Lecture #116: Pediatric Orthopedics

What is an overuse injury?

Injury resulting from repetitive microtrauma without adequate time for recovery leading to tissue damage.

What are the main types of overuse injuries?

Bone injuries such as stress fractures, muscle strains, and tendon injuries such as tendinitis.

What is the pathophysiology of overuse injuries?

Repetitive stress exceeds the body’s ability to repair tissue, resulting in cumulative damage and inflammation.

What is a stress reaction versus a stress fracture?

A stress reaction is early bone injury without fracture, while a stress fracture is a complete or partial break due to repeated stress.

What intrinsic factors contribute to overuse injuries?

Low bone density, low BMI, dietary deficiency, hormonal imbalance, sleep deprivation, and female sex.

What is the female athletic triad?

A condition involving amenorrhea, disordered eating, and osteoporosis increasing injury risk.

What extrinsic factors contribute to overuse injuries?

Training errors, excessive intensity or volume, poor technique, inadequate recovery, surface conditions, equipment issues, and environment.

What training errors increase risk of overuse injuries?

Rapid increase in intensity, duration, or frequency without adequate adaptation time.

How does surface affect overuse injury risk?

Hard or uneven surfaces increase stress on tissues and risk of injury.

How does equipment contribute to overuse injuries?

Inappropriate or worn equipment such as shoes can alter biomechanics and increase stress.

What environmental factors influence overuse injuries?

Heat, cold, and humidity can affect performance, recovery, and injury risk.

What is the importance of identifying risk factors in overuse injuries?

It allows prevention, accurate diagnosis, and targeted treatment strategies.

What are common symptoms of overuse injuries?

Gradual onset pain, worsens with activity, improves with rest, and possible swelling or stiffness.

What is the general approach to diagnosing overuse injuries?

History, physical exam, identification of risk factors, and imaging when necessary.

What is the role of rest in treating overuse injuries?

Relative rest allows tissue healing without complete immobilization.

What medications are used for overuse injuries?

NSAIDs or acetaminophen for pain and inflammation control.

What is the role of physical therapy in overuse injuries?

Improves strength, flexibility, and corrects biomechanical abnormalities.

What is return to play based on?

Resolution of pain, restoration of function, and correction of contributing factors.

Why is gradual return to activity important?

It prevents reinjury by allowing tissues to adapt progressively.

What is medial epicondylitis?

Overuse injury of the flexor pronator muscles causing pain at the medial elbow.

Which muscles are involved in medial epicondylitis?

Pronator teres and flexor carpi radialis.

What activities are associated with medial epicondylitis?

Golf, throwing, and repetitive wrist flexion and pronation.

What nerve can be involved in medial epicondylitis?

The ulnar nerve leading to possible neurologic symptoms.

What is lateral epicondylitis?

Overuse injury of wrist extensor muscles causing pain at the lateral elbow.

What activities are associated with lateral epicondylitis?

Tennis and repetitive wrist extension activities.

What is tendinitis?

Inflammation of a tendon due to repetitive use or overload.

What is tendinosis?

Degenerative changes in a tendon without significant inflammation.

What is the difference between acute and chronic overuse injuries?

Acute injuries occur suddenly, while chronic injuries develop gradually over time.

What is the importance of biomechanics in overuse injuries?

Poor biomechanics increase stress on tissues and contribute to injury development.

What is a key prevention strategy for overuse injuries?

Proper training progression, adequate rest, and appropriate equipment.

What is the role of sleep in injury prevention?

Adequate sleep supports recovery and reduces injury risk.

What is the role of nutrition in preventing overuse injuries?

Proper nutrition supports bone health and tissue repair.

What is a key principle in managing overuse injuries?

Address both symptoms and underlying causes to prevent recurrence.

What is the consequence of untreated overuse injuries?

Progression to more severe injury, chronic pain, and functional limitation.