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Injuries in Sport > MSK Injuries in Children and Adolescents > Flashcards

MSK Injuries in Children and Adolescents Flashcards

1
Q

Anatomical differences vs adults

A 
Epiphyseal plates and its junctions
Growth spurts 
Bone malleability
Apophysites
Articular cartilage
Muscle development
Frequency and variety of sports
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2
Q

Relevance of epiphysis

A

Epiphyseal plates in growing skeleton

site of weakness not seen in adults; susceptible to sheer forces

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3
Q

Relevance of metaphysis

A

Softer part of bone
bone malleability => absorbs greater energy => less brittle
more susceptible to fractures
most common = Greenstick

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4
Q

Relevance of diaphysis

A

main section of long bone made up of cortical bone

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5
Q

Growth plates and Growth spurts

A

Growth plates = between epiphyses and metaphysis - fracture lines

Growth spurts are a result of the changes in the balance of bone and muscle causing altered biomechanics, co-ordination and energy levels

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6
Q

Apophysites (function and relevance)

A

Boney attachment sites of muscle tendon

in maturing skeleton => area of weakness because bone is softer

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7
Q

Apophysites examples of the pelvis

A

ASIS - sartorius
AIIS - rectus femoris
PUBIC SYMPHYSIS - rectus abdominus via ing ligament
ILIAC CREST - gluteals, Tensor fascia latae
ISCHIAL TUBEROSITY - adductor magnus, biceps femoris, semitendinosus, semimembranosus
GREATER TROCHANTER - gluteus medius and minimus
LESSER TROCHANTER - psoas/iliacus

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8
Q

Features of articular cartilage in kids

A

thicker and greater ability to remodel

thus more likely to get osteochondritis diseccans; blood supply more easily modified

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9
Q

Factors of joint stability

A

muscle development
ligament laxity
core stability

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10
Q

Principles of Management of Sporting child

A

Manage physiological processes
identify causes and emphasise rehabilitation based on this
address biomechanics

do not forget

  • inflammatory conditions and other medical conditions
  • cardiovascular changes
  • nutrition
  • psychosocial factors
  • environmental factors; greater body SA
  • autonomy, beneficence, confidentiality, do not harm, equity
  • player development
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11
Q

Growth plate fractures

A

Salter harris classification (5 types)
can be complicated
Rx depends on type
healing depends on severity, age, which growth plate and type

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12
Q

Salter Harris Classification

A

Type I - straight through growth plate
Type II - extends through metaphysis (chip)
Type III - extends through epiphysis (T shaped)
Type IV - through both epiphysis and metaphysis
Type V - compression fracture

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13
Q

Greenstick fracture

A

one side broken and other is bent
reduced
casted for 6 wks
usually in metaphysis

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14
Q

Buckle fracture

A

‘torus’ fracture
FOOSH - fallen on outstretched hand
incomplete fracture of one side buckles without disrupting the other side
5-11yo

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15
Q

Groin pain in football

A

4th most common injury affecting footballers (10%)
3rd longest absence from sport
incorporates abdo, adductors, lumbar spine and SIJ, hip
Sx - pain in lower abdo, groin and testicles; weakness; running/cutting/side-steps, sit ups, coughing/sneezing

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16
Q

Groin pain in football - Mechanism of injury

A
  • torque with opposing forces
  • stronger leg muscles compared to abdominals
  • conjoint tendon pulls up and rotates the trunk
  • adductor pulls down and rotates upper leg
  • opposing forces disruption of muscles at their insertion
17
Q

Avascular necrosis of the hip

A

disrupted blood supply to neck of the femur due to damage to joint => collapse flattening of femoral head
pain on WB

Ax - NOF fracture (apophyseal injury), dislocation, ETOH, systemic cortisone
Ix - XR, Bone scan, MRI
Rx - conservative or surgical if needed (decompressing)

18
Q

Perthe’s disease

A

Rare childhood disease of femur
temporarily disrupted blood supply to head of femur
during revascularisation the bone is soft => painful hip, limp
boys, 5-12yo

Dx - XR, bone scan, MRI

19
Q

Slipped Upper Femoral Epiphysis

A

Traumatic cause of hip and groin pain
weakness of growth plates causes posterior translation of femoral head during periods of accelerated growth
develops gradually - pain, stiffness, instability
antalgic gait, leg short, ER
boys, pre-teens and teens

20
Q

Spondylolysis

A

Defect in pars interarticularis due to hyperextension
most common in L4-L5 and L5-S1
6% of general population and 50% of athletic back pain
daily activity-related pain and rest pain
ask about: morning stiffness, multiple joint pain/swelling, night pain, neuro Sx, systemic Sx

O/E - ROM, Stork test, Fitch-catch (variation of stork with rotation), palpation, leg length, SLR, Slump test
Ix - XR, SPECT, CT, MRI
Rx - relative rest, analgesia, rehab [core, hamstring stretch, flexion activities, aerobic fitness, sports-specific], bracing

21
Q

Other causes of back pathology in young athletes

A 
spondylolisthesis
lumbrosacral sprain
scoliosis 
scheuermann's
osteomyelitis
congenital abnormalities
ankylosing spondylitis
juvenile RA
malignancy
22
Q

Traction apophysitis

A

Inflammation of tendinous attachment site
potential avulsion fractures

  • Osgood Schlatters (patella)
  • Sever’s diseases (achilles)
  • Sinding Larsen Johansson (inf. pole patella)
  • Little league elbow ( med. epicondyle; wrist flex)
  • Iselin (5th metatarsal; peroneus brevis

Mx - relative rest, Rx inflammation, address biomechanical factors, improve movement patterns

23
Q

Osgood Schlatters

A

Inflammation of the patella tendon insertion at the tibial tubercule
TOP and protruted tib tubercule, pain on resisted knee extension/ squatting and on passive knee flexion, restricted hams flexibility
BIOMECH - Poor quads and hams flexibility, growth spurt, increased q angle, patella alta, ovepronated feet, knee valgus
Boys - due to q angle and type of sports; related to running and jumping
associated with growth and load

24
Q

Severs Disease

A

Inflammation of achilles tendon insertion on the calcaneous growth plate
TOP calcaneal growth plate, pain and restriction on DF, pain on resisted PF/calf raise
BIOMECH - overprontation/ valgus at the ankle, stiff forefoot

25
Q

Patello-femoral instability (Joint laxity)

A 
Younger population
Mechanism 
- patellar alignment
- lateral pull vs medial
- subluxation = partial loss
- dislocation = complete loss of congruity

BIOMECH - shallow femoral trochlea, hypoplastic lateral femoral condyle, patella shape, patella altam poor VMO strength

Rx - XR and ortho review, +/- brace, progressive knee flexion, strengthening VMO whilst limiting tension of lat structures

26
Q

Patella Dislocation

A

Most commonly one of the medial structures fails and patella moves laterally
medial patella femoral ligament detaches at femoral attachment
avulsion fracture at chondro-osseous junction

27
Q

Patellofemoral dislocation Protocol

A

W1 - knee extension brace + crutches, RICE, statuc quads, gluteal, grastroc strengthening
W2 - Same but no crutches + bilateral calf raises
W3 - No brace. No AROM exercises, but statuc. Bilat squats 30degrees. SL balance
W4 - SL calf raises. Static proprioception. Standing hip theraband strengthening
W5 - AROM exercises to 90 in supine. BL squats 45 degrees. Step ups. Static proprioception + wobble board. Hamstring bridging. Glut med strengthening
W6 - SL Squat to 45 degrees (rest same as W5)
W7 - Start bike. SL squat to 60
W8 - X-trainer. pool running. Fwds/bwds 1/2 lunges. Squats to 75 degrees
W9 - Start Trampette running. Progress to mat running. Fwds/bwds lunges
W10 - Running, keep ups, 1-2 volleys, technical volleys, accelerations
W11 - Slalom running, increase speed and CoD, dribble with ball , passing 5-10M
W12 - Increase technical sessions
W13 - Train 3x45 mins, no game
W14 - Train 3x60 mins, no game
W15 - Train 3x75 mins, game 45mins

28
Q

Osteochondritis Dissecans

A

Separation of articular cartilage from subchondral bone
85% on medial femoral condyle posteriorly

RF - trauma (50%), M, Overuse, familial (10%), ligamentous weakness, genu valgum/varus, meniscal lesions in the knee

Sx - Vague Hx of pain, effusion, locking (loose body), wilson sign (pain at 30degree flexion and IR of knee) children usually full ROM, tender joint line

Ix - XR (weight bearing , tunnel view), MRI (size of lesion, loose bodies)

Prognosis better if younger, on medial side, no synovial fluid on MRI

29
Q

Osteochondritis Dissecans - Stages

A

STAGE 1 - Depressed OD; intact cartilage, small area
STAGE 2 - Partially detached OD
STAGE 3 - Completely detached OD but not displaced; most common
STAGE 4 - Completely detached OD but displaced; avascular fragment = loose body

30
Q

Injury Prevention Concepts

A
  1. Anthropometric Measurements
  2. Load management (FITT principle)
  3. Generic warm up
  4. Functional movement screening (7 fundamental movement patterns)
  5. Injury prevention exercise programmes (strengthening and recovery)
31
Q

Recommended daily activity for 1-5yo

A

> = 180mins /d

32
Q

Recommended daily activity for 5-18yo

A

> =60mins/ d spread across the week

33
Q

Normal lower limb variants

A

Newborn = Genu varum
1.5-2 yo = Straight
3-8 yo = Genu valgum (knock knees)
>6-8 yo = Straight

34
Q

Transverse Plane Deformities of Hip

A 
Normal = 12-15 degrees
Retroversion = <12
Anteroversion = >15

Injuries in Sport (13 decks)

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