Week 13: Pediatric Injuries, Heat and Cold Injuries

Question 1

Growth Plates

Answer 1

-Area of new bone growth in kids & teens
-Usually located at the end of long bones
-Made up of cartilaginous tissue
-Growth plates close between the ages of:
○ 14-15 yrs old for females
○ 16-17 yrs old for males

Question 2

Pediatric Medical Conditions/Considerations (7 Specific)

Answer 2

-Juvenile Diabetes (Type 1 – insulin dependent)
-Juvenile Arthritis
-Asthma
-Epilepsy
-Allergies (*anaphylaxis)
-Water safety/CPR for drowning
-Choking
○ Kids are always eating snacks!

Question 3

Working in Youth Sports Important Considerations

Answer 3

-Pediatric sized emergency supplies:
○ Oropharyngeal airway (OPA)
○ Neck collar
○ Splints
○ EpiPen Jr® (weight: 15-30kg; 33-66lbs) *green for kids, yellow for adults
-Pediatric tools:
○ Child SCAT6 (ages 8-12 y.o.)

Question 4

Injury Prevention in Youth Sports

Answer 4

-Proper warm-up → often overlooked
-Properly fitted protective equipment
-Diversifying their activities
-Playing time limits – for training & competition
-Max games per day for tournaments
-Minimum hrs between games
-Rotating positions
-Proper nutrition & hydration
-Avoid overtraining
-Baseline concussion testing
-Psychological wellness
-Pre-season screenings
-Pitch count limits (mandated rest days)

Question 5

Pre-Season Screenings (5)

Answer 5

1. Identify current pain/injuries
2. Review medical conditions
3. Assess functional movement patterns
4. Concussion baseline testing
5. Discuss important topics
   -Concussions
   -Nutrition
   -Hydration
   -Overtraining
   -Communicating injuries early
   *Emphasis on RTP sooner if caught early

Question 6

Psychological Wellness

Answer 6

-Support following injury – parents, coach, team
-Healthy competition
-Healthy eating habits
-Inclusivity
-Motivational talks
-Encouraging cheers
-Promoting teamwork
*Sport is about so much more than sport-skills!

Question 7

Growth Plate Injuries/Fractures

Answer 7

-Excessive repeat stress on the growth plate of the bone, causes a widening of the growth plate
-Growth plate becomes inflamed
-If not addressed, can affect growth
○ Deformities
○ Bone stops growing prematurely
-Altered activity is essential
-May require 2-3 months of rest from aggravating sport skill
-Rest, cast or splint, may need surgical repair

Question 8

Little League Shoulder/Proximal Humeral Epiphysitis

Answer 8

-Irritation of the growth plate in the proximal humerus
-MOI: overuse in overhand motions causing excessive strain on growth plate
-S&S: progressive increase in pain in proximal humerus or shoulder
-May lead to stress fractures through growth plate
-Most common in pitchers & baseball players, but also seen in tennis, volleyball
-Prevention: limiting pitch counts, proper throwing mechanics
*Train the kinetic link (e.g. legs and sport-specific structures strengthened)

Question 9

Osgoode Schlatter’s Disease

Answer 9

-Irritation of the growth plate at the tibial tuberosity (attachment of patellar tendon)
-MOI: overuse – excessive traction of quads via patellar tendon
-S&S: pain over tibial tuberosity, eventually a visible bump over tibial tuberosity, pain with contraction & stretch of quads, jumping especially painful
-Special Tests: Thomas Test; resisted quads
-Acute management: PIER, roll/soft tissue mobility for quads, lower extremity mechanics
-Prevention: Diversify activity
-Important to train hamstrings to prevent ant translation of tibia on femur, & stability at hip & knee

Question 9

Patellar Tendonitis (a.k.a Jumper’s Knee)

Answer 9

-MOI: excessive traction on patellar tendon
-Often associated with growth spurts
-S&S: pain, swelling & heat over patellar tendon, pain with jumping, running, quick change in direction or strong quad contraction, pain with flexion and extension, can often train/compete through the pain
-Special Tests: Thomas Test; resisted quads
-Acute management: PIER, roll/soft tissue mobility for quads, lower extremity mechanics – how are they moving for the components of their sport?
-Important to train hamstrings to prevent ant translation of tibia on femur, & stability at hip & knee
-Tendinopathy rehab → eccentrics, X-training
-RTP: patellar tendonitis tape job

Question 10

Sever’s Disease

Answer 10

-Irritation of the calcaneal tuberosity growth plate (attachment for Achilles tendon)
-MOI: overuse – excessive traction of Achilles
-S&S: pain over Achilles insertion into calcaneus, pain with forceful Achilles contraction (jumping, sprinting, starts/stops)
-Special test: single leg calf raise
-Acute care: stretch gastrocs & soleus, NSAIDs, heel lift

Question 11

Little League Elbow

Answer 11

-MOI: chronic valgus overload to medial elbow from throwing
-Results in injury to one/many medial structures: medial epicondylitis, medial epicondylar apophysitis (growth plate injury), avulsion fracture, MCL sprain (older kids)
-S&S: pain & inflammation over medial elbow, pain & weakness with throwing, medial instability
-Special Test: wrist flexor muscle testing, valgus stress, X-rays
-Acute care: PIER (alter activity/rest)
-Prevention: limited pitch counts, proper throwing mechanics

Question 12

Other Growth Plate Irritation Sites (2)

Answer 12

1. Distal radius → gymnastics – from repeat load
2. Anterior Inferior Iliac Spine → tumbling sports (gymnastics, cheer) – rectus femoris contracts strongly while on stretch

Question 13

Principles of Splinting (3)

Answer 13

1. Include the joint above & below the injury
2. Pad the splint for comfort & added support
3. Check distal pulse before & after splinting

Question 14

Heat Illnesses (3)

Answer 14

1. Heat cramps
2. Heat exhaustion
3. Heat stroke

Question 15

Heat Cramps

Answer 15

-Muscle cramping during/after activity in the heat
-Thought to be caused by fluid & salt loss from sweating
-Common in distance runners
-S&S: pain, spasm (usually legs or abdomen)
-Acute care: rest in a cool area, water/sports drink, gentle stretching or massage
-Prevention: sufficient hydration & electrolytes (more than usual), avoid/minimize activity in high temperatures
-Should be seen as a warning to avoid more severe heat illness

Question 16

Heat Exhaustion

Answer 16

-Results from activity in hot temperatures
-Body’s ability to regulate temp becomes stressed
-S&S: normal or slightly elevated body temp; cool, moist, pale skin (red initially),
headache, nausea → vomiting, dizziness, weakness, exhaustion, level of consciousness starts to decline in later stages
-Acute care: rest in a cool place, cold cloths in armpits, groin, back of neck, drink cool water – early stages very treatable
-If left untreated, can progress to heat stroke (emergency)

Question 17

Heat Stroke

Answer 17

-Results from untreated heat exhaustion
-Body becomes unable to cool itself
-S&S: dry, red, hot skin, progressive loss of consciousness, rapid & weak pulse, rapid & shallow breathing, high body temp.
*Life threatening emergency
-Acute care: cool the body, give fluids, minimize shock, call EMS

Question 18

Cold-Related Emergencies (2)

Answer 18

1. Frostbite
2. Hypothermia

Question 19

Frostbite

Answer 19

-When body tissues freeze following prolonged exposure to cold
-Water within & surrounding cells freeze & swell which damages the cells
-Can result in loss of digits or limbs
-Superficial frostbite → skin only
-Deep frostbite → skin & underlying tissues freeze
-S&S: decreased sensation, skin is cold & waxy, discolouration (flushed, white, yellow, blue, black), tingling, swelling, pain with rewarming, blisters within 24hrs
-Once an area gets frostbite, subsequent exposure can result in frostbite more easily in area
-Acute care: gentle rewarming by soaking in warm water, apply dry sterile dressing, gauze between fingers/toes, warm drink, blanket
-Do not rub the area – this can further damage the tissues
-Common in snowboarding, skiing, hockey, skating, or fall sports that go late into the season (football, field hockey, rugby, soccer)
-Refer to doctor if any signs of infection, red streaks, blisters, drainage, no return
of sensation or normal skin tone
-Prevention: dressing in layers, removing wet clothing/gear, avoid extended time during extreme cold weather

Question 20

Hypothermia

Answer 20

-A dangerous drop in body temperature below 95°F (35°C) following extended exposure to cold
-S&S: shivering (stops in later stages), slow irregular pulse, slow breathing rate, numbness, confusion, drowsiness, pale cold skin, loss of coordination
-Can lead to shock, coma & cardiac arrest
-Acute care: ABCs, gradual rewarming with dry clothes, blankets, warm environment, heating pads, warm drinks if alert