adolescents

Question 1

overuse accounts for [ ] of sports related pediatric injuries

Answer 1

30-50%

Question 2

adolescent back pain

Answer 2

• patho-anatomy rare, typically around 13-14
• predictors: pain beliefs, mental health, presence of somatic complaints, anxiety/stress response, female > male
• NOT predictors: scoliosis, posture, joint hypermobility/flexibility, back/core muscle strength or endurance, school bag
• management: impairment based interventions, EDUCATION (you are healthy, you can manage your pain, exercise and motion keep you healthy)

Question 3

apophysitis

Answer 3

• similar mechanism to tendonopathy/strain, growth rate may play a role
• traction stress on growth center

Question 4

tibial tuberosity/Osgood-Schlatter’s apophysitis

Answer 4

• F 8-13
• M 10-15
• pain with resisted quad contraction, with quad stretch, TTP tibial tub
• mimics patellar tendonopathy, PFPS, fat pad syndrome

Question 5

apophysitis management

Answer 5

• like PFPS or patellar tendonitis
• activity modification/rest
• ice/anti-inflammatories
• modified quad stretching
• correct muscle imbalances at hip and thigh
• NO ECCENTRICS OR HEAVY SLOW RESISTANCE
• no aggressive stretching
• NO transverse friction massage

Question 6

patellar/Sinding-Larsen-Johansson apophysitis

Answer 6

• 9-12
• pain with resisted quad contraction, passive quad stretch, TTP distal patella
• mimics IP fat pad, patellar tendonopathy, PFPS, plica

Question 7

calcaneal/Sever’s apophysitis

Answer 7

• 8-13 YO
• diagnose with 1 leg heel-stand, squeeze and palpation tests
• mimics achilles T, retrocalcaneal bursitis, PF
• normal treatment but also can use heel cups/lifts/orthotics

Question 8

little leagure’s elbow

Answer 8

• most often medial epicondyle attachment of flexor tendons
• 10-16 YO
• mimics med epi, UCL complex injury
• pain with resisted flexion and gripping, maybe pain with elbow valgus stress, point tender over bony portion of medial epicondyle

Question 9

hip/pelvic apophysitisesssss

Answer 9

• iliac crest: abdominals, TFL, glute muscles
• ASIS: sartorius (12-16 YO)
• AIIS: rectus femoris (12-16)
• ischial tuberosity: hamstrings (!2-18)
• greater trochanter: glute med/min
• less trochanter: iliopsoas
• inferior pubic ramus: adductors

hamstring might be pain from with prone HS resistive testing, test at 90 degrees hip flexion

Question 10

avulsion fractures

Answer 10

• similar location and symptoms as apophysitis but often acute vs overuse
• minimal displacement can do “aggressive rest” but more might need surgical intervention or bracing

Question 11

ACL and adolescents

Answer 11

• higher rates of injury than adults - higher risk activities?
• chondral injuries in 6-10%, mensicus in 45-55% (like adults)

Question 12

ACL surgeries

Answer 12

• don’t screw growth plates or epiphyseal plates (risk limb length)
• if non-op, risk not able to return to sport, secondary injuries (meniscal, chondral, MCL)
• non-op increased risk of additional tissue injury along with inability to return to PLOF

surgery stabilizes knee, avoids later injury and OA

Question 13

transphyseal surgery ACL

Answer 13

• similar to standard fixation in adults but may or does cross both femoral and tibial physis
• 86% return to sport, 5/101 have leg length discrepancy
• for those 14ish (near skeletal maturity)

Question 14

nontransphyseal surgery ACL

Answer 14

• extra-articular reconstruction or direct repair
• poor outcomes : laxity and instability in > 65%
• reserved for 8-12 (skeletally immarture)

Question 15

partial transphyseal ACLr

current gold standard

Answer 15

• tunnel soft tissue graft - femoral fixation does not cross physis but tibial fixation may
• no limb length discrepancy
• most common for 12-15 with partially open growth centers

Question 16

epiphyseal ACLr

Answer 16

• rare, difficult
• native ACL anatomy replicated closely

Question 17

tibial spine/avulsion fractue

Answer 17

• I: minimal displacement - immobilize, leg cast/splint 4-6 weeks
• II: hinged - needs fixation, arthroscopic reduction
• III: completely displaced (same as II)
• IV: displaced with comminuted fragment - needs detailed fixation and longer rehab, screw, K-wire

IMAGING BEFORE YOU TRY TO GET FULL EXTENSION

Question 18

osteochondritis dissecans

Answer 18

• inflammatory reaction
• focal injury or condition of subchondral bone
• might be ischemic or traumatic
• symptoms are dull ache, pain, effusion, mechanical symptoms
• 6-19
• at knee (med > lat), elbow
• female > male
• I: conservative, NWB for up to 6 months
• II, III, IV: surgery

Question 19

Panner’s disease

Answer 19

• osteochondrosis: irregularity of humeral capitulum
• male > female, 5-11
• etiology unknown
• rest and avoidance of impact or high compression/torsion force
• typically self-resolving