Pediatric Sports Injuries and Overuse Syndromes - PowerPoint Presentation

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Pediatric Sports Injuries and Overuse Syndromes

M. Catherine Sargent, MD

Director, DCMC Pediatric & Adolescent Sports Medicine Program

Central Texas Pediatric Orthopedics

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Disclosure

No financial or material support has been received from any commercial enterprise.

No off-label or unapproved use of drugs or products is presented or endorsed in this presentation.

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Learning Objectives:

1. To understand the frequency and variable severity of pediatric sports injuries & issues

.

2. To recognize & manage pediatric sports injuries.

3. To

recognize & address overtraining issues in pediatric athletes.

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Pediatric Sports Participation

Team sports: 27million(age 6-17)

(sporting goods manufacturers)

Organized sports

(Nat’l Council of Youth Sports)

60million (age 6-18)

44million > 1 sport/ year

Sports Injury Rates

Sport specific

Increasing? Decreasing?

MSK injuries down 10.8% in 2005 & 12.4% in 2010 (5-14yo).

National Electronic Injury Surveillance System

ER visits only

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Pediatric Sports

Acute Injuries

Sprains, Strains, Fractures & Dislocations

Football: 10-35 injuries/1000 hrs played

Overuse Injuries

Overtraining Issues

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Fractures & Dislocations

More common than sprains & strains in kids

Slower healing

Bone heals w/o scar

Signs

Pain

Point tenderness

Swelling

Deformity

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Fractures & Dislocations

Evaluation & Treatment

Check neurovascular status frequently

Splint promptly to avoid ongoing injury

Orthogonal x-rays

Include joint above & below injury site*

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Missed Monteggia Fracture

Wrist x-rays only -> missed monteggia fracture

Radial head dislocation with ulnar shaft fracture

Bado classification- radial head is:

1-anterior

2-posterior

3-lateral

4-associated with radial shaft fx

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Stingers

Sudden burning & numbness of arm

Lateral arm, thumb &/or index finger

Stinging lasts 30-60min

Weakness

Shoulder, arm & wrist

Persists 1-2 minutes

Resolves spontaneously

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Stingers

Traction or compressing injury

Cervical Nerve Roots

Brachial Plexus

Usually C5-C6 dermatomes

Cervical stenosis increases risk

Football

Defensive back, Linebacker or Offensive lineman

70% college players

Spear tackling (illegal)

Wrestling

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Stingers - Management

Rule out C-spine injury:

Bilateral Sx

Spasm, limited neck AROM

Return to play

No Pain

No Numbness

No Weakness

Full neck AROM

Recurrent stingers: Neck roll or “Cowboy Collar”

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Gleno-humeral (shoulder)

dislocation

Mechanism

Forced Abduction and External Rotation

Symptoms

Pain

Restricted motion

+/-

parasthesias

Diagnosis

PE X-ray series AP, Scap Y, Ax latUsually anterior-inferior

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Gleno

-humeral (shoulder) dislocation

Treatment of

Gleno

-humeral dislocation

Relocation

Sling +/- swathe

Rehab

Early surgery?

Recurrence?

ReferMR Arthrogram superior to MRI to detect labral injuries>80% of <18yo suffer recurrent dislocations*Kids soft tissues stronger than hard tissues

Greater damage = greater residual instabilityMay need stabilization surgery

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ACL Tears

Plant & twist injury, non-contact

Female 4-7x > Males, weak core & Hip

“

Pop

”

, pain, ++effusion

Complete tear

Unable to walk

Requires reconstruction

Incomplete tear (sprain)May be able to walkMay respond to rehab only if >50% maintainedAcute mgmt: knee immobilizer, crutches, NV checkXrays* & MRI

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Pediatric ACL Tear Treatment

Conservative treatment:

PT: quadriceps & hamstrings

Counseling about risks of recurrent injury

Bracing & Activity modification

no cutting/ contact sports

Risk:

Recurrent instability episodes

Intra-articular damage

Sedentary Lifestyle

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Pediatric ACL Reconstruction

Transphyseal Reconstruction

Risks: Physeal closure

Growth arrest, valgus deformity, recurvatum

Safe in early – mid adolescents (Tanner 2, 3 & 4)

Physeal sparing reconstruction

Non-anatomic

ITB autograft

Longterm outcome?

Recurrent tears

Residual instabilityOver constrained lateral compartment

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Overuse & Overtraining Issues

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Overuse Injuries

Physiolysis Syndromes & Apophysitis

Traction +/or pressure on growth plate

Epiphyseal Injuries

Osteochondritis Dissecans

Stress Fractures

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Overuse Injuries

Physiolysis Syndromes & Apophysitis

Little League Shoulder

Distal Radius Stress Syndrome

Little League Elbow (medial epicondylitis)

ASIS Apophysitis

Osgood Schlatters/ SLJ

Sever

’

s Disease

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Distal Radius Stress Syndrome

Gymnasts, tumblers & cheerleaders

Compressive loads (tumbling, Horse, Vault)

Traction forces (bars)

Symptoms

Pain – particularly in wrist extension

Swelling & tenderness at radial physis

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Distal Radius Stress Syndrome

X-ray

Wide physis/ lucency

Sclerosis

Treatment

Rest 8-12 weeks

PT : forearm, shoulder & core strength

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Osgood-Schlatters Disease

Athletic early adolescents

Activity and post-activity pain, tenderness at tubercle

20% Bilateral

Traction apophysitis (

Incomplete avulsion fx)

S

welling & intermittent activity related pain x 18-24mo

Tx: MICE,

NSAIDs, Quad & HS stretching

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Epiphyseal Issues: Osteochondritis Dessicans

Etiology unknown

20-30% Bilateral

Variable symptoms

Effusion

Pain, activity related

Locking, loose body rare

Natural Hx is age dependent

Juvenile (open DF physis)

Adolescent (physis part closed)

Adult (closed physis)

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OCD Treatment

Stable lesions

Non-op Tx: activity modification

+/- brief immobilization

Unstable lesions

ATS Drilling

+/- Fixation

Excision, OC grafting/ microfx

Best case = 3 to 6 month healing time

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Overuse Issues

Year-round training in 1 sport +/- multiple teams= high risk

Soccer, baseball, and gymnastics

<0.5% HS athletes play professional sports!

Single-Sport Kids have > injuries & play for a shorter time!

Multiple similar sports pose higher overuse risk

e.g. soccer, field hockey, lacrosse

Participation on only 1 team per season is recommended

Maximum 10% weekly increase in training time, # of repetitions, or total distance.

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Conclusions

Sports participation & training entails risk

Brief, post-participation pain may respond to MICE & Stretching

When to refer?

Acute fractures or dislocations

Persistent or increasing pain

Swelling

Locking or loose body sensation

Limping

Inactivity entails risks, probably greater

ObesityDe-conditioning

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Thank You