CHAPTER 96 • THE PEDIATRIC ATHLETE 561•Growth cartilage is found at the articular surface,
physes, and apophyses.
- Also, as children experience growth spurts, there are
rapid changes in bone length, which can lead to a rel-
ative inflexibility of the muscle-tendon units that
cross joints. This may predispose the growing athlete
to muscular, joint, and physeal injury (Difiori, 1999). - Abnormalities in alignment may also predispose an
athlete to overuse injuries. Pes planus or cavus, over
pronation, patellofemoral malalignment, tibial tor-
sion, femoral anteversion and leg length discrepancies
may be related to increased risk for overuse injuries in
athletes (Difiori, 1999).
EXTRINSIC RISK FACTORS FOR OVERUSE INJURY
- Improper training technique can attribute to the risk
for overuse injury. - Increasing intensity or frequency of training can lead
to overuse injury. - In runners, injury may also result from persistently
running the same direction around the track or on the
same side of the street. - Also, parental and coaching pressures to increase the
intensity of a child’s training can contribute to injuries.
•Improperly fitting or worn out equipment may increase
the risk injury. For example, using worn out running
shoes or adult sized weight training equipment may
predispose the pediatric athlete to overuse injury.
COMMON OVERUSE INJURIES
TRACTIONAPOPHYSITIS
•A traction apophysitis occurs where a muscle group
attaches to a secondary center of ossification.
- It is caused by repetitive stress at these sites that can
lead to pain, swelling, and inflammation. - The diagnosis of an apophysitis can usually be made
on physical examinaton. In nonclassic cases, radi-
ographs may help rule out other conditions. - Osgood-Schlatter disease is an apophysitis of the tibial
tubercle. It is associated with inflexibility of the extensor
mechanism of the knee. Jumping activities exacerbate
Osgood-Schlatter disease, so it is commonly diagnosed
in basketball players. Treatment involves relative rest, as
well as quadriceps stretching and strengthening. - Sinding-Larsen-Johansson syndrome is an apophysi-
tis of the inferior pole of the patella, and is similar in
cause and treatment to Osgood-Schlatter disease. - Apophysitis of the medial epicondyle of the elbow is
common in throwing athletes. It is often termed “little
league elbow.”
•Traction on the medial epicondyle occurs as a result
of the valgus stress placed on the elbow during the
throwing motion.
•Treatment includes relative rest followed by progres-
sive strengthening and gradual return to throwing
activities is usually effective as a treatment. Also, the
athlete’s throwing technique should be evaluated and
any errors should be corrected.OSTEOCHONDRITISDESSICANS- Osteochondritis dessicans (OCD) is a disorder of
growth cartilage where there is a separation of carti-
lage and subchondral bone from underlying well vas-
cularized bone. - Common sites for OCD in children include the knee
and elbow. - OCD lesions are usually noted on plain radiographs.
MRI can be used to assess the stability of the fragment
and viability of subchondral bone. - In general, younger patients and patients with stable
lesions have the best prognosis. - OCD in the knee is most often found on the medial
femoral condyle. Patients usually complain of vague
knee pain and intermittent swelling. If the affected
fragment has detached from the underlying bone,
there may be complaints of locking and catching. If
the fragment is stable, a period of rest and a gradual
return to activity with physical therapy to improve leg
strength may be adequate for treatment. If the articu-
lar cartilage is disrupted or a loose body is present, a
surgical referral is indicated. - The capitellum of the elbow is a common site for
OCD lesions in throwing athletes and gymnasts. In
young patients with stable lesions, treatment includes
rest, physical therapy, and instruction in proper throw-
ing technique. If the affected fragment is unstable,
surgical referral is indicated.
SHEUERMANN’S DISEASE- Sheuermann’s disease is a common adolescent condi-
tion that causes painful dorsal kyphosis, loss of ante-
rior vertebral body height and wedging of the
vertebral body (Wheeless, 2003). - Most patients have tightness of the hamstrings,
gluteals and lumbodorsal fascia (Wheeless, 2003). - The etiology is unclear, but it may be an overuse syn-
drome. - Diagnosis can be made with plain radiographs of the
thoracic spine, which demonstrate anterior wedging
of the vertebral bodies, irregular vertebral end plates,
Schmorl’s nodes and narrow disc spaces.
•Treatment includes physical therapy for strength and
flexibility. Bracing may be used for a period of