Pediatric Orthopedic Lecture

At the Harris Health system we only see a small percentage of pediatric cases so our clinical experiences are limited in this area. To compensate for the lack of clinical hours, our residency director, Dana Tew, PT, DPT, FAAOMPT organized a lecture with a local pediatric orthopedic expert. In this post, I want to summarize a few key points regarding pediatric- especially sport related- injuries and management.

1. If a child presents to your clinic with pain near the bone, you should almost always order an X-ray. Since muscles attach at or near the apophysis (growth plate) it is easy to see how repetitive stresses to the muscle can create undue forces across growth plate. Combined with rapid growth, adolescents are at risk for apophysitis. Apophysitis commonly occurs at the knee (Osgood Schlatter Disease), heel (Sever Disease) and medial elbow (little league elbow). Since the apophysis is skeletally immature, this area is a common site for avulsion fractures as well. The patient will likely present similar to a tendinosis patient. They will have pain near the muscle insertion and describe their symptoms as achy or throbbing. Due to the osseous immaturity, obtaining films is necessary to rule out a fracture or apophyseal injury. 

2. Pediatric patients can have muscle shortness AND joint hypermobility.
This is an important concept when choosing appropriate treatment options in the pediatric population. For example, a young thrower may have short Lats and Pectoralis muscles, but the glenohumeral joint is hypermobile. Many times people assume muscle shortness coincides with joint hypomobility. This may be true in older adult joints where arthritis and synovial changes have occurred, but not always the case in children. When performing a pediatric evaluation, be sure to perform a thorough joint assessment in addition to checking muscle length. 

3. Parents are equally competitive about their child's athletic career as the child. 
Every parent dreams there child will become the next Lebron James or Aaron Rodgers, so missing this weekends little league tournament seems out of the question. It sounds ridiculous, but it is not far from the truth. Parents and children alike need education regarding tissue healing following an injury, return to sport, the importance of playing multiple sports throughout the year to avoid overuse injuries. 

4. As a population, we need to do a better job preventing pediatric injuries from (re)occurring.
In today's society, we have the knowledge to know what stresses will cause injury to a child. We know that factors such as pitch count, dehydration, the psychological effects of being in a sport are extremely important. However, this information is not being relayed to coaches, trainers, and parents. Despite the abundance of knowledge, rates of injury are increasing among young athletes. A recent article from Advances in Pediatrics states "the incidence of medial epicondyle apophysitis is increasing as the number and intensity of organized youth sports have increased (Hoang 2012)." As healthcare professionals specializing in movement and exercise prescription, we need to be taking a more firm approach regarding prevention, management, and discharge criteria of pediatric injuries.       

-Jim 

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References: 
Hoang, Quynh B., and Mohammed Mortazavi. "Pediatric Overuse Injuries in Sports." Advances in Pediatrics 59.1 (2012): 359-83. Web.