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.
• 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:
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–
–
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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
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–
–
–
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
• Symptoms
Pain
Restricted motion
+/- parasthesias
• Diagnosis
PE
X-ray series
• AP, Scap Y, Ax lat
Usually anterior-inferior
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
ACL Tears
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–
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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
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•
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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
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•
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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?
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•
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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