pediatric sports injuries and overuse syndromes m. catherine sargent, md director, dcmc pediatric...
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Pediatric Sports Injuries and Overuse Syndromes
M. Catherine Sargent, MDDirector, DCMC Pediatric & Adolescent Sports
Medicine Program
Central Texas Pediatric Orthopedics
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.
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.
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
Pediatric Sports
• Acute Injuries– Sprains, Strains, Fractures & Dislocations
• Football: 10-35 injuries/1000 hrs played
• Overuse Injuries• Overtraining Issues
Fractures & Dislocations
• More common than sprains & strains in kids– Slower healing– Bone heals w/o scar
Signs • Pain• Point tenderness• Swelling• Deformity
Fractures & Dislocations
Evaluation & Treatment
• Check neurovascular status frequently
• Splint promptly to avoid ongoing injury
• Orthogonal x-rays – Include joint above & below injury site*
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
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
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
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”
Gleno-humeral (shoulder) dislocation• Mechanism
Forced Abduction and External Rotation
• SymptomsPainRestricted motion+/- parasthesias
• DiagnosisPE X-ray series
• AP, Scap Y, Ax lat
Usually anterior-inferior
Gleno-humeral (shoulder) dislocationTreatment 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
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
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
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
Overuse & Overtraining Issues
Overuse Injuries
Physiolysis Syndromes & Apophysitis• Traction +/or pressure on growth plate
Epiphyseal Injuries• Osteochondritis Dissecans
Stress Fractures
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
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
Distal Radius Stress Syndrome
X-ray• Wide physis/ lucency• Sclerosis
Treatment• Rest 8-12 weeks• PT : forearm,
shoulder & core strength
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
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)
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
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.
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
Thank You