The Young Athlete Flashcards
1
Q
What are some differences between Adult and Growing Bone?
A
- Articular cartilage of growing bone is thicker and can remodel
- Junction between epiphyseal plate and the metaphysis is vulnerable to disruption, especially shearing forces
- Tendon attachment sites - apophyses - provide a relatively weak cartilaginous attachment, predisposing avulsion injuries
- Metaphysis of long bones in children is more resilient and elastic, predisposing to greenstick fractures
- During growth spurt, epiphyseal plate is more fragile leading to increased incidence of physeal fractures in pubescence
2
Q
What are the three most common types of fractures seen in the young athlete?
A
- Metaphyseal
- Epiphyseal Growth Plate
- Apophyseal Avulsion Fractures
3
Q
What is the most common metaphyseal fracture in young athletes
A
- Buckling in either forearm or lower leg
- Known as greenstick
4
Q
What is the treatment for greenstick fractures?
A
- If no growth plate involvement
- Immobilization, heals in three weeks
- Sometimes angular or rotational deformity requires ORIF
5
Q
Name the Site of Osteochondrosis associated with: Perthes, Kienbocks, Kohlers, Freibergs, and Osteochondritis Dissecans (Articular)
A
- Femoral Head
- Lunate
- Navicular
- Second Metatarsal
- Medial Femoral Condyle, Capitellum, talar dome
6
Q
Name the site of Osteochondrosis associated with Osgood Schlatter, Sinding Larsen Johansson, and Severs lesions (Non Articular)
A
- Tibial Tubercle
- Inferior Pole of Patella
- Calcaneus
7
Q
Name the site of Ostechondrosis associated with Sheurmanns and Blounts Lesions (Physeal)
A
- Thoracic Spine
- Proximal Tibia
8
Q
Describe the Salter Harris Classification of Growth Plate Fractures (Physeal)
A
- S - Slipped
- A - Above (growth plate)
- L - Lower
- T - Through
- ER - Erasure (of growth plate, crushed)
9
Q
How well do the different classifications of Salter Harris Fractures Heal?
A
- 1 and 2 heal well
- 3 and 4 involve joint surface and growth plate and have high complication rate
10
Q
What history best describes growth plate fracture?
A
- Severe rotational or shear force with accompanying localized swelling, bony tenderness, and loss of function
- Orthopedic referral mandatory
11
Q
What type of avulsion fracture can occur in children accompanying ACL injury?
A
- Avulsion of tibial spine or the Distal Femoral Attachment
12
Q
What is the most commonly reported acute apophyseal sports injury in the upper extremity? In the Spine?
A
- Injury to the olecranon and medial epicondyle of humerus
- in Spine it is the vertebral ring apophysis
13
Q
How are avulsion fractures in the young athlete treated?
A
- Same as grade 3 tears of muscle
- Reduce pain and swelling
- Restore full ROM with passive stretching and active ROM as symptoms settle
- Graduated return to strength training
- Reattachment is rarely necessary
14
Q
Are dislocations of the glenohumeral joint common in the younger child?
A
- No, but common in the adolescent
15
Q
What are the radiographic signs of Stress fracture of the proximal humeral epiphyseal plate?
A
- Widening of the proximal humeral epiphysis
- Metaphyseal sclerosis and demineralization or fragmentation of the epiphysis
- Most improve with rest and return to sport
16
Q
What causes shoulder impingement in the younger athlete?
A
- Secondary to atraumatic instability
- Because of repetitive stress to anterior capsule of the shoulder
- Also occur in swimmers where excessive IR causes a tendency to impinge
17
Q
What types of elbow pathology may be caused by forceful valgus stress in pitching?
A
- Medial stretching, Lateral Compression, and Posterior Impingement can cause:
- Apophysitis of the epicondyle
- Chronic strain of medial (ulnar) collateral ligament
- Avulsion fracture of the medial epicondylar apophysis
- Ulnar Nerve damage
- Lateral compressive forces in particular may damage articular cartilage of the capitellum or radial head
18
Q
Which individuals experience Osteochondritis Dissecans of the Capitellum? Treatment?
A
- Gymnasts
- Pitchers
- Early stages respond well to rest
- Loose bodies (if any) need surgery to remove
- Results of surgery are variable
19
Q
Describe a Panners Lesion
A
- Occurs in younger child (under 11 years)
- Self limiting
- Fragmentation of the entire ossific center of the capitellum
- No loose bodies, no surgery required
20
Q
What is a common cause of dorsal wrist pain in the young gymnast?
A
- Compromise of blood supply of the distal radial physis
- Aggravated by weight bearing
- On radiographs: widening, irregularity, haziness, or cystic changes within growth plate
- Other causes include scaphoid impaction syndrome, dorsal impingement, TFCC tear, stress fractures
21
Q
What is a Kienbocks Lesion?
A
- Osteochondrosis of lunate
- Usually in older patients (over 20)
22
Q
What is treatment for stress injuries of the distal radial physis in the young athlete?
A
- Rest
- However, premature closure can occur resulting in positive ulnar variance
23
Q
What is the most common postural abnormality of the spine in the younger athlete?
A
- Scheuermanns Lesion
24
Q
What is a Scheuermanns Lesion?
A
- Excessive kyphosis of the spine due to osteochondrosis
- Usually in thoracic spine but also at thoracolumbar junction
25
How is the radiologic diagnosis of Scheuermans Lesion Made?
- Presence of wedging of 5 degrees or more on 3 adjacent vertebrae
26
What is the management of Scheuermans Lesion in the young athlete?
- Aimed at preventing progression
- Joint mobilization, massage, stretching of hamstrings and abdominal strengthening
- Brace may be worn
- Surgery indicated if kyphosis greater than 50 degrees or signs of spinal cord irritation are present
27
What are the sites of apophysitis around the hip joint?
- ASIS - Sartorius
- AIIS - Rectus Femoris
- Lesser Trochanter - Iliopsoas
28
Describe Perthes Disease and its presentation
- Osteochondrosis of femoral head
- Ages 4-10
- Presents with limp or low grade ache in the thigh
- Unilateral
- Limited Abduction and Internal Rotation
- More common in males
- Radiographs show increased density and flattening of the femoral capital epiphysis
29
What is management of Perthes Disease?
- Rest
- ROM exercises to maintain Abduction and IR
- If severe may require arthroscopic chondroplasty and loose body removal
- Main long term concern is Osteoarthritis due to irregularity of the joint surface
30
Describe Slipped Capital Femoral Epiphysis and its presentation
- Ages 12-15
- Usually in overweight boys who tend to be late maturing
- Most common presenting symptom is limp, sometimes pain in the knee
- Shortening and External Rotation of the affected leg
- Hip Abduction and IR are reduced
- Bilateral Involvement common
- Radiographs show widening of growth plate
31
What is treatment of Slipped Capital Femoral Epiphyses?
- Gradually progressing slip is indication for surgery
- Acute severe slip is surgical emergency
- Can lead to Avascular Necrosis
32
What may be an anatomical predisposing factor to the development of Osgood Schlatter?
- Excessive Subtalar Pronation
33
What is a Sinding Larsen Johannson Lesion?
- Apophysitis of inferior patellar pole
- Prevalent in junior basketball players
- Self limiting and treated with rest
34
Describe Osteochondritis Dissecans of the Knee
- Presents with intermittent pain and swelling of gradual onset
- May present as acute painful and locked knee (Associated with hemarthrosis and loose bodies)
- Radiographs reveal defect at lateral aspect of Medial Femoral Condyle
- Ortho referral for fixation of loose fragment or removal of detached fragment
35
Describe Stills Disease
- Juvenile Rheumatoid Arthritis of the knee
- Persistent intermittent effusion with increased temperature and limited ROM
- May be family history of RA
- Needs serological examination including Rheumatoid factor, ESR, and maybe examination of joint aspirate
- Treatment is activity modification
36
Describe Diagnosis of Acute Rheumatic Fever?
- May or may not be history of sore throat and Carditis
- Must maintain high index of suspicion
- Investigations include markers of inflammation (ESR, C reactive protein), Serology for Streptococci, and echocardiography
- Treatment is Oral Penicillin and Aspirin
37
Describe a Discoid Meniscus
- May cause persistent knee pain and swelling in the adolescent athlete
- Marked Joint Line Tenderness
- History of clunking in the younger child (4 years)
38
Describe Adolescent Tibia Vara (Blounts Disease)
- Affects proximal tibial growth plate
- Affects tall, obese children around the age of 9
- Usually Unilateral
- Radiographs show a reduced height of the medial aspect of the proximal tibial growth plate
- May require surgery to correct mechanical abnormality
39
What are some Risk Factors for Females tearing an ACL?
- Being in pre-ovulatory phase of menstrual cycle vs post-ovulatory phase
- Decreased intercondylar notch width
- Increased knee abduction moment on impact on landing
40
When is non operative management suggested for children with ACL injury?
- Children who have not yet reached skeletal maturity (Tanner stages 1 and 2, Prepubescents)
- Poor Outcome
41
When is surgery recommended for children with ACL injury?
- Children who are non compliant with management
- Demonstrating functional instability with ADLs
- Associated Meniscal Pathology
- Usually use Autologous IT Band graft
42
What is a Severs Lesion?
- Apophysitis of the Calcaneus at the insertion of the achilles
- Patient complains of localized pain with activity
- Tenderness at insertion of achilles
- May be tightness of gastrocnemius or soleus
- May be limited dorsiflexion
43
What is management of Severs Lesion?
- Activity Modification
- Heel Raise
- Calf Stretching
- Strengthening to plantar flexors when pain free and symptoms permit
44
What are common Tarsal Coalitions?
- Most common form is a bony or cartilaginous bar between the navicular and calcaneus
- Second is between calcaneus and talus
- Calcaneocuboid is least common
45
What is presentation of Tarsal Coalition?
- Midfoot pain after recurrent ankle sprains or after repetitive running and jumping
- May have a limp
- Restriction of Subtalar Joint Motion
- Radiographs taken at 45 degree oblique may confirm
- If negative but clinical suspicion is high, MR or CT
46
What is treatment of Tarsal Coalition?
- Orthotic Therapy
- Surgical excision in younger patient with severe symptoms
- Coalition may recur after surgery
47
What is a Kohlers Lesion? Presentation?
- Osteochondrosis affecting navicular bone in young children
- Ages 2 to 8
- Pain over medial aspect of navicular
- Radiographs show increased density and narrowing of navicular bone
48
What is treatment of Kohlers Lesion?
- Waling Cast for Six Weeks to accelerate relief
| - Orthoses if biomechanical abnormalities are present
49
Describe Apophysitis of the Tarsal Navicular Bone
- May cause pain on the medial aspect of the tarsal navicular at insertion of tibialis posterior tendon
- Often associated with the presence of an accessory navicular or prominent navicular tuberosity
- Management includes activity modification, NSAIDs, and orthoses to control excessive pronation if present
50
Describe Apophysitis of the Fifth Metatarsal
- Traction apophysitis at insertion of Peroneus Brevis at base of fifth metatarsal
- Localized tenderness and pain on resisted eversion of the foot
- Manage with activity modification and stretching and strengthening of the peroneals
51
Describe Freibergs Lesion
- Osteochondrosis causing collapse of the articular surface and adjacent bone on the metatarsal head
- Second Metatarsal most commonly involved (ballet dancers)
- Most frequently in adolescents over age of 12
- Standing on forefoot aggravates pain
- Tenderness and swelling around second metatarsal joint
- Radiographs reveal a flattened head of metatarsal with fragmentation of the growth plate
52
What is treatment of Freibergs Lesion?
- If caught early, activity modification, padding under metatarsal, and footwear modification to reduce pressure over metatarsal heads
- If symptoms persist, surgery
