All other symotoms of grade 2
The treatment for a hip pointer injury includes:
- rest, ice, elevate (ice in a stretched position)
- crutches for walking
- NSAIDS
- TENS, interferential current, ultrasound,
Protective pad over area
Stretch and strengthening appropriate muscles
What is trochanteric bursitis?
Inflammation of the trochanteric bursa of the hip
Caused by a direct blow to the lateral aspect of the hip
Caused by excessive friction or shear forces of the tensor fascia latae, gluteus maximus or the iliotibial band
True or false: patients are able to pin point where the pain is in the case of trochanteric bursitis
True
What are the signs and symptoms of trochanteric bursitis?
Burning or aching over or posterior to the greater trochanter.
Pain on palpation of the greater trochanter
Pain with flexion, internal rotation, abduction of the hip (tensor fascia latae)
Pain with extension and external rotation of the hip (gluteus maximus)
Pain with passive movements of the hip
Pain with resistance testing of the hip
What is the treatment for trochanteric bursitis?
- ice
- protected rest
- NSAIDS’
- electric modalities: ultrasound, interferential current
- stretching of tight muscles
- aspiration of the bursa (draining of fluid)
Snapping hip syndrome will come back as _______ in Ober’s test
Snapping hip syndrome
What is the most commonly strained muscle in the body?
Hamstring
What stages of wlaking/running is the hamstring involved in?
Initial swing phase and late swing phase
What are some of the causes of a hamstring strain?
Dehydration (elastin stretching is limited).
Over emphasis on stretching without strengthening
Strength imbalance
Acting as antagonist to powerful quads (i.e in sprinting) (decelerating forceful contraction of quads)
What are some of the signs and symptoms of a hamstring strain?
Poor posture
Inflexibility
Muscle imbalance
Inability to fully flex the knee at heel strike
Sharp pain in posterior thigh and butt
Bruising and pain on palpation in within the muscle
Pain in buttocks (recall origin of hamstring muscles)
What are the signs and symptoms of a hamstring strain (passive/active) ?
Pain with active hip extension and knee flexion
Pain with passive hip flexion and knee extension
Pain and weakness with resisted hip extension and knee flexion
What do you NEVER do when you have a hamstring strain?
Stretch
Explain the three phases of treatment for a strained hamstring?
Phase 1
- protected rest, ice, compression, elevation
-NSAIDS
- crutches if limping
Phase 2
- electrical modalities such as ultrasound and EMS (?)
- slow, pain free, gradual stretching program
- gentle isometric strengthening exercises
Phase 3
- progress stretching and strengthening exercises
- sport specific exercises including starting, stopping, etc
- focus on prevention of future injuries
What is the most common type of hip dislocation?
“Posterior superior”
What causes a quadriceps muscle contusion? Where it the most common location?
Direct blow to the quads
Most common side is the anterolateral aspect of the thigh (vastus lateralis takes up the most surface area)
What are some of the signs and symptoms of a quadriceps muscle contusion?
Bruising and swelling over the anterior thigh
Antalgic gait
Pain with active hip flexion and knee extension
Pain with passive hip extension and knee flexion
Weakness with resisted knee extension and hip flexon
Palpable tenderness in anterior thigh region
What does the treatment for quadriceps contusion include?
Rest, ice, compress the area (do all of these at once in a position of maximal flexion)
Crutches initially
NSAIDS
Gentle stretching and strengthing
Electrical modalities: ultrasound, EMS
Progress exercises to be more specific
Protective pad on return to sport
What is myositis ossificans?
-abnormal ossification that involves deposition of bone within a muscle
- due to repetitive blows or one large enough blow
-
What are the most common sites for myositis ossificans?
Anterior and lateral thigh
Hip
Groin
Mid humerus
What may develop as a secondary condition to a contusion?
Myositis ossificans
What are some of the symptoms of myositis ossificans?
Warm, firm, swollen on palpation
Extended pain and dysfunction that does not improve with regular treatment
Self limiting progression with maturation at 6-12 months
X rays required for diagnosis (bone mass evident in muscle 3-4 weeks after diagnosis)
What causes a quadriceps strain? Which quad muscle is most commonly strained?
Forceful contraction of the quadriceps muscle. Rectus femoris is most commonly strained
What are the signs and symptoms of a quads muscle strain?
Tightness and pain in anterior thigh
Antalgic gait pattern
Pain with active knee extension, hip flexion, PASSIVE knee flexion, hip extension
Pain with resisted hip flexion
Palpable pain and defect in quadriceps
In what kind of activities do adductor strains occur?
Requiring quick changes of direction and acceleration/propulsion
Most severe adductor sprains involves proximal origin of __________ __________ particularly of the _________ __________ muscle
Pubis symphysis, adductor longus
What are some of the signs and symptoms of an adductor strain?
-pain with side to side movements
- palpable tenderness over the pubic ramus/lesser trochanter
- palpable defect in muscle belly
- pain with active hip adduction
Pain with PASSIVE hip abduction, extension, external rotation
Pain with resisted hip adduction
What is the treatment for a adductor muscle strain?
Rest
Ice
Compress
Elevate
NSAIDS
Strengthening
Other modality
SAME AS A CONTUSION
