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731: Pediatrics > Lower Extremity Sports Injuries > Flashcards

Lower Extremity Sports Injuries Flashcards

1
Q

What are 9 specific injuries to the pelvis, hip and thigh?

A
  • pelvic apophysitis
  • pelvic avulsion fractures
  • snapping hip syndrome
  • femoral stress fracture
  • femoral acetabular impingement/labral tears
  • muscle strains
    traumatic hip dislocation
  • slipped capital femoral epiphysis
  • Legg-Calve Perthes disease
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2
Q

What is the weakest point in the muscle-tendon unit of a growing athlete?

A

pelvic apophyses

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3
Q

Why do pelvic apophyses tend to occur?

A

bone growth exceeds the ability of the muscle tissue to sufficiently lengthen and stretch, thus increasing tensile forces which leads to microtrauma and progressive weakness and inflammation

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4
Q

What the 3 most common sites for pelvic apophysitis?

A
  • ASIS
  • AIIS
  • ischial tuberosity
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5
Q

ASIS apophysitis occurs because what 2 muscles are pulling?

A
  • Sartorius

- TFL

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6
Q

AIIS apophysitis occurs because what muscle is pulling?

A

rectus femoris

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7
Q

Between what ages do both the ASIS and AIIS apophyses ossify?

A

14-16

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8
Q

Ischial tuberosity apophysitis occurs because what muscle group is pulling?

A

hamstrings

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9
Q

Between what ages does the ischial tuberosity ossify?

A

21-25

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10
Q

What are 3 other less common apophysitis sites?

A
  • lesser trochanter
  • greater trochanter
  • iliac crest
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11
Q

What are the symptoms of pelvic apophysitis?

A

well-localized, dull pain with activity at the involved location

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12
Q

What can be done to reproduce the athlete’s symptoms?

A

tensioning of the muscle

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13
Q

What is the treatment for pelvic apophysitis?

A

rest, WBAT as long as there is no antalgic gait.

Once pain is controlled focus on muscle flexibility, ROM, and strengthening of the lumbopelvic and LE musculature

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14
Q

Return to sport following pelvic apophysitis is dependent upon symptoms and may take up to _ weeks

A

6

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15
Q

When do pelvic avulsion fractures tend to occur?

A

with the progression of an unmanaged apophysitis in the pelvis

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16
Q

What ages do pelvic avulsion fractures tend to occur the most?

A

adolescents ages 14-25 years

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17
Q

What are the signs and symptoms of a pelvic avulsion fracture?

A
  • sudden “pop”
  • tenderness and swelling
  • painful WB resulting in antalgic gait
  • associated bruising
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18
Q

What determines the treatment of pelvic avulsion fractures?

A

the degree of widening and displacement of the apophysis:

  • less than 2 cm = conservative
  • greater than 2 cm = surgical ORIF
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19
Q

Describe conservative treatment for pelvic avulsion fractures

A

relative rest from activity for 3 weeks followed by focus on regaining ROM, short course of muscle strengthening, followed by return to sport activities around 6-8 weeks

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20
Q

What is snapping hip syndrome characterized by?

A

audible and/or palpable “popping” of the hip caused by tendons moving over bony prominences

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21
Q

In what type of athletes is snapping hip syndrome most frequently found?

A
  • performing artists
  • distance runners
  • hurdlers
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22
Q

What are the 2 classifications of snapping hip?

A
  • external

- internal

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23
Q

What causes external snapping hip syndrome?

A

the friction of the IT band and/or anterior aspect of the glute max passing over the greater trochanter

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24
Q

What are 2 other pathologies that may occur with repetitive external snapping?

A
  • trochanteric bursitis

- damage to the glute med

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25
Q

What are the characteristics of external snapping hip syndrome?

A
  • lateral hip pain and tenderness around greater trochanter

- snapping with a description of “hip dislocation”

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26
Q

True or False

True external snapping hip syndrome does not contribute to altered athletic performance

A

True

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27
Q

What causes internal snapping hip syndrome?

A

the iliposoas tendon chronically subluxes from lateral to medial while the hip is brought from a flexed, abducted, and ER position into extension with IR

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28
Q

What are the characteristics of internal snapping hip syndrome?

A

Deep, often painful and audible clunking sensation in the anterior groin
- May also report achiness in posterior buttock/SI region

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29
Q

What can help aid in the diagnosis of internal snapping hip syndrome?

A

direct pressure over the iliopsoas decreases snapping

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30
Q

What is the treatment of both external and internal snapping hip syndrome?

A
  • soft tissue techniques and stretches

- exercises to improve trunk control, stability, and LE positioning

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31
Q

What are the 2 varieties of femoral stress fractures?

A
  • compression stress along the medial aspect of the femoral neck
  • tensioning along the lateral side
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32
Q

In what type of athlete do femoral stress fractures tend to occur?

A

long distance runners (females 4x more than males)

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33
Q

What causes femoral acetabular impingement (FAI)?

A

Abutment and approximation of the femoral head or neck with the acetabular ring

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34
Q

What are the 2 types of lesions FAI can result from?

A
  • Cam lesion

- pincer lesion

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35
Q

What are Cam lesions a result of?

A

abnormally shaped femoral head repeatedly impinging on the acetabulum

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36
Q

Cam lesions result in lesions to what aspect of the acetabulum?

A

anterior superior

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37
Q

What are pincer lesions a result of?

A

excessive coverage of the acetabular rim, resulting in abutment of the femoral head and neck when the hip is flexed

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38
Q

Pincer lesions result in lesions to what aspect of the acetabulum?

A

posterior inferior

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39
Q

Cam lesions are more common in _____ whereas pincer lesions are more common in _____.

A

males

mature females

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40
Q

What are the main complaints in patients with FAI?

A

Deep hip and groin pain in the shape of a “C” that is aggravated with long periods of sitting as well as athletic activity

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41
Q

How is anterior hip impingement tested for?

A

hip flexion and IR

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42
Q

How is posteroinferior hip impingement tested for?

A

hip extension and ER

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43
Q

True or False

Labral tears most often need surgical repair

A

True

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44
Q

What exercises should be avoided in the early phases of labral repair rehab?

A

anterior hip

  • SLR
  • situps
  • lunges
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45
Q

A torn labral early in life often times leads to earlier what in adults?

A

THA

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46
Q

Why are muscle strains not common in young athletes?

A

Because they tend to incur more apophyseal avulsion injuries instead

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47
Q

What are the 3 most common muscle strains to the hip and thigh?

A
  • adductor
  • flexor
  • hamstring
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48
Q

What are the 3 classifications of muscle strains?

A

1) minimal muscle damage
2) moderate amount of microtears
3) complete muscle rupture

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49
Q

Describe the conservative treatment of muscle strains (1 and 2)

A

PRICE (protection, rest, ice, compression, elevation)

  • avoid muscle stretching
  • pain free ROM activities to the associated joint segments
  • eccentric muscle training
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50
Q

True or False

Corticosteroid injections are used as a treatment intervention in the adolescent athlete with a muscle strain

A

False

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51
Q

In what direction do the majority of hip dislocations occur?

A

posterior

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52
Q

What is the protocol for traumatic hip disloctions?

A

splinting and prompt transport to a medical facility

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53
Q

How long after hip dislocation will an athlete be NWB?

A

6 weeks

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54
Q

How long after hip dislocation can an athlete begin hip mobility and strengthening?

A

12 weeks

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55
Q

What is Slipped capital femoral epiphysis (SCFE)?

A

Posterior slippage of the proximal epiphysis

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56
Q

In what patient population is SCFE most common?

A

boys around the age of 11 with a high BMI

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57
Q

What are the symptoms of SCFE?

A

insidious pain that was gradual in onset to the groin, thigh, or medial knee that increases with physical activity

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58
Q

What are 2 clinical signs that are indicative of SCFE?

A
  • resting LE in extension, adduction, and ER

- significant limp

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59
Q

What is the treatment of SCFE?

A

surgery

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60
Q

How long is a child NWB following SCFE repair surgery?

A

8-12 weeks

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61
Q

What is the PT intervention strategy for SCFE?

A

maximize ROM, muscle strength and endurance, balance, and proprioception

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62
Q

What is Legg-Calve-Perthes disease?

A

Idiopathic osteonecrosis of the capital epiphysis of the femoral head presenting in males 4 to 8 years old

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63
Q

What are the clinical signs and symptoms of Legg-Calve-Perthes disease?

A
  • insidious onset of limp usually without any associated pain
  • limitations in hip IR and abduction
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64
Q

What are the primary goals of LCP treatment?

A
  • maintenance of hip mobility
  • decreased pain with WB
  • containment of femoral epiphysis within acetabulum
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65
Q

What is the major difference between treatment approaches for SCFE and LCP?

A 
SCFE = surgery
Legg-Calve-Perthes = conservative
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66
Q

Describe the typical protocol following ACL repair

A
  • open-chain knee extension within 40-90 degrees for the first 8-10 weeks
  • progression to jogging and B jumping around 3-4 months
  • Return to sport 6-12 months
67
Q

Describe the 3 grades of MCL sprains

A

1) pain with stress testing without associated joint laxity
2) pain with stress testing with increased joint excursion; presence of distinct end point
3) complete ligament disruption with excessive excursion; no distinct end point

68
Q

A return to sport can be expected to occur - weeks following a grade 1 MCL sprain, - weeks following grade 2, and - weeks in grade 3

A

1-3

4-6

9-12

69
Q

Most meniscal injuries in children younger than age 10 occur in the setting of a congenital malformation known as what?

A

discoid meniscus

70
Q

Do discoid menisci tend to occur most commonly in the medial or lateral menisci?

A

lateral

71
Q

Describe the rehab process following repair of the meniscus in a child

A
  • NWB or PWB for 4-6 weeks with the use of a hinged brace to limited knee ROM to 0-90 degrees
  • address deficits in strength, coordination, and limb control
  • return to sport 3-4 months post-op
72
Q

What is an OCD lesion of the knee?

A

a condition in which damage to the subchondral bone causes secondary damage to the overlying articular cartilage

73
Q

What is the most commonly affected site within the knee?

A

lateral aspect of the medial femoral condyle

74
Q

What is the major complaint of a knee OCD lesion?

A

anterior knee pain

75
Q

Describe conservative treatment for a stable OCD lesion

A

NWB with the knee immobilized for 6-8 weeks

Return to sport around 3 months

76
Q

Return to sport is expected at - months following surgery to repair an unstable OCD lesion

A

6-9

77
Q

What are 3 differentials for an OCD lesion?

A
  • patellofemoral pain
  • chondromalacia
  • plica syndrome
78
Q

What are most acute patellar dislocations and associated osteochondral fractures caused by?

A

planting or twisting maneuvers

79
Q

Describe treatment if there is no osteochondral damage noted

A

immobilization for 4 weeks followed by progressive ROM and rehab

80
Q

Where do osteochondral fractures typically occur with an acute patella dislocation?

A

medial patella facet and/or lateral femoral condyle

81
Q

Describe treatment if there is no osteochondral damage noted

A

Surgery followed by a period of protective WB (dependent upon damage) and a return to sport within 4-6 months

82
Q

What are 5 commonly encountered diagnoses that cuase anterior knee pain due to overuse?

A
  • patellofemoral pain syndrome
  • Osgood-Schlatter disease
  • Sinding-Larsen-Johansson disease
  • inflamed synovial plica
  • patella tendinopathy
83
Q

What is the most common cause of all knee overuse injuries?

A

patellofemoral pain syndrome

84
Q

What causes patellofemoral pain syndrome?

A

biomechanical alterations in LE function resulting in abnormal stress across the patellofemoral joint and tissue overload

85
Q

What is the main complaint of PFPS?

A

Dull ache from underneath or around the patella that increases with squatting, stairs, running, and prolonged sitting

86
Q

What is the major proximal factor that may contributes to PFPS that should be part of the focus of treatment?

A

glute med and max strength and neuromuscular control during CKC

87
Q

What are 2 distal factors that may contribute to PFPS that should be part of the focus of treatment?

A
  • excessive foot pronation

- limited ankle dorsiflexion

88
Q

Where does Osgood-Schlatter disease represent injury at?

A

tibial tubercle

89
Q

Where does Sinding-Larsen-Johansson disease represent injury at?

A

inferior pole of the patella

90
Q

What is the focus of treatment for both Osgood-Schlatter and Sinding-Larsen-Johansson disease?

A
  • rest
  • NSAIDs
  • normalizing LE flexibility (esp quads and hamstrings)
  • strengthing of quads, adductors, and ERs
91
Q

In what patient population does patellar tendinopathy develop?

A

Older adolescents with fused growth plates

92
Q

What is patellar tendinopathy aka?

A

jumper’s knee

93
Q

Describe treatment for patellar tendinopathy

A
  • rest
  • eccentric strengthening
  • stretching of quads and hamstrings
94
Q

What are plicae?

A

bands of tissue in the synovial lining of the knee that arise from remnants of embryologic knee development

95
Q

When does a plica become symptomatic?

A

when it rubs across the medial femoral condyle

96
Q

What plica is most commonly symptomatic?

A

medial

97
Q

What is the plica usually felt as?

A

A painful, taught band, running from the medial patella to the medial femoral condyle

98
Q

Describe treatment for plica syndrome

A
  • activity modification
  • inflammation control
  • flexibility restoration
  • pain free strengthening
  • dynamic limb control
99
Q

What is the generic term to describe pain to the lower leg?

A

shin splints

100
Q

What are 3 differential diagnoses for lower leg pain?

A
  • medial tibial stress syndrome
  • tibial stress fracture
  • compartment syndrome
101
Q

What is medial tibial stress syndrome characterized by?

A

pain and inflammation along the anteromedial plane of the distal to central 1/3 of the tibia with running and jumping activities

102
Q

What causes medial tibial stress syndrome?

A

high, repetitive loads and rapid foot pronation

103
Q

What are 7 contributing factors to MTSS?

A
  • decreased hip IR ROM
  • excessive PF ROM
  • excessive midfoot mobility
  • poor shock attenuation
  • rapid changes in exercise intensity
  • weakness or imbalance about the lower leg
  • high BMI
104
Q

What is the suggested treatment for MTSS?

A
  • active rest (low impact activities)
  • ice
  • compression/taping
  • NSAIDs
  • flexibility and strengthening of lower leg musculature (focus on gastrocsoleus complex)
105
Q

How long is the return to sport following MTSS?

A

6-8 weeks

106
Q

What causes tibial stress fractures?

A

repetitive bony overload and the inability to meet the demands of the levels of force

107
Q

What are 5 contributing factors to tibial stress fractures?

A
  • improper training regimens
  • poor bone health
  • high BMI
  • abnormally high or low arches
  • excessive foot pronation
108
Q

What running characteristics lead to a high incidence of tibial stress fractures?

A
  • high vertical loading rates
  • heel striking at ground contact
  • increased step length
  • decreased cadence
  • high tibial acceleration
109
Q

What are the signs and symptoms of tibial stress fractures?

A

localized, acute, and sharp pain on the tibial surface along with palpable thickening usually along the central to upper 1/3 of the tibia

110
Q

What is the treatment option for acute compartment syndrome?

A

fasciotomy

111
Q

In what patient population is chronic exertional compartment syndrome or exercise-induced compartment syndrome common in?

A

long distance runners

112
Q

Why does exercise induced compartment syndrome occur?

A

Because the containing fascia is unable to expand, thereby constricting blood flow resulting in ischemia

113
Q

What compartments of the leg are most commonly affected by compartment syndrome?

A

anterior and lateral

114
Q

What are the signs and symptoms in an athlete with chronic exertional compartment syndrome (CECS)?

A

aching pain, tightness, and squeezing sensations about the lower leg in the distribution of the affected compartment

115
Q

What is the treatment for CECS?

A

alteration of running mechanics along with pain relief strategies

116
Q

The ankle is the most common site for athletic injuries, accounting for __-__% of all musculoskeletal injuries

A

20-30

117
Q

What motions occur at the talocrural joint?

A

DF and PF

118
Q

What motions occur at the subtalar joint?

A

inversion and eversion

119
Q

Ankle supination is a combination of what motions?

A

PF, inversion, and adduction

120
Q

Ankle pronation is a combination of what motions?

A

DF, eversion, and abduction

121
Q

85% of ankle pathology is due to what?

A

acute ankle sprain (lateral most often)

122
Q

What is a high ankle sprain aka?

A

syndesmotic sprain

123
Q

What causes a high ankle sprain?

A

forced eversion and ER of the ankle causing widening of the distal tib-fib joint

124
Q

What are the signs and symptoms of an ankle sprain?

A
  • patient reports a distinct injury with a sudden “pop”
  • unable to continue activity
  • pain, swelling, and ecchymosis throughout the ankle and into the foot and toes
  • limited and painful WB
125
Q

What is treatment for an ankle sprain?

A

PRICE (protection, rest, ice, compression, and elevation)

  • a few days of rest and immobilization due to pain
  • early joint mobility and weight bearing has been shown to be more favorable for functional return (begin DF and PF movements first followed by inversion and eversion movements)
126
Q

When do ankle fractures in sports tend to occur?

A

with deceleration or rotational forces about a fixed foot

127
Q

In children under 12 years with an immature skeletal system, a physeal fracture of the distal fibula is highly probable with what type of injury?

A

lateral ankle sprain

128
Q

What are the signs of a ankle fracture?

A

pain on palpation over the physeal growth plate (1 finger width above distal portion of lateral malleolus)
Ottawa Ankle Rules
- bone tenderness at posterior edge or tip of lateral malleolus
- bone tenderness at posterior edge or tip of medial malleolus
- inability to bear weight both immediately and in ER

129
Q

What is the treatment for an ankle fracture?

A

cast immobilization for 3 weeks followed by rehab similar to that of a lateral ankle sprain

130
Q

Ottawa ankle rules have been shown to be sensitive in detecting fractures to the foot in children over 5 years of age, what are they?

A
  • bone tenderness at posterior edge or tip of lateral malleolus
  • bone tenderness at posterior edge or tip of medial malleolus
  • inability to bear weight both immediately and in ER
131
Q

What is a triplane fracture?

A

an ankle fracture that occurs in older children ages 15-17 in 3 planes (coronal, sagittal, and transverse) due to partially closed growth plates

132
Q

What is a Tillaux fracture?

A

a Salter-Harris type III fracture of the unfused anterolateral segment of the distal tibia epiphysis caused by avulsion of the epiphyseal segment of the AFTL

133
Q

Where is pain experienced in a Tillaux fracture?

A

anterior lateral aspect of the foot

134
Q

What is the treatment protocol following a triplane of Tillaux fracture?

A
  • NWB for 3-4 weeks
  • short leg cast for 3-4 weeks
  • PT to restore normal strength and mobility
135
Q

When should you suspect a osteochondral fracture of the talar dome?

A

when there is persisten pain following a sprain with continued edema and intermittent clicking or locking

136
Q

What are the treatment methods of an osteochondral fracture of the talar dome?

A
  • conservative:
    casting and orthotic intervention
  • surgery to remove loose body
137
Q

Ankle _____ can be the source of anterior, antereolateral, or posterior ankle pain

A

impingement

138
Q

What causes ankle impingement?

A

the formation of an osteophyte on the distal tibia due to abnormal ankle mechanics

139
Q

What are the symptoms of ankle impingement?

A

Pain between the fibula and the lateral talus, within the sinus tarsi, or AFTL

140
Q

What is the treatment of ankle impingement?

A
  • rest
  • NSAIDs
  • bracing
  • joint mobilization
  • possible arthroscopic debridement
141
Q

What 2 overuse foot injures are often more frequent in the skeletally mature athlete?

A

tendonitis and plantar fasciitis

142
Q

In the skeletally immature athlete, atraumatic pain along the posterior calcaneus is likely due to what?

A

Sever’s Disease

143
Q

Describe what Sever’s disease is

A

a traction apophysitis of the calcaneus at the site of the attachment of the Achilles tendon, plantar fascia, and intrinsic muscles of the foot

144
Q

What are the symptoms of Sever’s disease?

A
  • pain along the heel that increase during sports such as soccer, gymnastics, and basketball with repetitive running and jumping (pain is usually bilateral)
  • muscles length restrictions to triceps surae muscle complex
  • excessive foot pronation
  • possible swelling
145
Q

What is the treatment for Sever’s disease?

A
  • pain control modalities
  • continuation of sports activities if tolerable
  • restore flexibility and length to impaired musculature
  • strengthening of calf and foot muscles
  • gel heel lift to unload Achilles
146
Q

What is Iselin’s disease?

A

A traction apophysitis to the proximal fifth metatarsal (insertion of peroneus brevis muscle)

147
Q

What are the symptoms of Iselin’s disease?

A
  • pain and swelling over the proximal 5th metatarsal
  • pain with WB
  • pain with resisted eversion
148
Q

What is the treatment for Iselin’s disease?

A

Rest and flexibility activities to the evertors and PFs

149
Q

A Lisfranc injury is an injury to what joint?

A

Tarsometatarsal joint

150
Q

What causes a Lisfranc injury in sports?

A

a low-energy axial load on a plantarflexed foot with the knee anchored on the ground

151
Q

What are the symptoms of a Lisfranc injury?

A
  • pain on the dorsum of the foot
  • forefoot edema and bruising along the plantar arch
  • weightbearing is painful and increases when asked to stand on tiptoes
  • tenderness upon palpation along the tarsometatarsal joints
  • gapping between the hallux and 2nd toe
152
Q

How are Lisfranc injuries treated?

A

conservatively with the athlete immobilized with a CAM walking boot for 6-10 weeks and allowed to WB according to pain tolerance

153
Q

How long does complete recovery take in a Lisfranc injury?

A

4 months, and some may not be able to return to sport

154
Q

What is tarsal coalition?

A

a congenital malformation where two or more tarsal bones are fused

155
Q

What are the symptoms of tarsal coalition?

A
  • restricted midfoot mobility
  • pain with cutting, pivoting, running
  • history of recurrent, chronic ankle sprains
156
Q

What is the treatment for tarsal coalition?

A

directed at controlling foot motion to decrease stresses about the fusing joints

157
Q

What is an os navicular secundum?

A

a congenital formation of a small ossicle next to the navicular or within the tibialis posterior tendon

158
Q

What metatarsal is the most commonly fractured in children?

A

5th

159
Q

What are the Ottawa foot rules?

A
  • bone tenderness at the base of the 5th metatarsal
  • bone tenderness at the navicular
  • inability to bear weight both immediately an in ER
160
Q

What is a Jones fracture?

A

a fracture of the proximal diaphysis of the fifth metatarsal

161
Q

What is turf toe?

A

Hyperextension injury to the first MTP, resulting in damage to the plantar capsuloligamentous structures

162
Q

What are the symptoms of turf toe?

A

pain along the plantar surface of the toe along with possible bruising and swelling
- pain is replicated with active or passive great tow extension

163
Q

What is the treatment for turf toe?

A

PRICE

- early mobility is key to avoid hallux rigidus

731: Pediatrics (19 decks)

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