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Elbow Injuries in Pediatric and Adolescent Athletes

Relevant Anatomy and Biomechanics Osteology Skeletal growth around the elbow typically follows a characteristic development process. The elbow joint consists of the articulation of the distal humerus with the ulna (the ulnohumeral joint), the articulation of the distal humerus with the radial head (the radiocapitellar joint), and the proximal articulation of the radius and ulna (the proximal radioulnar joint). Skeletal maturation occurs from the primary ossification…

Shoulder Injuries in the Young Athlete

Anatomy Skeletally immature bone contains growth plates, or physes, that represent the primary site of longitudinal bone growth. This area of rapidly growing cartilage transitions to bone by a process called endochondral ossification. Due to the nature of this rapid development, physes have much less tensile strength than the surrounding bony epiphysis and metaphysis, thereby rendering the physis more vulnerable to injury as a result of…

Imaging Considerations in Skeletally Immature Athletes

An increasing number of injuries are being seen in young, skeletally immature patients, which may be due to a decrease in free play combined with an increase in participation in competitive organized sports, sport specialization, and a general lack of physical preparedness. In this population, unique injuries are encountered related to the presence of an open growth plate, which is often the “weak link” between tendon…

The Young Athlete

Sports injuries in pediatric and adolescent athletes are being seen with increasing frequency, due to a variety of factors, including increased participation in higher levels of intensity and competition at younger ages, increased recognition of injuries in this age group, and the advent of arthroscopy and magnetic resonance imaging (MRI). The pediatric athlete differs from the adult athlete in terms of physiology, growth, psychology, and skills.…

Degenerative Conditions of the Cervical and Thoracolumbar Spine

Degenerative conditions of the cervical, thoracic, and lumbar spine are encountered at all levels of medical referral. Because of their prevalence, all practitioners, from primary care providers to spine specialists, should possess a basic understanding of the epidemiology, pathophysiology, diagnosis, and treatment principles of these conditions. The aim of this chapter is to provide an overview of the conditions most frequently encountered by primary care and…

Traumatic Injuries of the Thoracolumbar Spine in the Athlete

Trauma to the thoracolumbar spine in athletes is common and can vary from minor sprain to major spinal fracture. Severe and potentially unstable spinal injuries are uncommon in sports-related trauma, but may be seen in athletes participating in contact sports or high velocity accidents. In addition to the contact and collision sports, athletes participating in certain noncontact sports like gymnastics, diving and weight lifting are also…

Traumatic Injuries of the Cervical Spine in the Athlete

This chapter provides an evidence-based approach to history and physical examination, initial stabilization and triage, diagnosis and imaging, treatment, and outcomes for cervical spine injuries in athletes. Cervical spine injury ranges from neuropraxias, to herniated discs, to complete spinal cord injury. The latter is rare but devastating and warrants a high index of suspicion and familiarity with spine immobilization protocols when suspected. On-field catastrophic neurologic injury…

Stingers

Introduction The terms “ stinger ” and “ burner ” are synonymous, and together represent a range of brachial nerve plexopathies. Initially described by Chrisman et al., stingers are almost invariably trauma-mediated, unilateral, reversible injuries of the upper extremity. While stingers are among the most commonly cited injuries of the cervical region, they are solely pathology of peripheral nerves. Most often, traction secondary to trauma will cause…

Concussion and Brain Injury

Among the wide range of injuries that occur in the sports arena, traumatic brain injury (TBI) is a health problem that has garnered increasing public awareness during recent years. This heightened interest has been largely driven by intense media exposure, as well as the retirement of prominent professional athletes with cognitive and behavioral dysfunction purportedly representing lingering sequelae of brain injury. Player safety concerns have become…

Emergency and Field-Side Management of the Spine-Injured Athlete

Spine injuries in athletic events are uncommon, representing only 9% of the total spine injuries presenting to trauma centers. Spine injuries are potentially catastrophic events for the participants; these injuries can lead to significant morbidity and can alter a life permanently. Although thoracolumbar injuries do occur in athletics, the vast majority are less serious and usually involve repetitive and overuse mechanisms. This chapter will focus on…

Imaging of the Spine

Along with a comprehensive history and physical examination, imaging is essential for the evaluation of the patient who presents with suspected or known spine pathology. It facilitates preoperative assessment of a patient, generation of a differential diagnosis, selection of the most likely diagnosis, postoperative evaluation, and monitoring of disease progression. Unlike radiologists, most orthopaedic surgeons have little, if any, formal training in the systematic evaluation and…

Head and Spine Diagnosis and Decision-Making

Head Anatomy and Biomechanics Head injuries have multiple mechanisms, which include the injuries from an impact of the brain against the inside of the skull ( Fig. 123.1 ). A coup injury occurs when the brain strikes the inner skull on the same side of impact of an object and typically occurs when a moving object comes into contact with a patient's stationary head. A countrecoup…

Head and Spine Anatomy and Biomechanics

Introduction The complexity of the central nervous system (CNS) as well as the bones and soft tissues that provide its protection present special challenges when treating the injured athlete. A thorough understanding of the normal anatomy and biomechanics of the brain and spine are necessary in order to identify pathologic states or unstable injuries and treat them appropriately. The following chapter presents a review of the…

Forefoot Problems in Sport

Great caution must be exercised in dealing with forefoot problems, particularly in athletes. Although the outcomes are the same as in nonathletes, even a small decrease in performance may prove to be very significant for an athlete. Therefore with certain exceptions, forefoot surgery should be considered only when conservative management has failed and the athlete is no longer able to play through the pain Turf Toe…

Heel Pain and Plantar Fasciitis: Hindfoot Conditions

Posterior Heel Pain Pain in the posterior, superior portion of the calcaneus may be multifactorial, ranging from retrocalcaneal bursitis, enlargement of the superior bursal prominence of the calcaneus, insertional Achilles tendinosis, to inflammation of an adventitious bursa between the Achilles tendon and the skin ( Fig. 120.1 ). Each of these entities may exist as an isolated condition or may be part of a symptom complex.…

Articular Cartilage Injuries and Defects

Osteochondral Injuries and Defects in the Foot and Ankle Osteochondroses of the foot and ankle are found in multiple locations, including the talus, tibia, metatarsals, navicular, cuneiforms, and calcaneus. The cause of osteochondrosis is varied and complex, and has been described as traumatic, constitutional, idiopathic, and hereditary. Most investigators now believe that numerous factors are responsible for these changes. For example, excessive physical demands during athletic…

Tendon Injuries of the Foot and Ankle

Anterior Tibial Tendon Injuries Acute injuries to the anterior tibial tendon are uncommon and are often the result of open injuries or lacerations. Chronic ruptures are decidedly more common, but they usually occur in an older population either as a result of minor trauma or with an insidious onset. History Open injuries or lacerations to the anterior ankle should elicit suspicion of an acute injury to…

Ligamentous Injuries of the Foot and Ankle

The ankle is a highly specialized joint that allows us to propel ourselves in an efficient manner during multiple activities. The mortise shape facilitates transmission of 1.5 times the body weight when walking, and up to four times the body weight when running. Activities such as standing and walking and all athletic ability require stable, strong foot and ankle function to provide a stable platform for…

Sports Shoes and Orthoses

Sports Orthoses Foot orthoses—also commonly called orthotics, arch supports, and inserts—have been applied to the treatment of pathologic musculoskeletal conditions for more than a century. The term foot orthosis refers to any orthotic device that is distal to the ankle. This naming convention was introduced in the early 1970s by the Committee on Prosthetic-Orthotic Education. A foot orthosis may be as simple as a prefabricated arch…

Ankle Arthroscopy

Historically, the ankle joint was believed to be unsuitable for arthroscopy because intra-articular access of this joint is narrow. Tagaki and later Watanabe described techniques and pioneered the use of arthroscopy in the examination of the ankle. Compared with open arthrotomy, arthroscopy has recognized benefits of shortened recovery times and limited surgical morbidity. Today, arthroscopy of the foot and ankle has evolved from simply a diagnostic…