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MSK/Derm > Sports Injuries Unique to Young Athletes > Flashcards

Sports Injuries Unique to Young Athletes Flashcards

1
Q

apophysis

A

where muscle-tendon unit attaches to bone

provides contour and shape without adding length

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2
Q

What part of the bone structures are the “weakest links” in the musculoskeletal chain in children?

A

ossification centers

more vulnerable to injury than ligaments, tendons, and muscles

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3
Q

osteochondroses (apophysitis)

A

overuse injury

inflammation and irritation at an apophysis or physis due to excessive stress

inflammation results form mechanical pressure

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4
Q

acute injuries in children

A

physeal fractures

apophyseal avulsion fractures

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5
Q

What is the spectrum of pathology in osteochondrosis?

A

cartilage swelling

irregular ossification

tendon thickening

separation

fragmentation of cortical bone

delayed closure

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6
Q

What is the mechanism of injury in osteochondrosis?

A

mis-use due to:

improper technique

equipment poorly-fitted or worn out

change in playing surface

overuse:

rapid increase in volume or intensity of training

inadequate time for rest and recovery

adult-directed training vs. kid-directed free play

sports specialization at early age

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7
Q

What are the risk factors of osteochondrosis?

A

growth spurt

tight muscles

certain variants of normal anatomic alignment

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8
Q

What are the effects of a growth sport on the bones?

A

period of high metabolic activity at growth center - cells become more vulnerable to stress

bones grow faster than muscle-tendon units - results in tight muscle-tendon units and increase tension on apophyses where they attach

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9
Q

What are the common sites of osteochondroses?

A

lower extremity:

calcaneus (Sever’s Disease)

tibial tuberosity (Osgood-Schlatter Disease)

upper extremity:

medical epichondyle of elbow (Little League Elbow)

proximal humeral physis (Little League Shoulder)

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10
Q

Sever’s Disease

A

calcaneal osteochondrosis

peaks at age 8-11

bilateral up to 61%

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11
Q

What are the mechanisms of Sever’s Disease?

A

tension from Achilles and plantar fascia

direct impact pressure

most common sports are soccer and basketball

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12
Q

What are the risk factors for Sever’s Disease?

A

inappropriate shoes

tight calf muscles - less than 10 degrees of ankle dorsiflexion

subtalar overpronation

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13
Q

What is the common presentation of Sever’s Disease?

A

history of heel pain and worse with activity

physical exam shows pain with medio-lateral compression of heel

may find risk factor’s such as tight heel cords or subtalar overpronation

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14
Q

What is the treatment of Sever’s Disease?

A

rest from sports

ice massage

analgesics rarely necessary - never use before activity

calf muscle stretching - hold each ofr 30 seconds 1-2 times a day

heal cups

molded shoe inserts if overpronation is present

when severe, may need crutches until weightbearing is painfree

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15
Q

What is the prognosis of Sever’s Disease?

A

usually resolves in 2-8 weeks with proper treatment

no significant long-term effects

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16
Q

What is the occurrence of Osgood-Schlatter Diseaes (OSD)?

A

osteochondrosis of tibial tuberosity

girls aged 8-13

boys aged 10-15

21% of athletic adolescents

common in running, jumping sports

4.5% of non-athletes

bilateral in 20%

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17
Q

What are the risk factors of Osgood-Schlatter Disease?

A

right quadriceps and hip flexors

external tibial rotation:

when tibial tubercle sits lateral to the center of patella

increases traction stress from patellar tendon

patella alta - patella sits higher than normal

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18
Q

What is the clinical presentation of Osgood-Schlatter DIsease?

A

history of pain, swelling at tibial tubercle

worsens with activity, improves with rest

tenderness at tibial tubercle

pain with resisted knee extension

often have tight quadricepts and hip flexors

thomas test and/or ely test positive

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19
Q

What are common findings in x-rays in Osgood-Schlatter Disease?

A

not required for diagnosis

typically normal

may see soft tissue swelling

useful to rule out other pathology

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20
Q

What is the treatment for Osgood-Schlatter Disease?

A

rest from sports

ice massage

quad and hip flexor stretching - hold each for 30 seconds 1-2 times a day

analgesics rarely necessary - never use before activity

patellar tendon strap may help

severe cases may require immobilization - long leg cast or knee immobilizer brace for 3-4 weeks

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21
Q

What is the prognosis of Osgood-Schlatter Disease?

A

usually resolves with proper rest and treatment - may take 12-24 months to run its course

22
Q

What are the complications of Osgood-Schlatter Disease?

A

persistent painful ossicle - may require surgical excision for relief of symptoms

tibial tubercle aversion - rare and risk of avulsion does not warrant restriction from sports for those with OSD

23
Q

When should individuals return to play after Sever’s and OSD?

A

may continue play if pain occurs only after activity and resolves by the next day

should not return to play if pain occurs with daily activities or if pain occurs during sports activity

no analgesics prior to exercise - may mask pain which is a sign of worsening injury

24
Q

What is little league elbow?

A

osteochondrosis of medial epicondyle

affects up to 50% of pitchers between 9-14 years old

caused by excessive traction stress on medial epicondyle apophysis with pitching motion

25
Q

When does traction stress peak during phases of throwing?

A

traction stress peaks during late cocking and acceleration

26
Q

What is the mechanism of injury in little league elbow?

A

traction stress from flexor-pronator muscles and valgus force on elbow

27
Q

What are the risk factors of little league elbow?

A

lots of pitching

throwing breaking pitches before skeletal maturity - require more flexor-pronator muscle action and sliders rincrease risk for elbow pain by 86%

lack of pitching experience

poor conditioning and muscle strength

28
Q

What is the clinical presentation of little league elbow?

A

history of gradual onset of pain with pitching, recent increase in pitching volume, and usually no pain with throwing, batting, or AD:’s

tender at medial epicondyle

may have pain with valgus stress to elbow

may have pain with reisted wrist flexion or pronation

may lack full elbow extension

29
Q

What are findings on x-rays of little league elbow?

A

not required for diagnosis

may show widening, irregular ossification, and fragmentation

30
Q

What is the treatment of little league elbow?

A

rest from pitching for 2-4 weeks until physis is non-tender

rehabilitation for 4-6 weeks - stretch flexor/pronator muscles and strengthen shoulder, core/hip muscles

interval throwing program for 6-8 weeks that may begin when athlete has full ROM and strength, start at half distance and power and incrementally increase

31
Q

What is the prognosis of little league elbow?

A

most heal with conservative treatment

long-term problems are rare

indadequate rest/treatment can lead to failure of physeal closure, chornic pain from non-union, and acute avulsion fracture

32
Q

What is the mechanism of little league shoulder?

A

osteochondrosis of proximal humeral physis due to excessive rotational stress, 35% of pitchers are aged 9-14

seen in other overhand sports such as tennis and volleyball

33
Q

What are the risk factors of little league shoulder?

A

lots of pitching

throwing breaking pitches before skeletal maturity

lack of pitching experience

poor conditioning and muscle strength

34
Q

What is the clinical presentation of little league shoulder?

A

history of shoulder pain with pitching

may also have pain with regular throwing and ADLs

physical exam is tender at proximal humeral physis

may have painful arc of motion

weakness and pain with resisted shoulder abduction and external rotation

35
Q

What is the treatment of little league shoulder?

A

rest from pitching (4-6 wks) - until physis is non-tender and ROM is full and pain-free and strength testing does not generate pain

rehabilitation (4-6 wks) - stretch and strengthen shoulder, core/hip muscles

interval throwing program (6-8 wks) - may begin when athlete has full ROM and strength, start at 50% distance and power and incrementally increase

36
Q

What are the most important factors for preventing pitching injuries?

A

don’t pitch through pain or fatigue

follow guidelines for pitch count limits

37
Q

What are apophyseal avulasion fractures?

A

separation of apophysis from main bone

pelvis is most common site

90% occur in boys

80-90% are sport-related

peak incidence is at 14-18 years of age

38
Q

What is the mechanism of apophyseal avulsion fractures?

A

sudden, forceful eccentric muscle contraction

39
Q

What is the clinical presentation of avulsion fractures?

A

sudden forceful contraction of muscle pulls apophysis away from adjacent bone

athletes report a painful “pop”

commonly unable to bear weight after injury

upon physical exam: tender at apophysis, typically no swelling/bruising, muscle usuall ynot tender, pain with passive stretch and resisted muscle test

40
Q

What are common x-ray findings in avulsion fractures?

A

damage of the ischial tuberosity - 30-50% of pelvic avulsions, due to forceful contraction of hamstrings

anterior inferior iliac spine - 20% of pelvic avulsions, due to forceful contraction of rectus femoris

iliac crest - 2-11% of pelvic avulsions, due to forceful contraction of abdominal obliques

41
Q

What is the treatment of avulsion fractures?

A

majority respond to non-operative treatment

displacement > 2cm may require surgical fixation

rest (1-4 weeks) - goal is to releive tension on injured apophysis, requires crutches until weightbearing is pain-free

stretching (1-3 weeks) - may begin when apophysis is non-tender, gentle actuve stretching involved muscle group

rehabilitation (2-4 weeks) - progressive resistance exercises, proprioception training, jogging and sport-specific activities

42
Q

What is the prognosis of avulsion fractures?

A

generally good

ischial tuberosity avulsions:

longest recovery time (3-4 months)

up to 68% result in non-union

75% have difficulty returning to sports

25% dropped out of sports altogether

43
Q

What is spondylolysis?

A

stress freacture at pars interarticularis

most common at L4 and L5

44
Q

What is spondylolishtesis?

A

when upper vertebra slides forward

can occur if spondylolysis is bilateral

can also be congenital

45
Q

What is the clinical presentation of spondylolysis/listhesis?

A

symptoms of low back pain with lumber extension, loading

pain usually relieved with flexion

PE findings reveal positive Stork test - pain with single leg hyperextension

tender at affected vertebra

46
Q

What are common imaging modalities for spondylolysis/listhesis?

A

xrays (AP, lateral, obliques) - may see fx (dog collar) or slip, may be normal

SPECT scan - 100% sensitive

MRI - sensitivity improving with newer techniques (ex. saggital STIR)

47
Q

What is the treatment for spondylolysis/listhesis?

A

custom-fitted rigid brace until pain-free ROM

physical therapy - progressive core strengthening, first 4 weeks exercise with neutral spine and then slowly increase ROM if pain-free

no sports for at least 3 months and pain-free ROM, adequate core strength

48
Q

What are the risk factors for back pain?

A

common muscle imbalances in gymnasts increase risk for back pain

49
Q

What is the Thomas test? What does it measure?

A

touch the knee to the chest

measures hip flexor flexibility

if thigh lifts off table when opposite hip is maximally flexed, hip flexor is tight

50
Q

What is the Trendelenberg test and what does it measure?

A

the patient is asked to stand unassisted on each leg in turn, whilst the examiner’s fingers are placed on the anterior superior iliac spines. The foot on the contralateral side is elevated from the floor by bending at the knee

estimates gluteus medius strength

51
Q

What are some ways to prevent back injury?

A

core/gluteal strengthening

stretch hip flexors, erector spinae

MSK/Derm (54 decks)

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