MSK Injuries in Children and Adolescents Flashcards
(91 cards)
1
Q
Age 12-15 boys
A
Second growth spurt
Excessive stress on musculoskeletal system that isn’t present in mature skeleton
2
Q
Dominant biological process first 20 years of life
A
Growth
3
Q
Difference between child and mature adult
A
Epiphyseal plates Growth spurts Bone malleability Apophysites Articular cartilage Muscle development Frequency and variety fo sport
4
Q
Epiphysis
A
End of bone
Covered in articular cartilage
5
Q
Metaphysis
A
Adjacent to epiphyseal plate
Undergoes growth in adolescents
Softer
6
Q
Diaphysis
A
Shaft of long bone
7
Q
Epiphyseal plates
A
Developing skeleton
Site of weakness
Susceptible to sheer forces- are of bone weaker
8
Q
Epiphyseal plates + growth
A
Growth occurs and forms cell matrix
Then calcifies to become skeletal bone
9
Q
Growth spurts
A
Changes in balance between bone and muscle length
Change in coordination + biomechanics
Effect on energy levels
10
Q
How do kids grow
A
Bone length changes
Soft tissue adapts to that
11
Q
Bone malleability
A
Metaphysis of bone is softer
Absorbs greater energy
Bones less brittle- less likely to shatter
Less dense and more porous bone
12
Q
Bone in adolescents properties
A
Less brittle
Less dense
More porous
Susceptible to diff. form of fractures e.g. greenstick
13
Q
Apophysite
A
Bony attachment site of a tendon
14
Q
Pelvic apophysites
A
Iliac crest ASIS AIIS G. Troc L. Troc Ischial Tub Pubic symph
15
Q
Iliac crest is attachment site of
A
Gluteals
TFL
16
Q
ASIS is attachment site of
A
Sartorius
17
Q
AIIS is attachment site of
A
Rec Fem
18
Q
G. Troc is attachment site of
A
Glute Med/Min
19
Q
L. Troc is attachment site of
A
Psoas/Iliacus
20
Q
Ischial Tub is attachment site of
A
Add magnus
Biceps femoris
Semi tend
Semi memb
21
Q
Pubic Symph is attachment site of
A
Rectus abdominus via inguinal ligament
22
Q
Apophysitis
A
Inflammation of tendon attachment onto bone
Mature skeleton- area of weakness in bone itself not the MTU
23
Q
Articular cartilage is
A
Site of development and remodelling of adolescent bone
Thicker than in adults
Greater ability to remodel
24
Q
Articular cartilage remodelling
A
Can be damaged more easily
Thicker and less mature
But has a chance to mature
25
Articular Cartilage layers (top to bottom)
Articular surface
Superficial Tangential Zone (10-20%)
Middle Zone (40-60%)
Deep Zone (30%)
26
Osteochondritis Dessicans (OCD)
When blood supply is cut off
Cartilage starts to degenerate
More common in children
Damage can be caused by trauma or overuse
27
Joint stability
Lower in developing skeleton
Less muscle development
More ligament laxity- incomplete cross bridge formation
Less core stability
28
Inflammatory Conditions
```
Juvenile RA/SLE
Reactive arthritis
hx
Ex
Bloods
Urine
Joint aspiration
Management
```
29
Cardiovascular changes- compared to fully mature athlete
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Lower systolic BP
Lower SV
Increased maximal HR
Lower cardiac output
Increased RR
Less anaerobic power
Screening
```
30
Environmental changes
```
greater body SA to mass
Lower sweating rate
More skin SA to gain/lose heat
Rate of heat acclimatisation lower
Problems in hot and cold environments
More regular drinks breaks, subs waiting inside
```
31
Ethics
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Autonomy
Beneficence
Confidentiality
Do no harm
Equity
```
32
Important conditions
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Fractures
Hip + groin complaints
Back pathology
Traction apophysitis
Joint instability
```
33
Growth plate fracture
Salter-Harris classification
Treatment depends on type
Can be complicated
34
Growth plate fracture healing
```
Depends on:
severity
age
which growth plate
type
```
35
SALTER stands for
```
S- straight across
A- above
L- lower
TE- through everything
R- cRush
```
36
Salter Harris classification
```
1-5
All are complicated
Type 5 worst
GP effect--> affects growth
e.g. leg length discrepancy
GP can become inactive
```
37
Type 1
A complete physeal fracture with or without displacement
38
Type 1 treatment
Rarely will have to be put back in place
| Normally just need a cast- all things still intact- unless damage to blood supply, should grow normally once healed
39
Type 2
A physeal fracture that extends through the metaphysis, producing a chip fracture of the metaphysis, which may be very small
40
Type 2 treatment
Most common
| Typically have to be put back in place surgically and immobilised to allow growth to continue
41
Type 3
A physeal fracture that extends through the epiphysis
42
Type 3 treatment
Occurs rarely
Usually lower end of tibia
Surgery sometimes necessary
Outlook/prognosis for growth is good if blood supply to separated bit still intact
43
Type 4
A physeal fracture plus epiphyseal and metaphyseal fractures
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Type 4 treatment
Surgery needed to restore bone back and perfectly align growth plate
If not perfect alignment achieved when placed back or during growth, prognosis for growth is poor
45
Type 5
A compression fracture of the growth plate
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Type 5 treatment
Uncommon
Occurs when bone is crushed
Prognosis poor
Growth likely to be stunted in that portion only --> biomechanical imbalances
47
Greenstick Fracture
One side broken, one side bent- like breaking branch
Reduced
Casted 6 weeks
Usually occur in metaphysis
48
Buckle fracture
```
'Torus' fracture
Incomplete fracture as one side of bone
Buckles without disrupting other side --> outside intact, inside fractured
5-11 years
FOOSH
Pain that lasts couple of hours, child doesn't want to use arm
Quicker healing time
3 week cast
```
49
Hip/groin pain
```
Traumatic
Apophyseal injuries
Avascular necrosis of hip
Perthe's diseases
Slipped upper femoral epiphysis
Most common boys 5-12
4th most common injury affecting footballers
3rd longest absence from sport (after fracture + ACL injury)
```
50
Hip/groin pain mechanism of injury
Torque/twisting with opposing forces
Conjoint tendon pulls up and rotates trunk
Adductor pulls down and rotates upper leg
Opposing forces disruption of muscles at their insertion
Imbalance between weak abdominal muscles in relation to strong leg muscles
51
Perthe's disease
Reduced circulation to femoral head and vitamin deficiencies affecting bone formation and development
Avascular necrosis
During revascularisation bone is soft
52
Perthe's disease epidemiology
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Boys
5-12
Painful hip
Limp
X ray/bone scan/MRI
```
53
Perthe's disease x ray reasoning
Hip pain + limp + under 18
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Slipped Upper Femoral Epiphysis (SUFE)
Femoral head slips posteriorly
| Due to weakness of growth plate- sheer force across GP
55
SUFE Epidemiology
During periods of accelerated growth
Antalgic gait/limb
Leg short and externally rotated
Surgery
56
Avascular necrosis of hip
Ball/socket joint
Articular cartilage
Damage --> collapse/flattening of femoral head
blood supply is through neck of femur, so is shut off
57
Avascular necrosis of hip causes
NOF
Dislocation
ETOH
systemic cortisone
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Avascular necrosis of hip symptoms
```
Pain on weightbearing
Pain- lower abdo, groin, testicle
Weakness
running/cutting/side-steps
Sit ups
Coughing/sneezing
```
59
Avascular necrosis treatment
Conservative
| Surgical-decompressing femoral head
60
Blood supply age 8-10 head of femur
The artery to head of femur (goes through ligament to head of femur/teres) is lost and the medial femoral circumflex takes over
61
Back pain in young athletes
```
Spondylolysis
Spondylolisthesis
Lumbosacral sprain
Scoliosis
Scheuermann's disease
Osteomyelitis
Congenital abnormalities
Ankylosing spondylitis
Juvenile RA
Malignancy
```
62
Spondylolysis
Defect on pars interarticularis
6% general pop
50% sporting back pain
Repetitive hyperextension
63
Spondylolysis occurs commonly in
L4/5 or L5/S1
64
Spondylolysis history
Sport related pain
Can also be asymptomatic, and found incidentally on imaging
Football, cricket bowlers, gymnastics, weightlifting
Daily activity related pain
Rest pain
65
Spondylolysis history also ask
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Morning stiffness
Multiple joint pain/swelling
Night pain
Neuro symptoms
Systemic symptoms
```
66
Spondylolysis examination
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Observation
SIF
ROM
Pain on lumbar extension, single leg extension or extension combined with rotation
Slump test
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67
Spondylolysis investigations
X ray- AP, lat, oblique
SPECT
CT
MRI
68
Spondylolysis treaatment
Relative rest from extension or aggravating activities
Analgesia
Rehab- core, flexion activities, hamstring stretches, aerobic fitness, sports specific
Bracing
69
Traction Apophysitis'
Inflammation of site of tendinous attachment
70
Traction Apophysitis' examples (overuse injuries)
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Osgood Schlatters
Severs
Sinding Larsen Johansson
Little league elbow
Iselins
```
71
Severs
Calcaneum
| Achilles tendon
72
Sinding Larsen Johansson
Inf. pole patella
| Patella tendon
73
Little league elbow
Med. epicondyle
| Wrist flexors
74
Iselins
5th metatarsal
| Peroneus brevis
75
Avulsion fractures
Bone v soft
| Avulsion fracture
76
Osgood Schlatters
Inflammation at site of patella tendon attachment at tibial tubercle
In adults --> superior and inferior patella tendinopathy
77
Osgood Schlatters clinical findings
```
TOP tibial tubercle
Protruded tibial tubercle
Pain on resisted knee extension/squatting
Pain on passive knee flexion
Restricted hams ability
```
78
Osgood schlatters RFs
```
Biomechanical issues:
poor quads flexibility
poor hams flexibility
growth spurt
increased Q angle
patella alta
overpronated feet
knee valgum
Relationship between growth and load
```
79
Severs
Inflammation at site of calcaneal growth plate
80
Severs biomechanical factors
Overpronation/valgus at ankle
| Stiff forefoot
81
Severs clinical finding
TOP calcaneal growth plate
Pain and restriction on DF stretch
Pain on resisted PF/calf raise
82
Treatment and rehab of traction apophysitis
Rest
Treatment of inflammation
address biomechanical factors
improve movement factors
83
Patellofemoral instability
Patella will always dislocate laterally
| Joint laxity
84
Patella instability mechanism
Patellar alignment maintained by fibrous structures
Lateral pull vs medial pull
Subluxation if partial loss of patella femoral joint congruity
Dislocation is complete loss of joint congruity
85
Patella instability biomechanical RFs
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Shallow femoral trochlea
Hypoplastic lateral femoral condyle
Patella shape
Patella alta
Poor VMo strength
```
86
Patella dislocation
One of medial structures fail
Medial patella femoral ligament detached at femoral attachment, then pulled out by ITB
Avulsion fracture at chondro-osseus junction
87
Patella dislocation treatment
X ray and orthopaedic review
Brace vs no brace
progressive knee flexion
Main aims of rehab are to strengthen VMO whilst limiting tension of lateral structures
88
Osteochondritis Dissecans S and S
```
Vague history joint pain
in children normally full ROM
Effusion
Palpation of joint line will be tender
Locking/giving away may be reported
Wilson's sign
```
89
Osteochondritis dessicans
Separation of articular cartilage from subchondral bone
| Avascular fragment can result in loose body
90
RFs for OD in knee
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Trauma (50%)
Male sex
overuse due to sport
Familial 10%
ligamentous weakness
genu valgum/varum
meniscal lesions in knee
```
91
Anthropometric measurements
Height and weight measurements- 1 per month
Screen those with significant growth
Assess for growth related pathologies- moree than 1cm/month
Use to manage load
