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Flashcards in Musculoskeletal & Sports Medicine Deck (47)
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1
Q

Name 2 types of bone cysts and describe the appropriate treatment for each one.

A

Unicameral (Resolve Spontaneously) and

Aneurysmal (Surgically Removed)

Bone cysts are either fluid filled (unicameral) or blood filled (aneurysmal) within a bone. Both are noncancerous, typically solitary, and occur in children and young adults. They are either asymptomatic and found incidentally on imaging studies or symptomatic with pain, limping, or fracture due to weakened bone. Unicameral bone cysts are often observed because they resolve spontaneously. Aneurysmal bone cysts are more aggressive in growth and require surgical treatment.

2
Q

Name the differential diagnosis for hip pain in a child.

A
  • Infections
  • Tumors
  • Transient Synovitis
  • Legg-Calvé-Perthes Disease
  • Slipped Capital Femoral Epiphysis (SCFE)

Any child who presents with pain in the hip, limps, or refuses to bear weight or walk must be evaluated promptly.

3
Q

A 15-year-old female presents to the emergency department complaining of muscle cramps, nausea, dizziness, and weakness after playing volleyball at the beach all day long. Physical examination reveals dry mucous membranes, skin tenting, and rectal temperature of 101.0° F (38.3° C). The rest of the physical examination is unremarkable.

What is the likely cause of this patient’s illness?

A

Heat Illness

Heat illness occurs when the body cannot cool itself with the typical sweating mechanism. It usually occurs in hot, humid weather with strenuous activity occurring for a long period of time. Risk factors include young age, old age, illness, being overweight, alcohol consumption prior to activity, and certain medications such as stimulants. Prevention includes staying well hydrated, replenishing salt with sports drinks, and limiting time of activity.

4
Q

What steps prevent overuse injuries in child athletes?

A
  • Limit the number of teams an athlete is on in one season.
  • Do not allow an athlete to play one sport year-round.

Overuse injuries can affect bones, growth plates, and soft tissues. Due to the fact that these structures grow at an uneven rate, children are at increased risk for these types of injuries. Overuse injuries are increasing in frequency due to the competitive nature of youth sports and the year-round playing of a single sport. This puts repetitive stress on specific areas of the body without allowing for adequate rest. The main symptom is pain that is not due to an acute injury and that increases with activity. Rotation of the types of sports throughout the year allows other bones and muscle groups to be used instead of stressing the same structures for a single sport.

5
Q

What are the clinical findings associated with an anterior cruciate ligament (ACL) injury?

A
  • Knee Pain
  • Popping, Swelling
  • Difficulty Bearing Weight
  • Anterior Translation of the Tibia on the Femur

ACL tears are more common in female athletes and usually occur in sports that require jumping, sudden stops, or quick changes in direction. The most sensitive and specific test for an ACL tear is the Lachman test, which evaluates the anterior translation of the tibia on the femur. Anterior translation of the tibia, associated with a soft endpoint is indicative of a positive test. A difference of > 2 mm of anterior translation, when compared to the uninvolved knee, is diagnostic of an ACL tear, as is ≥ 10 mm of total anterior translation. Diagnosis is usually made clinically. MRI is useful to show the associated meniscus, collateral ligament injuries, and bone bruises. Surgical reconstruction is required in most cases.

6
Q

A 7-year-old boy presents with:

  • Pain in his left hip and knee
  • Limping for several days
  • Plain x-ray of the hip shows a “ratty” appearance of the left femoral head.

What is the most likely diagnosis?

A

Legg-Calvé-Perthes Disease

Legg-Calvé-Perthes disease is a partial or complete idiopathic avascular necrosis of the femoral head. It is most common in boys between 3 and 12 years of age, with a peak incidence at 5–7 years of age. In this case, tell the boy to not bear weight on the affected limb and refer him to an orthopedist. Generally, it resolves with time and does not require specific therapy.

7
Q

What are some of the clinical findings associated with the use of androgenic steroids as performance-enhancing drugs?

A

Acne, Muscle Mass Increase, Gynecomastia, Small Testicles, Hypertension, Aggressive Behavior, Inhibited Growth, Elevated Liver Enzymes, Cholestatic Jaundice

The highly competitive nature of sports today results in many athletes looking for an advantage over their opponents. Unfortunately, many of these athletes turn to performance-enhancing drugs (known as “doping”) and do not take into consideration the risks of using these substances.

8
Q

What is the proper management for the 2 types of bone cysts?

A

Unicameral: Serial Plain Films, Observation, and Fracture Prevention; Aneurysmal: Surgical Excision

Bone cysts are either fluid filled (unicameral) or blood filled (aneurysmal) within a bone. Both are noncancerous, typically solitary, and occur in children and young adults. Unicameral bone cysts are often observed with serial plain films and activity is restricted to prevent fracture. They often resolve spontaneously. Aneurysmal bone cysts are more aggressive in growth and require surgical treatment.

9
Q

A newborn is found to have the following triad:

  • Short neck
  • Limited neck motion
  • Low occipital hairline

These associated findings are noted as well:

  • Deafness
  • Macrocephaly
  • Meningocele

What is the syndrome?

A

Klippel-Feil Syndrome

Klippel-Feil syndrome occurs when there is congenital fusion of any 2 or more of the 7 cervical vertebrae. It presents with the classic triad of short neck, limited neck motion, and low occipital hairline. There are 3 types, differentiated based on the extent of vertebral column malformation. Note that fusion of C2–C3 is autosomal dominant, while C5–C6 is autosomal recessive. Deafness, macrocephaly, hydrocephalus, meningocele, and intellectual disability are common.

10
Q

What is the appropriate clinical evaluation and management of scoliosis?

A

Identify the type of scoliosis. Perform a back examination and order plain radiographs to determine the degree of curvature, which will dictate management.

Idiopathic scoliosis is the most common and is divided into 3 categories: infantile, juvenile, and adolescent. Depending on the age and sex of the child, most cases are detected by a simple back examination with forward flexion and plain radiographs. Most scoliosis cases are asymptomatic, but when the thoracic curve is > 50°, intervention may be needed due to pulmonary function abnormalities. Treatments include physical therapy, bracing, and surgery for more advanced cases.

11
Q

A 15-year-old male wants to play football at his local high school. His mother is concerned about her son getting hurt and sustaining a brain injury.

Besides a history and physical examination, what is an additional assessment now recommended for all athletes prior to participation in contact sports?

A

Computerized Neurocognitive Function Assessment

Computerized neurocognitive function assessment prior to participation in contact sports is growing in favor among athletic organizations. It is good to have this baseline cognitive assessment prior to any traumatic brain injury. Postconcussion assessments can then be compared for any changes in symptoms and/or cognition. It provides an objective comparison in order to improve return-to-play decisions.

12
Q

What is the appropriate diagnostic evaluation for developmental dysplasia of the hip (DDH) in patients of various ages?

A

> 6 Months of Age: Plain Radiographs of Both Hips

Ultrasonography of both hips is the preferred method of evaluation in infants < 4–6 months of age because the femoral head has not yet ossified and cartilage and soft tissues are better delineated on ultrasound. In older infants and children, plain hip radiographs are appropriate because the femoral heads are ossified and no longer cartilaginous.

13
Q

A 14-year-old female gymnast presents to the pediatrician’s office for an annual check-up. She states she has missed her period for several months and has lost some weight due to her strict diet. Physical examination reveals a thin, muscular female but nothing else of note. A urine pregnancy test is negative.

What condition is this gymnast likely experiencing?

A

Female Athlete Triad

The “female athlete triad” is a combination of energy deficiency (most often from disordered eating), menstural dysfunction, and decreased bone density. It is especially common in sports where a low body weight is favorable. A history of menstrual dysfunction is the earliest symptom; it should prompt you to get a detailed history of the patient’s diet and exercise. Lab work to test for pregnancy and thyroid dysfunction is usually warranted. Get a bone density study in patients with < 6 menses in 12 months and history of ≥ 2 stress fractures. Treatment requires a multidisciplinary team approach that includes the pediatrician, coach or trainer, nutritionist, and psychologist.

14
Q

A 16-year-old male basketball player has noticed a painless, enlarging mass at his right quadriceps muscle over the past several weeks. He denies fever, weight loss, night sweats, or other constitutional symptoms. He admits to getting hit a lot during his basketball activities. Physical examination reveals a fixed palpable mass in the proximal anterior right thigh but minimal tenderness to palpation. Both hip and knee joints have full range of motion.

What is the likely diagnosis for this condition?

A

Traumatic Myositis Ossificans

Traumatic myositis ossificans is characterized by extraskeletal ossification following blunt soft tissue trauma. It typically presents as a painless, enlarging mass, most often located in the quadriceps, brachialis, or deltoid muscles. The mass is typically located away from a joint and is rounded and well circumscribed. Evaluation with plain x-rays reveal mature peripheral ossification with a distinct margin surrounding a radiolucent center of immature osteoid and primitive mesenchymal tissue. This peripheral maturation is the reverse of that seen with a neoplasm. Also in neoplasm, the bony mass is always slightly separated from the long shaft of the bone.

15
Q

A 15-year-old boy presents after colliding with another player during a soccer game. He complains of knee pain, and his right knee is slightly swollen. You perform the duck walk test (patient is asked to squat down and walk like a duck), which causes reproducible pain in the medial joint line.

What is your diagnosis?

A

Meniscal Tear

Meniscal injuries are common, and tears usually occur due to twisting injuries while the foot is planted. Often symptoms are vague and nonspecific. Isolated meniscal tears usually cause localized pain and moderate effusion, whereas more diffuse pain and significant effusion occur if there is an associated injury to a cruciate ligament or a fracture. Diagnosis is made by asking the patient to do the duck walk; repeated passive knee flexion and extension with tibial internal and external rotation will produce pain and possible “clicking.” Note that x-rays of the knee are normal, but these injuries are clearly visible on MRI.

16
Q

A patient presents with knee pain and swelling. The valgus stress test shows medial instability.

What is your diagnosis?

A

Medial Collateral Ligament (MCL) Injury

MCL tears are common injuries among athletes. Such a tear occurs in contact sports when the lateral knee sustains a blow causing valgus stress or in activities that require significant torque of the leg (e.g., basketball, football, tennis). Symptoms include pain, swelling, and instability over the medial knee. Most MCL injuries can be diagnosed clinically, with tenderness to palpation over the MCL and valgus laxity with high-grade injuries. Treatment is usually nonsurgical and includes rest, ice, NSAIDs, bracing, and physical therapy.

17
Q

A 4-year-old boy presents with:

  • Bilateral thigh and calf pain that is worse in the evening and occasionally awakens him from sleep
  • No fever
  • No limping
  • No mobility problems
  • No joint involvement

What is the most likely diagnosis?

A

Growing Pains

This is the classic presentation for growing pains. The key is that this is muscle pain, not joint pain. Even though it awakens the child from sleep, it is not an unusual finding. The pain is typically worse in the afternoon or evening. There are no systemic symptoms, so there is no fever. Limping and other mobility problems are not associated with this disorder. Lab is generally not necessary, but perform it if there is something atypical about the findings to exclude possible organic etiologies before making the diagnosis of benign leg pain.

18
Q

What conditions are most commonly associated with congenital scoliosis?

A

Neuromuscular Diseases and Congenital Rib/Vertebral Anomalies

Although most cases of scoliosis are idiopathic, most of the remainder are due to neuromuscular diseases and/or congenital rib/vertebral anomalies. Cardiopulmonary compromise generally occurs if the scoliosis is severe. Ideally, congenital forms of scoliosis are diagnosed early in childhood. If found, bracing usually corrects or limits progression of the curve. Surgical intervention is often required when scoliosis is congenital or caused by neuromuscular weakness.

19
Q

What are the physical examination findings in patients with femoral anteversion?

A
  • Medial Orientation of Both the Toes and Patella When Walking
  • Increased Internal Rotation with Decreased External Rotation Bilaterally of the Hips (Patient Lying Prone with Knees Bent)

Femoral anteversion is due to medial rotation of the femur and presents in preschool-aged children (3–6 years of age). These children find the “W” sitting position comfortable. Most cases spontaneously resolve by 11 years of age; surgery is reserved for severe cases that interfere with ambulation.

20
Q

What would you recommend regarding sports participation to patients with diabetes mellitus (DM) Type 1?

A
  • Most sports are allowed, but watch for any signs of hypoglycemia.
  • Monitor blood sugars before and after activity (even up to 12 hours later).

A child with DM Type 1 must be watched for any signs of hypoglycemia, which is the greatest risk for these patients during exercise. Monitor blood sugars before and after activity (even up to 12 hours later). Depending on the results, either carbohydrate consumption or insulin dosing is given. Coaches must be trained to recognize and treat hypoglycemia.

21
Q

A 13-year-old boy presents with severe nighttime pain in his proximal femur. It gets markedly better with nonsteroidals but not with acetaminophen. Plain x-ray of the femur shows a sharp, round lesion 1 cm in diameter with a 1- to 2-mm peripheral radiolucent zone surrounding a homogenous dense center.

What is the most likely diagnosis?

A

Osteoid Osteoma

Osteoid osteoma presents as described. The key is that it responds to salicylates and NSAIDs but not acetaminophen. The plain film findings are classic (a well-circumscribed lytic lesion with sharp sclerotic borders). Do not think this represents a neoplastic lesion!

It is important to image children that have nighttime, unilateral bony pain.

22
Q

A 12-year-old boy is a pitcher for a junior league baseball team. For the past 2 weeks, he has complained to his parents of right elbow pain, especially after pitching a game. Physical examination reveals no swelling but painful palpation of the right medial epicondyle, worsened with resisted wrist flexion and valgus testing of the right elbow. Plain radiographs of the right elbow are negative for any fracture or dislocation.

What is the sports-related injury in this case?

A

Medial Elbow Aophysitis, a.k.a. Little League Elbow

Medial elbow apophysitis is inflammation of the growth plate of the medial epicondyle. It occurs in athletes who are skeletally immature, typically 9–14 years of age, and results from the valgus stress placed on the elbow during overhead throwing. Most patients present with medial epicondyle pain that intensifies as the number of throws increases. Physical examination elicits pain to palpation of the medial epicondyle and with valgus maneuvers of the elbow. X-rays are normal. Treatment consists of rest, NSAIDs, and physical therapy.

23
Q

A 13-year-old boy who plays basketball presents with:

  • Pain in his left knee
  • A swollen, tender tibial tubercle with a bump that is painful with palpation
  • Plain film shows fragmentary ossification of the tibial tubercle.

What is the most likely diagnosis?

A

Osgood-Schlatter Disease

Osgood-Schlatter disease is a repetitive stress injury (often a volleyball or basketball player) to the patellar tendon at its insertion into the tibial tubercle. Most commonly, it is seen in children 10–15 years of age. You may see apophysitis and/or fragmentary ossification of the tibial tubercle on plain films. NSAIDs are helpful. No specific therapy is necessary, but activity modification may be required.

24
Q

What are the essential nutritional requirements for hydration and rehydration during sports participation?

A

Water and Electrolytes

Hydration, including water and electrolyte replacement, is very important for the athlete and helps regulate body temperature and replace losses that occur during exercise. It must begin 3–4 hours prior to activity and continue throughout and after exercise. Higher environmental temperatures and humidity necessitate more fluids. Eat recovery foods that contain both carbohydrates and protein after exercise to help replenish glycogen to the muscles.

25
Q

What is the recommended treatment for prepatellar bursitis?

A

Treatment consists of rest, ice, elevation, and NSAIDs. If there is no improvement with time and treatment, needle aspiration of the bursa is sometimes needed.

Prepatellar bursitis is an inflammation of the bursa that is anterior to the kneecap. It is caused by a fall or direct blow to the anterior knee that can occur in sports such as wrestling and basketball. Symptoms include pain with activity, swelling, and tenderness. In chronic cases, bursal wall thickening can be demonstrated by palpation of a fluid-filled mass anterior to the patella or the patellar tendon. Diagnosis is usually made clinically.

26
Q

What would you recommend regarding sports participation to patients with epilepsy?

A
  • Avoid climbing, hang-gliding, scuba diving.
  • With proper supervision, above-water sports, horseback riding, harnessed rock climbing, and gymnastics are allowed.

Epileptic patients must be careful in activities involving heights, water, or horses and must be supervised so that in the event of a seizure, help is close by.

27
Q

What would you recommend regarding sports participation to patients with Down syndrome?

A

Most sports are allowed but first assess for any signs and/or symptoms of atlantoaxial (C1–C2) instability.

Down syndrome patients have a predisposition to atlantoaxial (C1–C2) instability and must be examined for this. If exam is abnormal and/or patients are symptomatic, cervical imaging and a pediatric neurosurgeon or orthopedist consult is warranted.

28
Q

A 12-year-old female athlete and her parents want advice on how to prevent injuries while playing soccer.

What are some of the safety tips recommended by the AAP?

A
  1. Take time off.
  2. Wear the right gear.
  3. Strengthen muscles.
  4. Increase flexibility.
  5. Use the proper technique.
  6. Take breaks.
  7. Play safe.
  8. Stop the activity if there is pain.
  9. Avoid heat illness.

Juvenile athletes are prone to trauma and overuse injuries. Most common injuries are caused by abnormal stress to bone or soft tissue resulting in a sprain, strain, or fracture. Follow the AAP Sports Injury Prevention Tip Sheet to help prevent sports injuries.

29
Q

What are the clinical findings associated with tibial torsion?

A

In-Toeing Due to Medial Rotation of the Tibia

Tibial torsion presents with in-toeing at the time the child starts walking. On physical examination, the medial malleolus is even with or posterior to the lateral malleolus, and although the toes are rotated medially, the patella faces forward when walking. Most cases spontaneously resolve by school age. Reserve surgery for severe cases that cause functional or cosmetic deformity that persists after 8 years of age.

30
Q

What are the most likely ankle injuries to occur in a prepubescent child?

A

Ankle Sprains With Fractures

Due to an immature growth plate, ankle sprains with fractures are the most likely ankle injury in the prepubescent child. In adults, ankle sprains are more likely, due to the mature skeleton.

31
Q

What would you recommend regarding sports participation to patients with Marfan syndrome?

A
  • Low-to-moderate activity/exercise is allowed.
  • Avoid contact sports and scuba diving.

Marfan syndrome patients can participate in low-to-moderate activity/exercise but must avoid contact sports and scuba diving to minimize the risk of high pressures to the aorta (which is already dilated or aneurysmal in these patients), of lens dislocation, and of pneumothorax.

32
Q

A 15-year-old obese African American boy presents with a limp. He complains of pain in his left hip and knee. Plain x-rays show the epiphysis has moved when compared to the metaphysis.

What is the most likely diagnosis?

A

Slipped Capital Femoral Epiphysis (SCFE)

SCFE is the slipping of the epiphysis off the metaphysis causing a limp and impaired internal rotation. It most commonly occurs in boys, obese children, eunuchoid adolescents, and African Americans. Get an AP and frog-leg view. This requires surgery! It is important to consider conditions 1 joint above and below the area of pain. In this case, knee pain should make you think of the hip.

33
Q

Identify the cardiac conditions that would limit sports participation and require further cardiac evaluation.

A

Hypertrophic Cardiomyopathy, Prolonged QT Interval, Aortic Stenosis, Coronary Artery Anomalies, Myocarditis, Uncontrolled Stage 2 Hypertension, Fever

History and physical examination are always important in assessing an athlete prior to sports participation. If an athlete has ever experienced chest pain and/or dizziness, then further cardiac evaluation is warranted (e.g., ECG, echo). The listed cardiac conditions pose serious and possibly life-threatening complications and therefore restrict sports participation. Fever is included because it increases the risk of heat illness.

34
Q

What are the clinical findings associated with patellar dislocation?

A
  • Knee Pain
  • Buckling of the Knee
  • Popping Sound
  • Deformed Appearance of the Knee

Patellar dislocation can result from a contact or noncontact injury. Risk factors include quadriceps or hip weakness, a shallow femoral groove, or ligament laxity. Physical examination shows an effusion and a positive apprehension test (fear with lateral displacement of the patella). Initial treatment is closed reduction. Postreduction radiographs can show fractures. Further treatment includes ice, NSAIDs, brief immobilization, a patellar stability brace, and physical therapy. Sometimes surgery is required if the knee remains unstable after rehabilitation.

35
Q

What are the clinical findings seen in kyphosis?

A

Spine is Angled in the Anterior-Posterior Direction, Causing a Humped Back

Kyphosis is diagnosed when the curves of the spine are greater than normal, causing the spine to be abnormally convex. In kyphosis, the spine is angled in the anterior-posterior direction, giving it a forward flexion. This gives the appearance of a humped back. Kyphosis typically involves the upper thoracic region of the spine and usually does not cause respiratory compromise.

36
Q

A newborn presents with the following:

  • Short ribs
  • Small rib cage
  • Renal disease
  • ± Short-limb dwarfism
  • ± Pelvic anomalies
  • ± Polydactyly
  • ± Hepatic involvement

What is the most likely diagnosis?

A

Jeune Syndrome (Asphyxiating Thoracic Dystrophy)

Jeune syndrome is an AR disorder that presents with short ribs, a small rib cage, and renal disease. The other findings listed may or may not be present. Restrictive lung disease is common due to the small rib cage.

37
Q

Describe the clinical findings seen with clubfoot.

A

Plantar Flexion and Medial Rotation of the Foot

Clubfoot is a congenital defect in which the foot is plantar flexed and medially rotated due to shortened ligaments. Promptly refer to an orthopedist to correct the issue before the child begins walking.

38
Q

What are some of the common overuse injuries in athletes?

A

Sever Disease, Osgood-Schlatter Disease, Patellofemoral Syndrome, Iliotibial Band Syndrome, Medial Apophysitis, Lateral Epicondylitis, Osteochondritis Dessicans, Stress Fractures, Spondylolysis/Spondylolisthesis

Overuse injuries can affect bones, growth plates, and soft tissues. Due to the fact that these structures grow at an uneven rate, children are at increased risk for these types of injuries. Overuse injuries are increasing in frequency due to the competitive nature of youth sports and the year-round playing of a single sport. This puts repetitive stress on specific areas of the body without allowing for adequate rest.

39
Q

What is the most common etiology of torticollis?

A

Injury or Inflammation of Neck Muscles

Torticollis is most commonly caused by injury or inflammation of the sternocleidomastoid or trapezius muscle. NSAIDs and muscle relaxants are the recommended treatments.

40
Q

A 15-year-old male track and field sprinter has broken his running records by several seconds each time he races. In addition, his muscle mass has increased in a short period of time. His coach has become concerned because of his aggressive behavior and fighting in the men’s locker room. His friends have also commented that his eyes seem “yellow.”

What is the appropriate evaluation for this patient given this scenario?

A

Drug Screening for Performance-Enhancing Drugs

The primary physician must be prepared to identify risk factors, physical signs, and symptoms of performance-enhancing drug use (doping). Ask appropriate screening questions and perform a thorough physical examination, looking for exaggerated muscle mass, enlarged liver, and rapid heart rate. It is important to emphasize to the athlete the risks involved and healthy alternatives to achieve his goals. Involvement of the coach and counseling are often needed. A drug screen and liver function test are necessary to detect doping. In this case, the patient was taking androgenic steroids.

41
Q

What are the clinical findings associated with a sports-related prepatellar bursitis?

A

The prepatellar bursa is palpated and demonstrates warmth, focal tenderness, and swelling.

In chronic cases, bursal wall thickening is noticeable when squeezed between the fingertips.

Prepatellar bursitis is an inflammation of the bursa that is anterior to the kneecap. It is caused by a fall or direct blow to the anterior knee that can occur in sports such as football and basketball. Symptoms include pain with activity, swelling, and tenderness. Diagnosis is usually made clinically by examining the overlying skin and bursa, which are squeezed between the fingertips to assess for bursal wall thickening. Full range of motion at the knee remains intact.

42
Q

What is the diagnostic approach for the evaluation of hip pain in a child?

A
  • CBC
  • Acute Phase Reactants (e.g., ESR and CRP)
  • Plain Radiographs of the Hip

Any child who presents with pain in the hip, limps, or refuses to bear weight or walk must be evaluated promptly. Potential diagnoses are infections, tumors, transient synovitis , Legg-Calvé-Perthes disease, or slipped Capital Femoral Epiphysis (SCFE).

43
Q

A 15-year-old female joined her high school cross country/track team. She has been running several miles per day for the past several weeks but increased her running mileage in preparation for a track meet next month. Since then, she has noticed her right knee “giving out” during her runs, along with pain at the anterior portion of her kneecap. Physical examination reveals tenderness on palpation of the patella, but there is no swelling or effusion of the knee joint. There is full range of motion of both knees, but pain of the right knee is noted with squatting.

What is the sports-related injury in this case?

A

Patellofemoral Syndrome (PFS)

PFS is the most common cause of anterior knee pain in young athletes, particularly females. Pain occurs especially with prolonged sitting, running, or with activities that require bending of the knees. The pathophysiology seems to be related to overuse and joint malalignment. In PFS, the patella does not track straight down the middle but instead rubs against the inner or outer femur, resulting in the patellofemoral joint becoming inflamed and painful. If the condition progresses, the articular cartilage on the underside of the patella softens, causing decay. This syndrome is chondromalacia patella. Diagnosis of PFS is by history and physical examination findings of patellar pain with movement.

44
Q

A 14-year-old male hurt his left ankle playing basketball. He recalls stumbling onto the floor in pursuit of the ball and twisting his ankle. He is able to bear weight on it, but it is painful. Examination of the ankle reveals soft tissue swelling, warmth, and slight tenderness over the lateral malleolus. There is full but painful range of motion of the ankle. Plain radiographs of the left ankle are negative for fracture.

What is the sport injury in this patient?

A

Ankle Sprain

Ankle sprains occur when the ankle is pushed past its normal range of motion, leading to stretching or tearing of the involved tendon. Lateral ankle sprain, caused by inversion of the foot, is more common than medial. Symptoms include pain, swelling, decreased range of motion, and inability to bear weight. Diagnosis is made by physical exam and possibly x-rays to rule out fracture; in the skeletally immature athlete, the growth plate can get injured before the ligaments do. Treat with rest, ice, compression, and elevation (R.I.C.E.). Strengthening and stretching exercises are necessary and possibly physical therapy.

45
Q

What is the initial management of an acute shoulder dislocation?

A

Closed Reduction and Immobilization

Because the shoulder moves in many directions, it can dislocate anteriorly, posteriorly, or inferiorly, with anteriorly being the most common. Extreme rotation or a forceful blow that occurs during sports or from a fall are common causes. Symptoms include severe pain, inability to move the joint, and a visible deformity to the shoulder. Closed reduction is the treatment. Before and after plain radiographs confirm successful reduction and rule out fractures. Immobilization of the arm after reduction is usually needed. After immobilization, physical therapy is the next course of treatment. If the condition becomes chronic, surgery is often required.

46
Q

A 14-year-old female gymnast presents to the pediatrician’s office for an annual check-up. She states she has missed her period for several months and has lost some weight due to her strict diet. Physical examination reveals a thin, muscular female but nothing else of note. A urine pregnancy test is negative.

What condition is this gymnast likely experiencing?

A

Female Athlete Triad

The “female athlete triad” is a combination of energy deficiency (most often from disordered eating), menstural dysfunction, and decreased bone density. It is especially common in sports where a low body weight is favorable. A history of menstrual dysfunction is the earliest symptom; it should prompt you to get a detailed history of the patient’s diet and exercise. Lab work to test for pregnancy and thyroid dysfunction is usually warranted. Get a bone density study in patients with < 6 menses in 12 months and history of ≥ 2 stress fractures. Treatment requires a multidisciplinary team approach that includes the pediatrician, coach or trainer, nutritionist, and psychologist.

47
Q

What is the best advice for athletes who experience sprains and strains?

A

Rest, Ice, Compression, Elevation (R.I.C.E.), then Strengthening Exercises and Rehabilitation (If Needed)

Soft tissue can be injured from trauma or twisting. A sprain is tearing of a ligament while a strain is tearing of muscle fibers or tendon. Patients present with pain of affected area and diagnosis is typically made clinically by history and examination. Treatment consists of rest, ice, compression, and elevation (R.I.C.E.) in the acute phase, followed by strengthening exercises. Note that adequate rest and rehabilitation of a current injury is key in the prevention of future injury.