Femoroacetabular Impingement in Pediatric Patients.

Subacute, nontraumatic hip pain is often a diagnostic challenge. Femoroacetabular impingement (FAI) is a common cause of atraumatic hip pain that is poorly understood. FAI is a result of abnormal morphologic changes in either the femoral head or the acetabulum. FAI is more prevalent in people who perform activities requiring repetitive hip flexion, but it remains common in the general population. Evaluation begins with physical examination maneuvers to rule out additional hip pathology and provocation tests to reproduce hip pain. Diagnosis is often made by radiography or magnetic resonance imaging. Initial treatment is generally more conservative, featuring activity modification and physical therapy, whereas more aggressive treatment requires operative management.

The effects of resistance training, overtraining, and early specialization on youth athlete injury and development.

INTRODUCTION: In 2014, 60 million youth ages 6-18 participated in some form of generalized athletics. Around 3.5 million children are injured annually participating in organized sport or recreational activities. While sound physical education can decrease the burden of youth sports injuries, the median annual physical education budget of $ 764 for USA elementary, middle, and high schools may not allow enough flexibility to apply evidenced-based guidelines. EVIDENCE ACQUISITION: The topics were selected after a careful review of the 2016 National Strength and Conditioning Association Position Statement on Long-Term Athletic Development. Articles used to summarize the topics were located by using and cross-referencing sources from this statement. PubMed searches were also conducted using the key words "youth sports injuries," "early sports specialization," "training and maturation," "training versus developmental stage," and "long-term athletic development." EVIDENCE SYNTHESIS: Youth resistance training has been shown to decrease not only the risk of injury, but also of the development of diabetes and metabolic syndrome. Adequate recovery time also decreases injury risk, and resources such as the RESTQ-Sport are available to help coaches identify stress-recovery imbalances, which can be detected two months before an athlete becomes overreached. Through early detection of overtraining, a significant proportion of overuse injuries can be prevented. Early specialization causes fewer muscle groups to be worked and increased repetition, theoretically increasing the risk of injury and early sport dropout. Prior to puberty, increased neuronal activation and adaptation can be achieved through focusing on agility, balance and coordination, thus taking advantage of increased synaptoplasticity. In these early years, neuronal stimulation is more important than muscle hypertrophy, which plays a greater role in athletic development after puberty. CONCLUSIONS: A substantial proportion of youth injuries are preventable. Coaches and physical educators who correctly understand and apply the principles outlined in this review can help youth under their supervision engage in healthy training for sport.

Competitive bass anglers: a new concern in sports medicine.

OBJECTIVE: Competitive bass angling involves sport fishing against other anglers while targeting a species of fish known as the black basses. Due to the rapidly growing popularity of high school competitive bass angling in Alabama and the nature of the casting motion similar to that of overhead athletes, we sought to examine the prevalence of sports type injuries in this population. METHODS: In spring 2016, an anonymous survey was distributed across two large scale competitive high school fishing tournaments, allowing for a broad sampling of anglers throughout the state of Alabama. Survey items included demographic information, relevant past medical history, and various pains associated with the shoulder, elbow and wrist. Results were recorded and analyzed electronically using Microsoft Excel and IBM SPSS statistical software. RESULTS: A total of 257 surveys were recorded. The response rate was 61%. The mean age of participating anglers was 15 ± 1.61 years. The majority (42%) of anglers fished year round. On average, anglers casted nearly 1,000 more times while competing versus fishing recreationally. Approximately 15% of anglers experienced shoulder, elbow, and wrist pain. The most common factors associated with pain included higher tournament cast counts, number of competitive years, number of tournaments/year, number of tournaments, and use of light weight lures. CONCLUSION: A large portion of high school competitive anglers experience upper extremity pain. Knowledge of angling factors associated with pain allow for the creation of a modifiable routine to help reduce pain in affected anglers and prevent pain in healthy anglers.

Overuse Injuries of the Pediatric and Adolescent Throwing Athlete.

In the hypercompetitive environment of year round youth baseball, arm pain is commonplace. Although much research has been done about injuries in the overhead throwing athlete, the emphasis has been on the more elite levels, where athletes have reached full development. The anatomy of the skeletally immature athlete, including open physeal plates and increased tissue laxity, raises unique issues in the presentation and treatment of repetitive throwing injuries of the elbow and shoulder. With a focus on "little leaguers," this discussion evaluates five of the most common elbow and shoulder injuries-Little Leaguer's elbow, ulnar collateral ligament sprain or tear, osteochondritis dissecans/Panner's disease, Little Leaguer's shoulder, and multidirectional instability. In the developmentally distinct pediatric athlete, pathogenesis, diagnosis, and treatment may differ from that established for adults. Offering early diagnosis and treatment appropriate to a child's level of development will enable youth to not only continue to play sports but to also maintain full functionality as active adults.

Arthroscopic treatment of tibial spine malunion with resorbable screws.

Anterior tibial spine fractures are rare and were thought to occur mainly in children; however, recent literature indicates that the incidence in adults is much greater than previously thought. Because the tibial spine is an attachment point for the anterior cruciate ligament (ACL), an avulsion may produce ACL laxity, predisposing to further issues. We report the case of an 11-year-old boy with a tibial spine fracture that failed conservative management. He developed a malunion with impingement anteriorly of the tibial spine on the notch and residual instability of the ACL. In this report, we present a novel approach for arthroscopic reduction of a tibial spine fracture using 8 resorbable poly-L-lactic/polyglycolic acid nails.

Spine problems in young athletes.

As the number of young people involved in sports activities increases, acute and chronic back pain has become more common. With a careful medical history and physical examination, along with the judicious use of imaging modalities, the causes of back pain can be correctly diagnosed and treated so that young athletes can quickly return to sports participation. Although most back pain in these young patients is muscular in origin, findings that should trigger increased concern include night pain, marked hamstring tightness, pain with lumbar spine hyperextension, or any neurologic finding. When recently developed vague back pain is present, a delay in radiographic imaging is warranted. With new back pain after trauma, AP and lateral radiographs of the symptomatic spinal area are indicated. CT, bone scans, and MRI should be reserved for special circumstances. Spondylolysis is the most common bony cause of back pain in young athletes. Spondylolysis can be treated with activity limitation, a specific exercise program, a thoracolumbar orthosis, and/or surgery. Treatment should be based on the amount of pain as well as the desire of the young athlete to continue in the sports activity that caused the pain. Other significant causes of back pain that require more extensive treatment in these young athletes include spondylolisthesis, lumbar disk disorders, and sacral stress fractures. It is anticipated that nearly all young athletes can return to sports activity after successful treatment. Even if surgical treatment is needed, return to all sports is expected, with the occasional exception of collision sports.