Sports Medicine: Just the Facts

9–12 months if kyphosis with Cobb angle >50°is

present (Ali, Green, and Patel, 1999).

STRESS FRACTURES

• Stress fractures occur when there is an accumulation
  of microdamage from repetitive stresses, which out-
  strips the bone’s ability to repair and remodel.


• Stress fractures are most commonly found in the
  lower extremities, but can also be found in the spine
  and upper extremity.


• Stress fractures may be diagnosed with plain radi-
  ographs, but single photon emission computed tomog-
  raphy(SPECT) scan, CT or MRI may be needed.


• Many stress fractures are similar in the adult and pedi-
  atric populations, only stress fractures specific to the
  pediatric population are discussed here.

SPONDYLOLYSIS

• The term spondylolysis refers to a stress fracture of
  the pars interarticularis of the spine.


• If the fracture is unstable forward displacement of one
  vertebra on another may result, which is termed
  spondylolisthesis.


• Athletes participating in sports that require repetitive
  hyperextension, like gymnastics or football, may be at
  increased risk for spondylolysis.


• Most patients complain of low back pain, which is
  worse with extension and is relieved by rest.


• Spondylolysis is often be diagnosed with plain radi-
  ographs and is best seen on oblique views. It can,
  however, occur without changes on plain radiographs.
  In this case SPECT scan can be used to detect the
  abnormality.
  •Treatment includes activity restriction until the patient
  is asymptomatic, followed by a gradual return to
  activity. A program of core/lumbar strengthening and
  flexibility should also be instituted. Some practition-
  ers recommend bracing at diagnosis, others recom-
  mend bracing only if the patient continues to have
  pain, despite adequate rest.


• Prognosis is best in cases where only SPECT scan is
  positive and there is not yet plain radiographic evi-
  dence of disease. In cases where radiographic evi-
  dence of spondylolysis is present, the likelihood of
  healing is lower.


• If spondylolisthesis has occurred, there is no chance
  for healing.


• Conservative therapy is the most widely recom-
  mended treatment for spondylolisthesis.


• The role of surgery is controversial. In cases where
  neurologic compromise is evident or slipping of the

vertebra progresses, surgical stabilization is recom-

mended (Richardson and Furey, 2000).

PROXIMALHUMERALSTRESSFRACTURE

• The proximal humeral stress fracture is often referred to
  as little league shoulder, though it is also seen in other
  overhead athletes, such as tennis or volleyball players.


• The throwing motion places torsion and distraction
  forces on the proximal humerus, which when done
  repetitively can result in proximal humeral stress frac-
  ture.


• AP internal and external rotation views of the shoul-
  der with comparison views of the opposite shoulder
  on radiograph should demonstrate widening of the
  affected physis.
  •Treatment involves cessation of throwing or other
  overhead activities until the child is asymptomatic,
  usually about 3 months (Stanitski, DeLee, and Drez,
  1994). Then, progressive return to activity is allowed.
  Throwing mechanics should be evaluated and parents
  and coaches should be warned not to encourage
  excessive throwing.

DISTALRADIUSPHYSEALSTRESSFRACTURES

• Distal radius physeal stress fracture is a Salter-Harris
  type I stress fracture, which typically occurs in gym-
  nasts.


• It is caused by the unusual amount of weightbearing
  activities that gymnasts perform with their upper
  extremities.


• Dorsal wrist pain is the most common symptom.


• The diagnosis may be made with plain radiographs by
  comparing the affected side to the nonpainful side.
  Abnormal widening of the physis, beaking of the epi-
  physis and cystic changes on the metaphyseal side
  of the bone may be noted on the affected radius;
  however, MRI may be needed to make the diagnosis
  if plain radiographs are normal.
  •Treatment includes rest until the athlete is asympto-
  matic, usually 1–3 months. Splinting or casting may
  be helpful.


• When pain has completely resolved, a gradual return
  to upper extremity weightbearing is permitted.

ANATOMIC VARIANTS

•Several anatomic variants may predispose the pedi-

atric athlete to pain and injury.

DISCOID LATERAL MENISCUS

• Athletes with discoid lateral meniscus often complain
  of a snapping sensation with extension of the knee.

562 SECTION 7 • SPECIAL POPULATIONS