Common Overuse Adolescent Injuries - PowerPoint PPT Presentation

Common Overuse Adolescent Injuries

David B. Gealt, D.O.

Assistant Professor UMDNJ-SOM

Assistant Professor UMDNJ-RWJ

Cooper Bone and Joint Institute

Cooper University Hospital

August 24, 2011

Inverted

Normal

Everted

Bow-legged

Knock-kneed

Normal

These are abnormal foot types…a normal or neutral foot type is a happy medium between these two.

Pes cavus = High arch foot

Pes planus = Flatfoot

Lands on heel

Foot rolls to ball of toe while turning inward (pronates)

A person who runs flat footed:

Lands on heel AND ball of foot

Foot rolls inward excessively, which also causes the lower leg to turn inward

• A person who runs with a high arch:
• Lands hard on heel
• Doesn’t pronate enough to allow the impact of running to be absorbed through the body
• The feet and outer part of knee and hip bear the brunt of each step

It depends on how much running you do per week…

Ex: Jog 60-70 mi/wk, replace shoes every 3-4 mos

Worn-out shoes (esp if soles are worn down unevenly) can be dangerous

They don’t provide proper support/stability anymore

Be aware of your foot type before purchasing new shoes

With all the new shoes available, choosing a shoe is no easy task…this is where running shoe store experts come in!

Prescription orthotics are custom-designed from a mold of the foot

Sport orthotics should be made of soft, but firm materials

Most commonly in metatarsals (esp 2-4)

Other common sites are tibia and sesamoids

First symptom is pain, often vague but localized

• History is extremely important
• Usually 2-3 weeks into season
• Often after radical increases in training

If the clinician has a high degree of suspicion, an early diagnosis can be made by bone scans and MRI

Pneumatic CAM walker (pictured)

Cast boot

Below knee cast

Orthotic with aperture cut-outs for involved metatarsal to redistribute forces around it

Other causes

Instability of foot and heel strike

Running on unyielding surfaces

Inadequate shoes

Symptoms include tightness and aching in the front or back of the leg muscles during and after running

X-rays or MRIs must be taken to be sure of diagnosis

Other possible diagnoses with similar symptoms:

Stress fracture

Chronic compartment syndromes

Periostitis

Myositis

Tendonitis

Treatment

Shoe inserts or orthotics

Ice massage

Strengthening exercises

Change in running surface (hard to soft)

Wearing shoes with thick, shock-absorbing soles

Posterior muscles fatigue and fibers can tear loose from attachment to leg bone

Treatment

Custom molded orthotics

Stretching exercises

Ice massage

Frequently worse with running uphill or climbing stairs

Patellofemoral pain is in and around kneecap, often associated with swelling and a sense that the knee cap is “off track”

• Seen in young active persons, either gender, female predominance
• Subactue onset of patellar pain, worse walking, stairs, little pain at rest, theater sign
• Running Hills
• Joint shows reproduction of pain on pressing patella against femoral condyles—pushing down on kneecap

Treatment

quadriceps isometric strengthening exercises,

NSAIDs,

bracing,

orthotics

• The ankle sprain is most common single injury seen by sports medicine physicians.
• This injury is often viewed as minor, but can be associated with prolonged disability and recurrent instability in 25-30% of patients.

• 1.non-wgt bearing (crutches)
• 2.Touch Down- Partial wgt bearing w/ crutches
• 3.Full 4 point gait- Full wgt bearing w/ crutches
• 4.Once crutch on opposite side
• 5.Cane
• 6.Nml gait

• P - Protection
• R - Rest
• I - Ice
• C - Compression
• E - Elevation
• S - Support

• Prevents re-injury during rehab and on return to activity
• Use taping and/or bracing, air-stirrups, laced Swed-O/McDavid, Kalassy velcro wrap, or Active ankle

• Categorized as overuse injuries
• Once thought to be found only in elite, highly trained athletes
• With the growth of organized sports for children and adolescents, have seen a large increase in these types of injuries

• Associated with the growth cartilage
• Located at three sites:
• Epiphyseal plate
• Joint Surface
• Apophyseal insertions of major muscle-tendon units

• Sites of active growth in a child
• Consists of columns of growth cartilage uniting tendon with a bone

Calcaneal apophysis

Knee

Tibial tuberosity

Inferior pole of the patella

• First recorded in 1903 simultaneously by both R.B. Osgood and C. Schlatter
• Osgood believed this was caused by microavulsions of the tibial tubercle from the insertion of the quadriceps mechanism
• Age range is 10 – 15 years old
• Girls 11 – 13 years old
• Goys 12 – 14 years old

• At risk sports – repetitive impact sports
• Football
• Hockey
• Soccer
• Basketball
• Running
• Gymnastics

• Affects young adolescents
• Pain at the inferior aspect of the patella, subacute to chronic onset
• Joint is tender to palpation, occasionally swelling in region of tibial tubercle

• Clinical manifestations
• Pain and swelling over the tibial tubercle especially after athletic activities
• Pain with running, jumping, squatting, kneeling
• May have permanent “bump” under knee

• Tx is via reassurance and analgesics

• Treatment
• RICE
• Bracing
• Education of disease process to parents and athlete (self-limiting)
• Modification of sports activity/avoidance of exacerbating activities

• Treatment
• Stretching and strengthening of the hamstring and quadriceps muscle groups as well as the gastrocnemius-soleus muscle complex
• Bracing may be needed for restraint or severe cases that dissipate the force of the quadriceps contraction

(chopat strap)

• Similar to Osgood-Schlatter disease
• Pain is over the distal pole of the patella
• Like OSD, debate over whether pain is from avulsion fractures vs. patellar tendonitis
• Analogous to “jumper’s knee” in the skeletally mature athlete (patellar tendonitis)

• Calcaneal Apophysitis
• Heel pain is the presenting symptom located over the oscalcis apophysis
• Most common cause of heel pain in adolescents
• At risk sports include soccer, running, and gymnastics

• + Squeeze Test
• Treatment
• Self Limiting
• Rest from activity; NSAIDS
• Silicone Heel Cups
• Stretching of the gastrocnemius-soleus muscle complex and strengthening of the dorsiflexors of the ankle
• Cam Walker Boot
• Orthotics if necessary

• Physical Exam
• Pain over posterior heel

• Treatment
• Stretching of the gastrocnemius-soleus muscle complex and strengthening of the dorsiflexors of the ankle
• Orthotics if necessary
• Heel cups or other OTC orthotics
• Custom orthotics

Cycling

Swimming

Water running in waist-high water

Rowing

Upper body ergometer

Etc.

ALSO remember the concept behind the original injury so you can help to prevent it in the future