Upper Extremity Sports Injuries Flashcards
Sports injuries in children include both traumatic and overuse conditions and account for about __% of all childhood reported injuries
25
What 2 things can cause a physeal fracture?
falls and overuse
Physeal fractures are classified using what scheme?
Salter-Harris Classification
Describe the 5 types of physeal fractures according to the Salter-Harris classification system
- Type I: Fracture line extends through the physeal plate
- Type II: Fracture line extends through the physeal plate metaphysis
- Type III: Fracture line extends from the joint surface through the epiphysis and across the physis, causing a portion of the epiphysis to become displaced
- Type IV: Fracture line extends from the joint surface through the epiphysis, physeal plate, and metaphysis causing a fracture fragment
- Type V: Crush injury to the growth plate
Physeal fractures result in a risk for what?
Premature physeal closure, creating a shorter limb or angular limb deformity as the patient progresses toward skeletal maturity
What is an apophysis?
a prominence containing growth cartilage that is located on the bones and serves as an attachment site for muscle tendons
What may the result be if tensile forces are large enough on the apophysis?
Avulsion fractures, in which the entire apophysis is separated from the underlying bone
Are children at a disadvantage or an advantage in bon ehealing in comparison to adults? Explain why…
Advantage, because their bones are more highly vascularized, which allows for improved availability of healing factors after fracture. The periosteum is also thicker which makes it less likely to be disrupted during injury
What is juvenile osteochondritis dissecans (OCD)?
a lesion of the subchondral bone that often results in articular cartilage softening, fibrillation, and fragmentation, which may result in loose bodies with the joint
What is the proposed cause of OCD?
repetitive stress to the subchondral bone resulting in cumulative microtrauma in a region with poor blood supply, resulting in damage
Are boys or girls more affected by OCD?
boys
What joint is the most prone to OCD?
knee joint
Describe the treatment process following an OCD lesion
Prolonged rest or immobilization, followed by rehab and gradual return to sports over a 3-6 month period
When is surgical treatment for OCD advocated?
- unstable lesions
- failure of conservative treatment
- in adolescents to maintain the integrity of the joint
True or False
Prepubescent children can demonstrate strength gains
True
What happens to muscular flexibility during the adolescent growth spurt?
it decreases which may lead to an increased potential for injury
What are important components of the history?
- details regarding the MOI
- acute response to injury
- sport specific history
What is the most frequently used ligament laxity scale?
Beighton-Horan
A score of - on the Beighton-Horan scale typically indicates a high degree of laxity
5-9
What functional movement tests provide information regarding how the neuromusculoskeletal system performs as a unit?
- single leg squat
- lateral step down
What positions lead to a position of dynamic knee valgus?
- femoral IR
- femoral adduction
- tibial IR
- foot pronation
When observing from the frontal plane the forward projection of the knee should be kept in alignment with what?
the 2nd metatarsal
What should you suspect if the patient does not experience pain when performing functional tests?
overuse injuries in which pain does not begin until several minutes into activity
What test allows for the identification of pathologic LE alignment during a more sport specific task?
drop vertical jump
Describe the drop vertical test
The aptinet stands on top of a 12” box and then jumps down and then immediately performs a maximal vertical jump raising both arms overhead
What is the drop vertical test a good predictor for?
ACL injury in female athletes
Describe what is happening when a person has a rearfoot strike pattern while running
They are overstriding and contacting anterior to the BOS with their knee extended
Describe what is happening when a person has a forefoot strike pattern while running
They are contacting closer to their BOS and there is greater knee flexion on contact
What 3 things should be included in the comprehensive exam even if the patient doesn’t present with seemingly related injuries?
- single limb balance
- core stability
- hip muscle function
When measured in 90 degrees of abduction, the throwing athlete will typically demonstrate limited _____ rotation and excessive _____ rotation
internal
external
If there is a relative difference greater than __ degrees of loss of IR between sides the patient is considered to have developed what pathology?
20
glenohumeral internal rotation deficit (GIRD)
The total arc of IR+ER should be within _ degrees of the nonthrowing shoulder
5
What muscles are responsible for deceleration of the shoulder after ball release?
RC muscles
What is Little League Shoulder?
an overuse injury caused by rotational torque and stress across the proximal humeral physis, leading to a type of Salter I fracture
**Diagnostic if RC testing is negative
How may little league shoulder appear on x-ray?
widening of the proximal humeral physis
What is the initial treatment of little league shoulder?
rest 6-12 weeks
What is the maximum pitches a child ages 7-8 can throw per day?
50
What is the maximum pitches a child ages 9-10 can throw per day?
75
What is the maximum pitches a child ages 11-12 can throw per day?
85
What is the maximum pitches a child ages 13-16 can throw per day?
95
What is the maximum pitches a child ages 17-18 can throw per day?
105
If a child under the age of 14 throws less than __ pitches in 1 day they do not need to rest a day
1-20
If a child under the age of 14 throws anywhere from __-__ pitches in 1 day they need to rest 1 day
21-35
If a child under the age of 14 throws anywhere from __-__ pitches in 1 day they need to rest 2 days
36-50
If a child under the age of 14 throws anywhere from __-__ pitches in 1 day they need to rest 3 days
51-65
If a child under the age of 14 throws anymore than __ pitches in 1 day they need to rest 4 days
66
If a child from the ages of 15-18 throws less than __ pitches in 1 day they do not need to rest a day
30
If a child from the ages of 15-18 throws anywhere from __-__ pitches in 1 day they need to rest 1 day
31-45
If a child from the ages of 15-18 throws anywhere from __-__ pitches in 1 day they need to rest 2 days
46-60
If a child from the ages of 15-18 throws anywhere from __-__ pitches in 1 day they need to rest 3 days
61-75
If a child from the ages of 15-18 throws anymore than __ pitches in 1 day they need to rest 4 days
76
What are the 3 theories regarding the pathophysiology of SLAP lesions in throwers?
1) traction injury from the pull of the biceps tendon on the labrum during the deceleration phase of throwing
2) contracture of the posterior shoulder capsule resulting in a posterosuperior migration of the humeral head
3) “peel back” mechanism where the biceps tendon imparts torsional forces to the posteriosuperior labrum in the late cocking phase of throwing
What are the signs and symptoms of a SLAP tear?
- vague shoulder pain with overhead or cross-body activities
- complaints of popping, clicking, or catching
What is the typical treatment of a SLAP lesion?
Rest followed by rehab with a focus on restoring normal scapular mechanics, strengthening of scapular stabilizers and RC muscles, dynamic stabilization, and proprioceptive awareness
What pathology is often present with SLAP lesions?
GIRD
What 2 things may cause chronic multidirectional instability (MDI) of the shoulder in the young athlete?
- an acute traumatic dislocation
- an underlying capsular laxity (most common)
What are the symptoms of MDI?
bilateral shoulder pain with a loose or unstable feeling during activity and they may evem experience shoulder subluxation during normal ADLs
What does the clinical exam of a patient with MDI reveal?
- increased GH translation during passive mobility
- positive Sulcus sign
- increased AP glide with load and shift
What are the clinical signs of MDI?
- avoidance of horizontal GH extension
- scapular dyskinesia
- weakness in the scapular stabilizers and RC muscles
What is the preferred initial management strategy for MDI?
PT with a focus on avoiding provocative positions and subsequent dislocations with exercises focusing on normalizing scapular mechanics
What is generalized shoulder pain resulting from overuse or rapid advancement of training protocols often caused by?
tendinitis with secondary impingement.
What are the clinical findings of shoulder tendinitis with secondary impingement?
- tight posterior rotator cuff or shoulder capsule
- weakness of the posterior scapulothoracic musculature and external rotators
- forward rounded shoulders
Acute traumatic shoulder dislocations occur most commonly in what direction?
anterior
What is the typical MOI for a traumatic shoulder dislocation?
Fall onto the arm while the shoulder is in an abducted and externally rotated position
What is the typical treatment for an acute traumatic shoulder dislocation?
rest or sling immobilization for 1-3 weeks
What positions should be avoided until the lateral phases of rehab in kids who have experienced a traumatic shoulder dislocation?
90 degrees of abduction and ER
True or False
Secondary injuries and recurrent instability are not common after first-time dislocation
False
What should the focus of rehab be following the period of immobilization?
- restoring ROM
- strength
- normalizing scapular movement
- dynamic stabilization of the shoulder
**aggressive ROM techniques are contraindicated!
What is the typical return to contact sports period following dislocation?
6 months
Rehab is minimal in nondisplaced clavicle fractures and return to sports activity is usually around - weeks
6-8
Following surgical management of a displaced or comminuted clavicle fracture the patient is immobilized for _ weeks, after which they may begin progressive ROM and strengthening exercises with a return to sports allowed at __ weeks
3
12
Describe the forces at the elbow during the late cocking and early acceleration phases of throwing
- Valgus tension stresses placed across the medial elbow
- Compressive forces across the lateral aspect of the elbow
Describe the forces at the elbow during the deceleration phase of throwing
shearing forces occur across the elbow as the forearm fully pronates and the elbow extends
What are 3 medial elbow injuries commonly encountered in the pediatric thrower?
- little league elbow
- medial epicondyle apophysitis
- medial epicondyle avulsion fracture
What typically causes injuries to the medial elbow?
valgus forces
What are the symptoms of little league elbow?
- medial elbow pain while throwing
- decreased throwing velocity (prior to pain)
- pain with writing
What is the typical treatment for little league elbow?
rest from throwing and activity modification until pain free (may take up to 3-6 weeks)
What is the focus of PT for little league elbow?
- Gentle ROM
- Strengthening of scapular and RC musculature
- Slow return to sports when pain free
What are 2 lateral elbow injuries commonly encountered in the pediatric thrower?
- Panner’s disease
- OCD of the capitellum
What is Panner’s disease?
A self-limiting AVN o the developing ossific nucleus of the capitellum in kids ages 4-8
What is the majority symptom that helps to diagnose Panner’s disease?
lateral elbow pain that hurts both at REST and during activity
What is Osteochondritis dissecans (OCD)?
Repetitive microinjury that leads to subcondral fractures in a region with tenuous blood supply
In what age range and types of atheltes are OCD lesions most common?
12-17 year olds involved in baseball, gymnastics, racquet sports, football, or weightlifting
What are the signs and symptoms of OCD lesions?
- localized lateral elbow pain
- decreased ROM
- tenderness to palpation over radiocapitellar joint
Describe conservative treatment for an elbow OCD lesion
complete rest for up to 6 months with a gradual return to full activity over the span of 12 months
When is surgical treatment indicated in an OCD lesion of the elbow?
When there is cartilaginous involvement
What is the typical immobilization period following elbow fracture?
6-8 weeks
What type of elbow fractures most commonly occur in children and carry a risk of secondary neurovascular damage?
supracondylar elbow fractures
What is a Monteggia fracture?
Radial dislocation with an ulnar fracture
What type of forearm/wrist injury is the most common?
Gymnast wrist
What is the most common carpal bone fracture?
scaphoid
A fracture at the 5th MC is called a _____ fracture
Boxer’s
