Kategoriarkiv: Childrens injuries

Inflammation of the outer shin bone

 

Diagnosis: INFLAMMATION OF THE OUTER SHIN BONE
(LATERAL TIBIAL PERIOSTITIS)


Anatomy:
The calf muscles are divided in three muscle groups (compartments) by powerful muscle membranes (fascies). A forward, an exterior and a rear muscle group (which is divided in a superficial and a deep part). The large rear muscle groups’ muscle membrane is fastened on the inner edge of the shin bone, while the forward muscle group is fastened on the external edge of the shin bone (photo).

Cause: In cases of repeated uniform loads, a stress related inflammation, can occur where the muscle membrane fastens on the edge of the shin bone. The condition is most often seen in athletes who jump a lot and with frequent change of running surface or shoes.

Symptoms: Pain upon applying pressure, particularly on the exterior edge of the shin bone and upon straining, and is aggravated when the foot is bent upwards against resistance (extension). Occasionally an irregular bone edge can be felt on the shin bone.

Acute treatment:

Examination: In light cases medical examination is not necessarily required. In cases with more pronounced pain or lack of progress despite relief, a medical examination is recommended to ensure the diagnosis and rule out amongst other things a stress fracture. A medical examination is usually sufficient in order to make the diagnosis. It can be necessary to supplement with X-ray, Scintigraphy, ultrasonography or MRI (article).

Treatment: The treatment involves relief, stretching and slow rehabilitation. It is imperative that there are good shock absorbing soles in the shoes.

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If the course does not progress smoothly, you should be medically re-examined to ensure that the diagnosis is correct, and that complications have not arisen in the form of stress fracture.

Special: Shock absorbing shoes or inlays will reduce the load.

 

Inflammation of the inner shin bone

Diagnosis: INFLAMMATION OF THE INNER SHIN BONE
(MEDIAL TIBIAL PERIOSTITIS, “SHIN SPLINT”)


Anatomy:
The calf muscles are divided in three muscle groups (compartments) by powerful muscle membranes (fascies). A forward, an exterior and a rear muscle group (which is divided into a superficial and a deep part). The large rear muscle groups’ muscle membrane is fastened on the inner edge of the shin bone (tibia), while the forward muscle group is fastened on the external edge of the shin bone (photo).

Cause: In cases of repeated uniform loads, a stress related inflammation, can occur where the muscle membrane fastens on the edge of the shin bone. The condition is most often seen in athletes with a tendency to rotate the foot outwards (hyperpronation) or with a high foot arch. Frequent change of running surface or shoes increases the risk.

Symptoms: Pain on the inner edge of the shin bone, aggravated upon applying pressure, load (running) and stretching in the foot joint against resistance (flexion). The pain is often localized to the lower part of the shin bone. Sometimes an irregular bone edge can be felt on the shin bone.

Acute treatment:

Examination: In light cases medical examination is not necessarily required. In cases with more pronounced pain or lack of progress despite relief, medical examination is recommended to ensure the diagnosis and rule out amongst other things a stress fracture. A medical examination is usually sufficient in order to make the diagnosis. In some cases it may be necessary to supplement with X-rays, scintigraphy or ultrasound scanning.

Treatment: The treatment comprises relief, stretching and slow rehabilitation. It is imperative that there are good shock absorbing soles in the shoes.

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If the course does not progress smoothly, you should be medically re-examined to ensure that the diagnosis is correct, and that complication have not arisen in the form of stress fracture.

Special: Shock absorbing shoes or inlays will reduce the load.

Bone fracture

Diagnosis: BONE FRACTURE OF THE SHIN BONE
(FRACTURE)


Anatomy:
The bones in the lower leg comprise the shin bone (tibia) and the calf bone (fibula).

  1. Tibia
  2. Fibula

SHIN BONE FROM THE FRONT

Cause: Violent loads in the form of a blow or twist can cause a fracture on the shin-bone as well as the calf bone (article). Fracture of the fibula is often seen after a kick on the outer side of the shin bone.

Symptoms: Pain upon applying pressure (direct and indirect tenderness) and when under load (walking and running).

Acute treatment: Click here.

Examination: X-ray.

Treatment: The treatment comprises relief and bandaging. In some cases surgery is necessary depending on the type of fracture and any displacement of the fracture-surfaces (article).

Rehabilitation of children and adolescents: Which loads and rehabilitation that can be permitted is completely dependent upon the severity and the treatment of the fracture. It is therefore important that the rehabilitation is performed in close cooperation with the doctors controlling the treatment. Approximately six months’ rehabilitation must be expected before shin bone fractures allow resumption of maximum load, and approximately 3 months’ rehabilitation before calf bone fractures allow maximum load.

Plastic bandage: Individual plastic bandages can be manufactured for use during sports activity after bone fractures. Individual plastic bandages are particularly well-suited after a fracture of the fibula.

Complications: If progress is not smooth you should be medically re-examined to ensure that the fracture is healing according to plan. In some cases a false joint can be formed (pseudoarthrosis) (article), requiring surgical treatment.

Scheuermans decease

Diagnosis: SCHEUERMANN’S DISEASE


Anatomy:
The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles.

 

  1. Vertebra prominens
  2. Vertebra coccygea I
  3. Promontorium
  4. L I
  5. Th I
  6. Axis

THE BACK SEEN FROM THE SIDE

Cause: Scheuermann’s disease occurring in approximately 4% of the population (article). A curvature of the back occurs (bending over forwards) due to the vertebrae becoming wedge shaped. There are also characteristic x-ray finds. The cause of the condition is unknown, but evidence tends to suggest that the condition is hereditary (article).

Symptoms: Back curvature localised high in the back (thoracal Scheuermann) gives often only few, if any, symptoms. Back curvature localised in the lower back (thoracolumbal or lumbal Scheuermann) does entail back pain for the majority (article).

Examination: The diagnosis is usually made following a medical examination supplemented with an x-ray (at least 3 adjacent vertebrae with at least 5 degrees wedge form, Schmorlske impressions, flattening of discs, irregular end plates) (article). The crooked back is often mistaken in the beginning for “bad posture”. In some cases, CT or MRI scanning is recommended.

Treatment: The vast majority of cases can be treated with training, attempting to maintain the mobility of the back, counteract the curvature tendency and strengthen the stomach and back muscles. A corset can in some cases be used until the young person is fully grown. An operation can be performed only in very rare cases. The condition has a good prognosis (article), and even after an operation it is still possible to take part in many different forms of sport (article).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: In some cases a crooked back can have other causes (infection, nerve disease, inborn bone change, rheumatic illness, bone disease, metabolic disorder).

Crooked back

Diagnosis: CROOKED BACK
(SCOLIOSIS)


Anatomy:
The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles.

 

  1. Vertebra prominens
  2. Vertebra coccygea I
  3. Promontorium
  4. L I
  5. Th I
  6. Axis

THE BACK SEEN FROM THE SIDE

Cause: The cause of scoliosis in children and adolescents is unknown in the majority of cases (idiopathic). Scoliosis is most commonly seen during the growing years, and is more often seen in girls than boys (Photo).

Symptoms: Scoliosis does not necessarily cause pain or other symptoms.

Examination: It is important that the diagnosis is made as soon as possible as better results are achieved if the treatment is commenced as soon as it is necessary. One should therefore always be aware of the early signs of scoliosis (uneven shoulder or hip level, one or both shoulder blades being prominent, slanting waist). A normal medical examination will usually be sufficient to make the diagnosis. X-rays will reveal the degree of severity of the scoliosis. In some cases, CT or MRI scanning is recommended (article).

Treatment: Treatment is dependant upon the degree of severity. The majority of cases will normally be able to be controlled without treatment (article). It will normally be possible to take part in sports activities without any problems (article). Strength training and stretching of the stomach and back muscles is recommended. Supportive bandaging can be used if the scoliosis becomes worse (> 25-30 degrees) and the young person is still growing. It is normally possible to take part in sport at the usual level despite the bandaging (article). An operation may become necessary if the scoliosis becomes pronounced (> 40-50 degrees), and even earlier in some special cases. Certain forms of sport can be resumed 6-9 months after the operation (article).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: In some cases the presence of scoliosis can have other causes (infection, nerve disease, inborn bone change, rheumatic illness, bone disease, metabolic disorder).

Fracture of the vertebral arch

Diagnosis: FRACTURE OF THE VERTEBRAL ARCH
(SPONDYLOLYSIS)


Anatomy:
The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles (sketch).

Cause: There are several causes for looseness of the lumbar vertebrae (spondylolyse): inborn (dysplastic), fracture of the vertebral arch and degenerative. Fracture of the vertebral arch is the most frequent cause amongst adolescents and athletes, and is seen in 5% of the normal population. It is most often seen in athletes who repeatedly bend the back backwards (high-jumpers, gymnasts, pole vaulters, footballers) (article-1) (article-2). In some cases, the looseness can cause one of the vertebrae to slide forwards and apply pressure on the spinal cord (spondylolisthesis).

Symptoms: Pain and stiffness in the lower back (lumbago) and buttocks, occasionally radiating to the leg (“sciatica”).

Examination: Slight back discomfort does not necessarily require medical examination, however, all cases with strong or repeated back pain should be examined. The doctor will be able to evaluate whether further examination is required, i.e. x-ray (including lateral projection) (X-Ray) (Scintigraphy), CT or MRI scanning (article).

Treatment: Treatment is dependant upon the degree of severity. The majority of cases will normally be able to be treated with relief (article-1) (article-2) (which in sever cases must last for several months). In approximately 10% of cases where a vertebra has slid significantly forwards (spondylolisthesis), it will be necessary to operate (article).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If the pain does not decline under the treatment, medical (re)examination by a doctor should be performed. Special consideration should be given to slipped disc, secondary muscle infiltrations (myalgia) and piriformis syndrome, Scheuermanns disease, however, many other causes of lumbago are found (infection, tumour), of which some will require further examination.

Special:
Training should be performed on a “lifelong” basis to reduce the risk of relapse after a successful rehabilitation.

Muscle rupture in the anterioir thigh

Diagnosis: MUSCLE RUPTURE IN THE ANTERIOR THIGH
(RUPTURA MUSCULI)


Anatomy:
A rupture can in principle occur to all muscles in the thigh, however, ruptures most often happen in the anterior muscle (M quadriceps femoris) which has the function of stretching the knee and flexing the hip. The anterior thigh muscle consists of four muscles (M vastus lateralis, M vastus medialis, M rectus femoris and the deep lying M vastus intermedius).

 

  1. Spina iliaca anterior superior
  2. M. iliopsoas
  3. Lig. inguinale
  4. Tuberculum pubicum
  5. M. pectineus
  6. M. adductor longus
  7. M. gracilis
  8. M. adductor magnus
  9. M. rectus femoris
  10. M. sartorius
  11. M. vastus medialis
  12. Tractus iliotibialis
  13. M. vastus lateralis
  14. M. tensor fasciae latae et tractus iliotibialis
  15. M. gluteus medius

THIGH FROM THE FRONT

Cause: When a muscle is subjected to a load beyond the strength of the muscle (jump, kick), a rupture occurs. The vast majority of ruptures are partial muscle ruptures. The weakest point is often at the junction between the muscle tendon and the muscle belly. Muscle ruptures in children and adolescents are relatively rare compared with adults.

Symptoms: In slight cases a local tenderness is felt after being subjected to load (“sprained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). The following three symptoms are characteristic in connection with muscle injuries: pain upon applying pressure, stretching and activation of the muscle (stretching knee) against resistance. With total ruptures a defect can often be seen and felt in the muscle, and above and below the rupture a swelling can be felt (the contracted muscle belly and bleeding). The most frequent place for partial ruptures on the anterior thigh is approximately 10 cm below the upper front iliac crest projection (spina iliaca anterior superior) in the rectus femoris muscle.

Acute treatment: Click here.

Examination: In very slight cases (light muscle sprains) with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning can be performed, as it is the most suitable examination to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury (article).

Treatment: The treatment of the vast majority of muscle injuries today involves relief and rehabilitation. It is only in very rare cases that surgery is indicated (e.g. total rupture in the anterior muscle tendon close to the attachment on the upper knee cap where surgery is recommended very quickly (article). Even large ruptures in the thigh muscles will usually be able to be healed and rehabilitated without giving functional disorder (but often cosmetic disfigurement with an irregular thigh muscle).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.

Muscle rupture in the posterior thigh

Diagnosis: MUSCLE RUPTURE IN THE POSTERIOR THIGH
(RUPTURA MUSCULI)


Anatomy:
A rupture can in principle occur to all muscles in the rear of the thigh, however, ruptures most often happen in the large posterior muscles in the centre of the thigh (M biceps femoris, M semitendinosus, M semimembranosus) which have the function of stretching the hip and flexing the knee.

 

  1. M. biceps femoris (caput longum)
  2. M. semitendinosus
  3. Caput breve m. bicipitis femoris
  4. M. plantaris
  5. Tendo m. bicipitis femoris
  6. M. gastrocnemius
  7. M. sartorius
  8. M. gracilis
  9. M. semimembranosus

THIGH FROM THE REAR

Cause: When one of the posterior thigh muscles is subjected to a load beyond the strength of the muscle (typically sprinting), a rupture occurs. The vast majority of ruptures are partial muscle ruptures. Muscle ruptures in children and adolescents are relatively rare compared with adults.

Symptoms: In slight cases a local tenderness is felt after being subjected to load (“sprained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). The following three symptoms are characteristic in connection with muscle injuries: pain upon applying pressure, stretching and activation of the muscle (flexing knee) against resistance. With total ruptures a defect can often be seen and felt in the muscle, and above and below the rupture a swelling can be felt (the contracted muscle belly and bleeding). The most frequent place for partial ruptures on the posterior thigh is the large posterior muscles in the centre of the thigh (M biceps femoris, M semitendinosus, M semimembranosus) which have the function of stretching the hip and flexing the knee.

Acute treatment: Click here.

Examination: In very slight cases with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning (or MRI scanning) can be performed, as these are the most suitable examinations to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury (article).

Treatment: The treatment of the vast majority of muscle injuries today involves relief and rehabilitation. It is only in very rare cases that surgery is indicated Even large ruptures in the thigh muscles will usually be able to be healed and rehabilitated without giving functional disorder (but often cosmetic disfigurement with an irregular thigh muscle).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.

Muscular bleeding in the anterior thigh

Diagnosis: MUSCULAR BLEEDING IN THE ANTERIOR THIGH
(HAEMATOMA MUSCULI)


Anatomy:
The thigh muscles are dealt up in three muscle groups (muscle compartments) of powerful, partially unyielding, muscle membranes (fascias): a front, an inner and a rear muscle compartment. The anterior thigh muscle consists of four muscles (M vastus lateralis, M vastus medialis, M rectus femoris and the deep lying M vastus intermedius).

 

  1. Spina iliaca anterior superior
  2. M. iliopsoas
  3. Lig. inguinale
  4. Tuberculum pubicum
  5. M. pectineus
  6. M. adductor longus
  7. M. gracilis
  8. M. adductor magnus
  9. M. rectus femoris
  10. M. sartorius
  11. M. vastus medialis
  12. Tractus iliotibialis
  13. M. vastus lateralis
  14. M. tensor fasciae latae et tractus iliotibialis
  15. M. gluteus medius

THIGH FROM THE FRONT

Cause: If a muscle is subjected to kicks or the like the muscle belly, which contains blood vessels, is pressed against the bones inflicting a contusion and rupture of the muscle fibres and blood vessels. The rupture usually occurs deep in the muscle. In other cases the bleeding can occur after a large or smaller muscle rupture in the anterior thigh. The bleeding can either penetrate the muscle membrane and spread over a large area, or it can accumulate in the muscle.

Symptoms: Pain and swelling in the muscle. In some cases a hard, tender accumulation can be felt (accumulated bleeding in the muscle), in other cases a bluish discoloration of the subcutis (the bleeding has penetrated the muscle membrane and spread into the sub cutis). The pain is aggravated upon activation and stretching of the muscle.

Acute treatment: Click here.

Examination: In slight cases with only minimal tenderness and no discomfort when walking, medical examination is not necessarily required. The severity of the tenderness is, however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. Acute medical attention is necessary in cases of pronounced pain or sensory disturbance, as the bleeding can occasionally cause the pressure in the muscle compartment to increase so greatly that the blood supply and nerves can be damaged (acute compartment syndrom). The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning can be performed, as this is the most suitable examination to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury.

Treatment: The treatment primarily consists of relief and rehabilitation as with muscle rupture in the anterior thigh. In cases of large accumulated bleeding the blood accumulation can be drained under ultrasound guidance. If the bleeding is located medial (M vastus mediale) or lateral on the thigh (M vastus lateralis), the rehabilitation will usually go more quickly. If the bleeding is located in the centre of the front thigh muscle (M vastus intermedius or M rectus femoris), a longer period of rehabilitation must be expected as sudden jumping or kicking will comprise a risk of a muscle rupture in the damaged anterior thigh muscle. Some advise caution with massage to reduce the risk of myositis ossificans (formation of bony bars within the muscle). Treatment with ultrasound has generally no convincing effect.

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen (article).

Thigh bone fracture

Diagnosis: THIGH BONE FRACTURE
(FRACTURA)


Anatomy:
The femur is the only bone in the thigh. Innumerable muscles are attached to the bone.

  1. Caput femoris
  2. Collum femoris
  3. Trochanter minor
  4. Trochanter major

THIGH BONE FROM THE FRONT

Cause: Fracture of the thigh bone occurs most commonly following a heavy blow or twist. By far the majority of fractures occur in the middle section of the thigh bone. A fracture of the femoral neck (article) and stress fractures are very seldom seen in children (article).

Symptoms: Pain and swelling. It will most often be impossible for the patient to support himself on the leg due to pain.

Examination: X-ray examination will usually reveal the fracture. Since many stress fractures are not visible early in the course, x-ray examination can be repeated after a few weeks. Scintigraphy, CT, MRI and ultrasound scans can often diagnose stress fractures far earlier than x-rays (Ultrasonic image). The occurrence of stress fractures in the thigh bone is very rare in children, but much more frequent in adults (see thigh stress fracture in SportNetDoc adults).

Treatment: The treatment primarily comprises relief (article). Only in special cases is surgery necessary (article).

Rehabilitation of children and adolescents: The rehabilitation is completely dependant on the severity of the fracture and the treatment. All rehabilitation should therefore be performed in close cooperation with the doctor controlling the treatment. A period of at least two months is usually recommended before full participation in sport can be permitted.

Complications: The great majority of cases heal without complication or after-effects following non-operative treatment. Complications are more frequently seen following surgical treatment of the fracture (article). A shortening of the leg can be seen following a thigh bone fracture (article) and problems in the healing process where in some cases a false joint is formed (pseudoarthrosis), which requires surgical treatment.