Sports Injuries Unique to Young Athletes Flashcards
apophysis
where muscle-tendon unit attaches to bone
provides contour and shape without adding length
What part of the bone structures are the “weakest links” in the musculoskeletal chain in children?
ossification centers
more vulnerable to injury than ligaments, tendons, and muscles
osteochondroses (apophysitis)
overuse injury
inflammation and irritation at an apophysis or physis due to excessive stress
inflammation results form mechanical pressure
acute injuries in children
physeal fractures
apophyseal avulsion fractures
What is the spectrum of pathology in osteochondrosis?
cartilage swelling
irregular ossification
tendon thickening
separation
fragmentation of cortical bone
delayed closure
What is the mechanism of injury in osteochondrosis?
mis-use due to:
improper technique
equipment poorly-fitted or worn out
change in playing surface
overuse:
rapid increase in volume or intensity of training
inadequate time for rest and recovery
adult-directed training vs. kid-directed free play
sports specialization at early age
What are the risk factors of osteochondrosis?
growth spurt
tight muscles
certain variants of normal anatomic alignment
What are the effects of a growth sport on the bones?
period of high metabolic activity at growth center - cells become more vulnerable to stress
bones grow faster than muscle-tendon units - results in tight muscle-tendon units and increase tension on apophyses where they attach
What are the common sites of osteochondroses?
lower extremity:
calcaneus (Sever’s Disease)
tibial tuberosity (Osgood-Schlatter Disease)
upper extremity:
medical epichondyle of elbow (Little League Elbow)
proximal humeral physis (Little League Shoulder)
Sever’s Disease
calcaneal osteochondrosis
peaks at age 8-11
bilateral up to 61%
What are the mechanisms of Sever’s Disease?
tension from Achilles and plantar fascia
direct impact pressure
most common sports are soccer and basketball
What are the risk factors for Sever’s Disease?
inappropriate shoes
tight calf muscles - less than 10 degrees of ankle dorsiflexion
subtalar overpronation
What is the common presentation of Sever’s Disease?
history of heel pain and worse with activity
physical exam shows pain with medio-lateral compression of heel
may find risk factor’s such as tight heel cords or subtalar overpronation
What is the treatment of Sever’s Disease?
rest from sports
ice massage
analgesics rarely necessary - never use before activity
calf muscle stretching - hold each ofr 30 seconds 1-2 times a day
heal cups
molded shoe inserts if overpronation is present
when severe, may need crutches until weightbearing is painfree
What is the prognosis of Sever’s Disease?
usually resolves in 2-8 weeks with proper treatment
no significant long-term effects
What is the occurrence of Osgood-Schlatter Diseaes (OSD)?
osteochondrosis of tibial tuberosity
girls aged 8-13
boys aged 10-15
21% of athletic adolescents
common in running, jumping sports
4.5% of non-athletes
bilateral in 20%
What are the risk factors of Osgood-Schlatter Disease?
right quadriceps and hip flexors
external tibial rotation:
when tibial tubercle sits lateral to the center of patella
increases traction stress from patellar tendon
patella alta - patella sits higher than normal
What is the clinical presentation of Osgood-Schlatter DIsease?
history of pain, swelling at tibial tubercle
worsens with activity, improves with rest
tenderness at tibial tubercle
pain with resisted knee extension
often have tight quadricepts and hip flexors
thomas test and/or ely test positive
What are common findings in x-rays in Osgood-Schlatter Disease?
not required for diagnosis
typically normal
may see soft tissue swelling
useful to rule out other pathology
What is the treatment for Osgood-Schlatter Disease?
rest from sports
ice massage
quad and hip flexor stretching - hold each for 30 seconds 1-2 times a day
analgesics rarely necessary - never use before activity
patellar tendon strap may help
severe cases may require immobilization - long leg cast or knee immobilizer brace for 3-4 weeks