Sports Injuries

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Chapter 61 Sports Injuries

Lauren P. Daly, MD, Maria Carmen G. Diaz, MD

EPIDEMIOLOGY

1 Which sports are associated with the highest injury rates in children? What are the most common types of injuries seen?

In boys, the most injuries are seen with football. In girls, soccer accounts for the highest injury rates. Other sport activities that commonly lead to the emergency department evaluation of pediatric injuries include basketball, baseball/softball, inline skating, and hockey.

The most common types of ac ute injuries are soft tissue injuries, including sprains, strains, and contusions. Fractures and lacerations occur less frequently. However, in adolescents, overuse injuries are more common than acute injuries.

Patel DR, Nelson TL: Sports injuries in adolescents. Med Clin North Am 84:983–1007, 2000.

Taylor BL, Attia MW: Sports-related injuries in children. Acad Emerg Med 7:1376–1382, 2000.

OVERUSE INJURIES

2 What are overuse injuries? How are they managed?

Overuse injuries are chronic injuries that are related to constant high levels of physiologic stress without sufficient recovery time. These injuries are characterized by repetitive microtrauma and the development of inflammation that lead to significant pain and loss or limitation of function.

Overuse injuries are treated with rest and supportive bracing. Additionally the athlete should partake in proper training regimens that emphasize flexibility and stretching.

3 What is “Little League shoulder”? How does it present?

“Little League shoulder,” also known as proximal humeral epiphysitis, is most often seen in high-performance pitchers between 11 and 16 years of age. It may also be seen in tennis players, swimmers, and gymnasts. It is caused by overuse and subsequent inflammation of the proximal humeral physis. The chief complaint is gradual pain localized to the proximal humerus during the act of throwing or serving. The physical examination may be negative, or there may be tenderness to palpation of the proximal humerus. Radiographs may reveal a widening of the proximal humeral physis. Treatment is almost always nonsurgical and includes a rest period of 2 to 3 months, along with physical therapy.

Walter KD, Congeni JA: Don’t let little league shoulder or elbow sideline your patient permanently. Contemp Pediatr 21:69–92, 2004.

4 What is “Little League elbow”?

“Little League elbow”, or medial epicondylar apophysitis, results from stress to the medial epicondyle of the humerus. It is most commonly seen in children between the ages of 9 and 12 years who are baseball pitchers, infielders, or tennis players. An excessive number of pitches thrown and a sidearm pitching style have both been implicated as causes. The athlete presents with gradual onset of pain in the medial elbow and proximal forearm while throwing. Radiographs may be normal or reveal medial epicondylar apophyseal widening. Treatment is complete rest from throwing activities, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy.

Saperstein AL, Nicholas SJ: Pediatric and adolescent sports medicine. Pediatr Clin North Am 43:1013–1033, 1996.

5 Why is the early identification of “gymnast’s wrist” important?

Left untreated, “gymnast’s wrist,” a stress injury to the distal radial physis, may lead to premature fusion of the physis, growth arrest, and radial shortening. These patients present with activity-related pain of the dorsal aspect of the wrist, especially with floor exercises and vaulting, where there is an excessive load on a dorsiflexed wrist. There is tenderness over the distal radius, and radiographic findings may be normal or exhibit widening, beaking, or an indistinct appearance of the physis. Treatment is rest for 2–4 weeks. If there are radiographic changes, immobilization may be necessary.

Patel DR, Nelson TL: Sports injuries in adolescents. Med Clin North Am 84:983–1007, 2000.

6 Name the two types of apophysitis syndromes that occur surrounding the patellar tendon

image Osgood-Schlatter disease: An apophysitis at the anterior tibial tubercle due to traction by the inferior aspect of the patellar tendon.

image Sinding-Larsen-Johansson syndrome: An apophysitis of the inferior pole of the patella due to traction by the superior aspect of the patellar tendon. Treatment is analogous to that for Osgood-Schlatter disease. Sinding-Larsen-Johansson syndrome is differentiated from “jumper’s knee” in that the latter is not an apophysitis but rather an inflammation within the proximal patellar tendon itself.

Ganley TJ, Lou JE, Pryor K, et al: Sports medicine. In Dormans JP, Bell LM (eds): Pediatric Orthopedics and Sports Medicine: The Requisites in Pediatrics. St. Louis, Mosby, 2004, pp 278–279.

7 Which is the most common overuse injury in the young athlete?

Osgood-Schlatter disease commonly affects adolescents during periods of rapid growth. Symptoms include tenderness and a prominence at the tibial tubercle, with pain worsened by high-impact sports, kneeling, or squatting. The diagnosis is usually made clinically. However, plain radiographs will demonstrate enlargement or fragmentation at the anterior tibial tubercle due to the traction force at the insertion of the patellar tendon. Management includes rest, ice, NSAIDs, and stretching regimens to increase flexibility of the quadriceps and hamstrings. The problem usually resolves with closure of the physis, but children rarely may develop ossicles within the patellar tendon that require surgical removal.

Adirim TA, Cheng TL: Overview of injuries in the young athlete. Sports Med 33:75–81, 2003.

Ganley TJ, et al: Sports medicine. In Dormans JP, Bell LM (eds): Pediatric Orthopedics and Sports Medicine: The Requisites in Pediatrics. St. Louis, Mosby, 2004, pp 278–279.

8 What is the recommended management for Sever disease?

Sever disease, an apophysitis resulting from repetitive stresses on the calcaneal ossification center by the Achilles tendon, is often seen in young runners. The athlete will report heel pain and often has had a recent growth spurt and increase in activity level. Management includes rest, NSAIDs, Achilles tendon stretching, and the use of heel cups in cleats or sneakers. It usually resolves in 2–4 months without the need for surgery.

Ganley TJ, et al: Sports medicine. In Dormans JP, Bell LM (eds): Pediatric Orthopedics and Sports Medicine: The Requisites in Pediatrics. St. Louis, Mosby, 2004, pp 273–298.

Simons SM, Sloan BK: Foot injuries. In Birrer RB, Griesemer BA, Cataletto MB (eds): Pediatric Sports Medicine for Primary Care. Philadelphia, Lippincott Williams & Wilkins, 2002, pp 443–444.

9 List the most common locations for stress fractures in pediatric athletes

image Tibia 51%

image Fibula 20%

image Pars interarticularis 15%

image Femur 3%

image Metatarsal 2%

image Tarsal navicular 2%

Coady CM, Micheli LJ: Stress fractures in the pediatric athlete. Clin Sports Med 16:225–238, 1997.

10 In which sports are participants most likely to sustain stress fractures?

image Running

image Basketball

image Gymnastics

image Football

image Ice skating

Saperstein AL, Nicholas SJ: Pediatric and adolescent sports medicine. Pediatr Clin North Am 43:1013–1033, 1996.

KEY POINTS: OVERUSE INJURIES

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