Sports injuries and children

Extrinsic

Dislocated shoulder

Cause

Follows a fall onto the arm.

Symptoms

There is pain in the shoulder and may be pain and tingling in the arm.

Investigations

An X-ray will confirm the diagnosis. MRI will be helpful if the problem is recurrent.

Treatment

The dislocation must be reduced under sedation or anaesthetic.

Surgery

May be required to deal with further dislocations.

Fractured collar bone (clavicle)

Cause

Follows a fall onto the arm.

Symptoms

Pain that may be severe over the collar bone.

Investigations

An X-ray will confirm the diagnosis.

Treatment

Usually requires a sling, occasionally surgery is required.

Greenstick fractures

Cause

Follows a fall or twisting injury.

Symptoms

Pain at the site of the injury.

Investigations

X-ray of the affected limb.

Treatment

May require nothing more than support in a plaster cast, although if out of position a manipulation under general anaesthesia may be needed.

Concussion

Cause

Follows a fall onto or direct blow to the head.

Symptoms

Headache, loss of consciousness (if severe), visual disturbance, vertigo or confusion.

Investigations

If associated with vomiting and increasing loss or fluctuating consciousness will need specialised investigations.

Treatment

For minor injuries no specific treatment, however if more serious may need neurosurgical treatment.

Ankle sprains

Cause

Follows a twisting injury.

Symptoms

Pain most commonly over the outer ankle.

Investigations

A sprain must be distinguished from a fracture and X-rays may be required.

Treatment

Rest, ice, compression and elevation.

Intrinsic

Anterior knee pain

Cause

This pain in the front of the knee. It is very common and in the most cases no cause will be found.

Symptoms

Pain in the front of the knee, if there is swelling of the knee treatment should be sought.

Investigations

Usually non required, in severe cases MRI will be used to rule out rare causes of the pain.

Treatment

Depends on the severity of the pain, usually reassurance is required but physiotherapy is also an option. Occasionally key hole surgery (arthroscopy) is required.

Osgood-schlatters disease

Cause

This is an overuse syndrome.

Symptoms

Pain and swelling just below the knee cap.

Investigations

Occasionally an X-ray or MRI scan is required.

Treatment

No specific treatment is required.

Osteochondritis of the knee or ankle

Cause

A fragment of bone dies in the knee.

Symptoms

Pain alone or in combination with swelling and/or locking.

Investigations

X-ray and MRI scan.

Treatment

Depends on the degree of separation of the fragment. At the very least nothing more than observation required although key hole surgery may be required to stabilise the fragment.

Unstable kneecap (patella)

Cause

This is usually intrinsic but may occur with trauma.

Symptoms

The dislocation may be obvious with a swelling on the outside of the knee or if it is a momentary event there may be a feeling of instability followed by pain and swelling.

Investigations

X-rays will identify the dislocation and may be helpful to exclude a fracture within the knee (osteochondral fracture). MRI scanning may be required in more serious cases where surgical reconstruction is considered.

Treatment

It usually respond to physiotherapy, although occasionally surgery is required.

Heel pain

Cause

The commonest cause is Severs Disease which is a overuse condition of the insertion of the Achilles tendon. Another cause is heel pad syndrome that is an overuse syndrome of the heel pad.

Symptoms

Pain in the heel occasionally with swelling.

Investigations

None usually required, although an MRI scan can be helpful and will exclude rare serious causes of heel pain.

Treatment

None usually required, although rest may be advised.

Accessory navicular

Cause

This is an extra bone attached to the navicular bone in the foot.

Symptoms

Swelling with or without pain halfway along the inside of the foot.

Investigations

An X-ray will confirm the diagnosis.

Treatment

None is usually required although in persistent cases surgery to remove the bone is indicated.

Low back pain

Cause

Pain that is brought on by activity is rare in children, however worn (degenerate) intervertebral disc and a stress fracture at the base of the spine will cause back pain.

Symptoms

Pain at the base of the spine usually activity induced.

Investigations

X-rays and MR scanning.

Treatment

This is usually non-operative, and involves physiotherapy. Surgery is required when symptoms are disabling.

Hip pain

Cause

There are many causes of hip pain in children, ranging from unstable tendons to displacement of the head of the thigh bone.

Symptoms

In addition to pain there may also be a limp, stiffness of the hip and deformity of the leg.

Investigations

Hip pain should be investigated by X-rays and in some cases an MRI scan.

Treatment

This will depend on the cause of the problem. Surgery is a rare requirement and most children will respond to physiotherapy.

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