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Pediatric Sports Injuries and Overuse Syndromes

Pediatric Sports Injuries and Overuse Syndromes. M. Catherine Sargent, MD Director, DCMC Pediatric & Adolescent Sports Medicine Program Central Texas Pediatric Orthopedics. Disclosure. No financial or material support has been received from any commercial enterprise.

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Pediatric Sports Injuries and Overuse Syndromes

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  1. Pediatric Sports Injuries and Overuse Syndromes M. Catherine Sargent, MD Director, DCMC Pediatric & Adolescent Sports Medicine Program Central Texas Pediatric Orthopedics

  2. 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.

  3. 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.

  4. 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

  5. Pediatric Sports • Acute Injuries • Sprains, Strains, Fractures & Dislocations • Football: 10-35 injuries/1000 hrs played • Overuse Injuries • Overtraining Issues

  6. Fractures & Dislocations • More common than sprains & strains in kids • Slower healing • Bone heals w/o scar Signs • Pain • Point tenderness • Swelling • Deformity

  7. Fractures & Dislocations Evaluation & Treatment • Check neurovascular status frequently • Splint promptly to avoid ongoing injury • Orthogonal x-rays • Include joint above & below injury site*

  8. 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

  9. 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

  10. 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

  11. 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”

  12. Gleno-humeral (shoulder) dislocation • Mechanism Forced Abduction and External Rotation • Symptoms Pain Restricted motion +/- parasthesias • Diagnosis PE X-ray series • AP, Scap Y, Ax lat Usually anterior-inferior

  13. Gleno-humeral (shoulder) dislocation Treatment of Gleno-humeral dislocation • Relocation • Sling +/- swathe • Rehab • Early surgery? Recurrence? • Refer • MR 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 instability May need stabilization surgery

  14. 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 walk • May respond to rehab only if >50% maintained • Acute mgmt: knee immobilizer, crutches, NV check • Xrays* & MRI

  15. 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

  16. 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 instability • Over constrained lateral compartment

  17. Overuse & Overtraining Issues

  18. Overuse Injuries Physiolysis Syndromes & Apophysitis • Traction +/or pressure on growth plate Epiphyseal Injuries • Osteochondritis Dissecans Stress Fractures

  19. 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

  20. 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

  21. Distal Radius Stress Syndrome X-ray • Wide physis/ lucency • Sclerosis • Treatment • Rest 8-12 weeks • PT : forearm, shoulder & core strength

  22. Osgood-Schlatters Disease • Athletic early adolescents • Activity and post-activity pain, tenderness at tubercle • 20% Bilateral • Traction apophysitis (Incomplete avulsion fx) • Swelling & intermittent activity related pain x 18-24mo • Tx: MICE, NSAIDs, Quad & HS stretching

  23. 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)

  24. 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

  25. 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.

  26. 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 • Obesity • De-conditioning

  27. Thank You

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