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Topics in Peds > Pediatric Sports Injuries > Flashcards

Pediatric Sports Injuries Flashcards

1
Q

most common sports that result in injuries in boys

A

soccer, baseball, football, ice hockey, rugby, XC
* Males have greater risk of injury with age

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2
Q

sports with most common injury for girls

A

gymnastics
soccer
basketball
volleyball
XC

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3
Q

injury patterns for females

A

More LE injuries, spine injuries, patellofemoral knee pain, overuse injuries

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4
Q

injury patterns for males

A

more UE injuries, OCD lesions, fractures

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5
Q

ACL injuries

A
  • equal between females and males
  • M>F skeletall immature
  • F>M skeletally mature
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6
Q

common types of injuries

A
  • contusions
  • sprains
  • fractures
  • strains
  • knee and ankle most common location of injury in children
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7
Q

risk factors:

A
  • Intrinsic Risk Factors
  • Extrinsic Risk Factors
  • Developmental Factors
  • Growth Related Factors
  • Muscle-Tendon Imbalances
  • Anatomic Malalignment
  • Associated Disease States
  • Improper Foot Wear
  • Training Errors
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8
Q

Intrinsic risk factors

A
  • Previous injury
  • Malalignment: LLD, foot hyperpronation
  • Female gender: menstrual cycle irregularity
  • Physiological issues
  • Psychological issues
  • Muscle imbalances/ inflexibility
  • Instability/Laxity
  • Level of Play/Experience
  • Age
  • Height
  • Tanner stage
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9
Q

Extrinsic Risk Factors

A
  • Training and recovery
  • Equipment
  • Poor technique
  • Environment
  • Sport-acquired deficiencies
  • Conditioning
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10
Q

lack of psychological and developmental maturity….

A

predisposes on to injury, especially with specialization
- risk of overtraining and burnout

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11
Q

positive changes in mental and emotional well-being with physical activity

A
  • Decreased anxiety, depression
  • Increased concentration, attention, memory, academic
    achievement
  • Strong “athletic identity” have increased self-esteem
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12
Q

Physiological Risk Factors

A
  • Smaller hearts and lower blood volume → lower stroke
    volume and higher heart rate
  • Lower glycolytic capacity → decreased anaerobic
    performance
  • Slowly maturing nervous system and incomplete myelination of nerve fibers –> Balance, agility, coordination, strength, neuromuscular control
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13
Q

Growth related risk factors

A
  • Cartilage at a growth plate more susceptible to injury
  • Growing bones cannot handle as much stress as mature bones
  • Increased risk of injury during growth spurt
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14
Q

Why is there an increased risk of injury during growth spurt?

A
  • Muscle imbalances d/t asymmetrical growth
  • Shortened muscles d/t bones grow faster than muscle
  • Decreased proprioception and balance
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15
Q

Articular Cartilage and Repetitive Loading

A
  • Growing articular cartilage has lower resistance to repetitive loading and can lead to microtrauma to cartilage or growth plate
  • Tissue damage can lead to asymmetrical growth and/or early onset osteoarthritis
  • Repetitive running or jumping can lead to knee OA and/or disruption to growth plate, leading to altered growth
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16
Q

Osteochondritis Dissecans Lesions

A
  • Caused by repetitive shearing stresses, often at elbow, knee, ankle
  • Segment of subchondral bone becomes avascular and causes small segment
    to separate with its articular cartilage and from the surrounding bone to become a loose body
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17
Q

Examples of OCD Lesions

A
  • OCD of the talus (runners)
  • OCD of the capitellum (“Little League Elbow”)
  • Shear stress has also been implicated in epiphyseal
    displacement
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18
Q

Apophysis

A

sit of attachment of the tendon to the bone and represents and ossification center of the bone
- eventually will fuse with maturation but susceptible to overuse injuries while growing

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19
Q

apophysitis

A

inflammation secondary to microavulsions at the bone-cartilage junction caused by repetitive motion and overuse at times of rapid growth

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20
Q

Where are some places that are especially susceptible to overuse stresses

A
  • insertion point for musculotendinous unit –> microavulsion fracture
  • Osgood-Schlatter disease at knee
  • Sever’s disease at heel
  • Little League Elbow at med epicondyle
  • Pelvic apophysitis and apophyseal avulsion injury at pelvis
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21
Q

What is Osgood-Schlatter Disease

A
  • Traction apophysitis of tibial tuberosity
  • Occurs during growth spurt: girls 12-14 yo, boys 14-16 yo
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22
Q

Osgood-Schlatter Disease Symptoms

A
  • TTP and swelling over tibial tuberosity, onset of pain with
    resisted knee extension, tight HS/quads
  • X-ray r/o avulsion fx
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23
Q

Osgood-Schlatter Disease Treatment

A

rest, pain management, stretching, modalities, knee pad, infrapatellar strap 6-8 wks

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24
Q

When do symptoms improve in Osgood-Schlatter Disease

A
  • 4-6 weeks
  • resolution about 12-18 months ween growth plate closes
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25
Q

Osgood-Schlatter Disease MOI

A

repetitive running, jumping, cutting, squatting (basketball,
football, soccer, volleyball, track, cross country)

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26
Q

what is Sever’s Disease

A
  • Traction apophysitis at insertion of Achilles tendon on calcaneus
  • Boys (10-12 yo) > Girls (8-10 yo)
  • Tight Achilles tendons, tendency to in-toe, forefoot varus
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27
Q

Symptoms of Sever’s Disease

A

TTP Achilles tendon, mild swelling, limited and painful
DF, (+) squeeze test

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28
Q

Sever’s Disease Treatment

A

rest, pain management, cushioned heel lifts, stretching,
strengthening, gradual RTS over 6-8 wks

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29
Q

When does Sever’s Disease Resolve

A

with closure of growth plate

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30
Q

Sever’s Disease MOI

A

repetitive running, jumping

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31
Q

What is Little League Elbow?

A
  • Medial condyle apophysitis
  • Overuse injury to medial elbow as a result of repetitive stress, causing separation of physis at medial epicondyle
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32
Q

MOI of Little League Elbow

A
  • Baseball pitching/throwing
  • Valgus load to medial elbow during acceleration causes traction force to medial elbow; forceful wrist flexion and forearm pronation increase stress to m. attachment distal to physis during throwing; improper mechanics
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33
Q

Treatment of Little League Elbow

A
  • rest, pain management, strengthening, stretching, teach
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34
Q

How to prevent little league elbow

A

pitch count

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35
Q

what causes pelvic apophysitis

A
  • repetitive overuse of hip flexors (sartorius - ASIS, rectus femoris - AIIS)
  • Adolescents with tight hip and thigh muscles
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36
Q

Symptoms of pelvic apophysitis

A
  • gradual, dull activity-related pain at front/side of hip;
    TTP ASIS or AIIS, pain with resisted HF, pain with passive stretching
    HF
  • X-rays r/o apophyseal avulsion fx, SCFE, or LCPD
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37
Q

Treatment of pelvic apophysitis

A

rest, pain management, gradual functional rehab, stretching, strengthening, RTS activities once strength and flexibility WFL

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38
Q

Epiphysis

A
  • area of growth in long bone
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39
Q

what occurs to bone with growth

A

bone becomes more stiff and less cartilaginous, making it less resistant to impact

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40
Q

Ossification center

A
  • points where ossification of the cartilage begins during growth, and there are charts that can be referenced regarding the expected age-range time frames for fusion of growth ossification centers
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41
Q

sudden overload of bone can cause…

A

bowing or buckling

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42
Q

epiphysis more susceptible, may shear off causing an avulsion fracture

A
  • Avulsion fx of ACL
  • Avulsion fx of ankle ligament * Growth plate fxs
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43
Q

longitudinal bone growth

A
  • bone grows in spurts with slower secondary elongation of soft tissue
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44
Q

periods of decreased musculotendinous flexibility during growth spurts –>

A

higher risk for overuse injures
* Girls: 11-13.5 yo, average growth 3.5”/yr at peak
* Boys: 12+ yo, average growth 4”/yr at peak

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45
Q

what is the focus in PT during growth spurt?

A

prevention of overuse injuries

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46
Q

What is negatively impacted during a growth spurt?

A

strength and flexibility
- flexibility decreases leaving tendons taut and at risk for avulsion at the bone

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47
Q

what does longitudinal bone growth put a strain on?

A

muscle
increases risk of micro tears and repetitive strains

48
Q

What can sport specific bulk training cause?

A

muscular imbalances
increases risk for injury

49
Q

Anatomic malalignment

A
  • Hyperlordosis of the spine
  • Femoral anteversion
  • Hyperextension of the knee
  • Pes Planus
  • Hypermobility
  • LLD
50
Q

improper footwear can lead to…

A

LE and foot injuries

51
Q

shoes should…

A

compensate for changes in alignment

52
Q

ensure adequate footwear fit

A
  • Toe box: ½ inch between longest toe and tip of heel
  • Firm heel counter and adequately grips heel, rearfoot control
  • Adequate cushioning, sole flexibility
  • Shock absorption
  • Feet swell so best to try on shoes toward end of day
53
Q

Playing surface

A
  • Improper playing surface can lead to knee pain, shin splints, stress fractures
  • Cleat wear on grass associated with 2.4% increased risk for injuries among female youth soccer players
54
Q

training errors

A
  • Sudden increase in total volume or intensity of activity
  • Increased rate of progression * Attempt to participate at level above capacity of individual
    athlete
  • Several seasons of same sport with few rest periods
  • Untrained coaches
55
Q

Sports injury

A
  • can be due to a single macro trauma or repetitive micro traumas
  • > 50% of sports injuries associated with overuse injury –> underreported since many athletes do not seek medical treatment
56
Q

Common sports injuries

A
  • fractures
  • joint injuries
  • musculotendinous unit injuries
57
Q

what causes stress fractures

A
  • excessive repetitive loading of WB bones or poor training
  • cancellous bone fracture in kids vs cortical bone fracture in adults
58
Q

what is optimal for diagnosing stress fractures

A
  • bone scan
  • x ray may not show for 6-8 weeks
59
Q

areas that are high risk for stress fractures

A

pars interarticularis, medial malleolus, femur, lower
1/3 of anterior tibia, 5th MT head

60
Q

risk factors for stress fractures

A

Sudden increase in volume or intensity of PA, h/o
previous fx, hard running surface, poor footwear, overtraining, female especially if h/o eating disorder or osteoporosis

61
Q

shaft fractures

A
  • more common in older children near adulthood
  • also seen with abuse, falls in toddlers, high trauma
62
Q

greenstick fractures

A
  • Specific to pediatrics
  • Force applied to one side of a long bone breaks the cortex on the side of impact and
    bends the other
  • Causes angular deformity
63
Q

Epiphyseal Fractures

A
  • goes through growth plate
  • 20% of pediatric fractures
  • cartilaginous growth plate less resistant to shear or tensile deforming force than ligament or bony cortex –> growth plate most susceptible
64
Q

What can epiphyseal fractures cause

A

angular deformity, LLD, joint incongruity, premature closure

65
Q

who is the common population for epiphyseal fractures

A
  • boys in early adolescence
  • macrotrauma
  • repetitive microtrauma
66
Q

Salter-Harris Classification

A
  • S: straight across physis
  • A: above physis
  • L: lower than physis
  • TE: through everything
  • R: Rammed –> crushed
67
Q

What is stronger than growth plate during growth?

A

ligaments

68
Q

Most common ligamentous strains

A
  • ankle
  • knee
69
Q

who has the greatest incidence of ACL sprains

A

females about 16 yo in soccer

70
Q

factors contributing to ACL sprain

A

genu recurvatum, navicular
drop, excessive pronation, hormonal status, level of neuromuscular control,
biomechanical differences including landing mechanics and muscle strength

71
Q

Internal Derangement

A

damage to joint due to trauma

72
Q

avulsion fractures

A

muscle or tendon detaches from bone; common in ankle, hip, elbow

73
Q

tendonitis

A

less frequently seen in kids (apophysis more
susceptible); Achilles tendonitis in dancers

74
Q

Enthesis

A
  • pain and inflammation of connective tissue between ligament, tendon, joint capsule and bone; associated with rheumatologist condition and in overuse
75
Q

muscle strains

A

injury to muscle or tendon similar to adult, due to excessive stretching or overuse

76
Q

Exertion Compartment Syndromes

A

due to increases in muscle volume during exercise, symptoms include pain and swelling

77
Q

muscle hernia

A

soft tissue injury in the groin area where abdominals and adductors attach to pubic bone or in the abdomen; caused by tight fascial or musculotendinous structures or weakness in the abdominal muscles

78
Q

sports injury prevention

A
  • Pre-participation Screening
  • Trained Coaches
  • Supervision
  • Training Periodization
  • Proper Equipment
  • Environmental Control
  • Appropriate Nutrition and Hydration
  • Multisport Participation
79
Q

Pre-participation screening

A
  • AAP recommends biannual complete evaluation followed by a limited annual re-evaluation
  • performed at least 6 weeks prior to start of sport to allow treatment of any ID’d problems
80
Q

What does pre-participation screening include

A
  • medical history and exam, musculoskeletal exam, body composition assessment, physical maturity evaluation, sport specific functional tests, and assessment of readiness including physical, psychologic and mental health
  • may include dynamic functional performance assessments tailored to specific demands of sport
81
Q

Pre-participation screening goals

A
  • determine general health
  • screen for conditions that might be life-threatening or disabling
  • detect conditions that may limit participation or predispose to injury or illness
  • assess maturity and fitness level
  • educate athlete/family
  • identify appropriate sports
  • determine clearance for sport
  • ID strengths and weaknesses to determine individualized training plan
82
Q

clearance for sport

A
  • unrestricted for any sport
  • no collision or contact
  • limited contact or impact
  • no contact only
83
Q

trained coaches

A
  • need for coaching has increased; shortage of qualified applicants
  • awareness of emotional and psychological development
  • decreased risk of overuse injury with strengthening, NM control, flexibility, balance, and task specific training
  • various education programs offered online
84
Q

supervision

A
  • adequate supervision from coaches, officials, medical professionals
  • injuries incurred with weight lifting are typically due to accidents in weight room
85
Q

proper training

A
  • fitness should be year-round endeavor
  • incorporate fun, cooperation, team play, learning
  • age-appropriate
86
Q

ideal training incorporates…

A
  • strengthening
  • flexibility
  • NM control
  • balance
  • CV exercise
  • task specific training
87
Q

Proper protective equipment

A
  • Protective: helmets, goggles/eyewear, padding, mouth guards, proper footwear, auricular protection * High quality equipment that is properly fitted, appropriate for sport
  • PT and/or ATC may fit or modify equipment
  • PTs may fabricate specialized equipment (orthotics, splints, braces)
88
Q

hydration

A
  • Kids require more liquid per body weight
  • AAP: water breaks every 5-10 min if >82º
  • ACE: 3-8 oz water every 20 min of play in 9-12 yo and 11-16 oz if >12 yo
  • ACSM: 13.5-16.9 oz prior to running, water break every
    35-45 min in football
  • Thirst is not a valid indicator
  • Every lb (16 oz) lost should be replaced by 2C (16 oz)
  • Monitor content of sports drinks
89
Q

environmental control

A
  • Well-lit and safe environment, free from obstacles, smooth/even,
    shock-absorbing surfaces, equipment modifications for injury prevention
  • Age-appropriate, scaled appropriately for size
  • Accommodate for temperature and humidity, modify exercise if >75º
90
Q

Children have a harder time regulating temperature due to greater surface area: body mass

A
  • acclimatize slower
  • greater heat gain on hot days
  • greater heat loss on cold days
  • produce less sweat and less evaporative heat loss
  • at greater risk for heat exhaustion
91
Q

multisport participation

A
  • Multisport participation can be protective against overtraining/burnout and sports injuries
  • If adequate rest between daily activities and/or seasons, athletes are likely to participate in sports longer
  • May be at risk if fail to get adequate rest between daily activities and/or seasons as in
    with poor periodization
  • If athlete plays ≥2 sports that emphasize the same body part, at risk for overuse injury
  • Important to monitor for signs of overtraining/burnout
92
Q

Sport Specialization

A
  • Reality: 1% of young athletes age 6-17 will achieve elite status in basketball,
    soccer, baseball, softball, or football.
  • Greater risk of overuse injury/fracture during peak height velocity
93
Q

risks of single sport specialization

A
  • Adverse psychological stress * Premature withdrawal and burnout
  • Higher rates of injury >13 yo and athletes competing at higher levels
94
Q

pediatric rehab considerations

A
  • Ultimate LTG to RTS in safe manner with minimal risk of further injury
  • Criterion-based vs. time-based
  • Age-appropriate modifications
95
Q

PT interventions for sports injuries

A
  • Strengthening
  • Aerobic Conditioning
  • Modalities
  • Splints/orthotics
  • Pain management
  • Specific Examination Measures
96
Q

Who is safe to do resistance training

A
  • children > 8yo when supervised
97
Q

Strengthening considerations

A
  • development
  • emotional maturity
  • supervision at all times
  • technique
  • home program
  • concentrate on flexibility during growth spurt
  • avoid adult weight machines
98
Q

Why do kids need supervision at all times when strength training

A
  • to decrease risk of accidental injuries
  • to get regular feedback on technique
99
Q

strength training technique

A
  • Goal to develop good lifting techniques at early age
  • Dynamic warm up
  • Appropriate volume/intensity
  • Avoid 1RM
  • Low weight, high reps/sets
  • Non-ballistic movements
  • Move through full ROM
  • Limit eccentric work
100
Q

strength gains in post pubescent kids

A

similar gains to adult

101
Q

strength gains if prepubescent

A

lack androgens for hypertrophy therefor gains are neuromuscular based

102
Q

aerobic training

A

3-4x/week, 40-60 min, 85-90% HRmax

103
Q

anaerobic training

A

2x/week
90% HRmax
less than 30 seconds

104
Q

considerations for anaerobic training

A
  • temperature
  • impact of body mass ratio
  • Kidd less able to use muscle glycogen, less able to produce lactic acid, produce sweat, and acclimatize slower
105
Q

Modalities

A
  • US/Interferential: contraindicated over growing
    epiphysis
  • Strong precautions with diathermy and TENS
  • Ice: 15-minute intervals, do not apply to multiple
    areas to avoid widespread vasoconstriction
  • Hot pack: with supervision and never lying on it
106
Q

Splints/ Orthotics

A
  • support and protect joint
  • ensure proper brace application/wear
107
Q

pain medication

A
  • monitor use
  • watch for toxicity and abuse
108
Q

return to play

A
  • Adequate tissue healing
  • Resolution of impairments
  • Adequate muscle strength (85-90% sound side)
  • Functional/sports-specific
    performance within 85-90% sound side
109
Q

Recommendations from AAP

A
  • Age-appropriate, fun games/training
  • 1-2 days/week off from organized activity for rest and participation in other activities
  • 2-3 month per year break from specific sport to focus on other activities, cross-train
  • Modify endurance events (triathlons/races)
  • 10% rule for training progression – no more than a 10% progression each
    week
  • Educate athletes/families on recognizing when appropriate to slow down or change training methods
110
Q

Athletes with disabilities

A
  • lower overall fitness
  • same activity needs
  • pre-participation screenings the same except more thorough exam for potential medical risks
  • identify if prone to additional injury
  • classify athlete based on type and severity of disability based on international and national classification systems
111
Q

athletes with disability: improved overall health

A
  • decreased physician visits
  • hospitalizations
  • decubitus ulcers
  • medical complications
112
Q

athletes with disability: physiological benefits

A
  • decreased body fat
  • increased muscle strength and endurance
113
Q

athletes with disability: psychological benefit

A
  • increased self-concept, self acceptance, perceived physical appearance/self esteem
  • lower levels of depression
114
Q

what is the injury rate for athletes with disabilities

A

same rates as those without disability

115
Q
A

Topics in Peds (15 decks)

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