Snap, Crackle, ApophysitisArAFP 66th

Annual Scientific AssemblyJune 15, 2013

Elton R. Cleveland, DVM, MD.University of Arkansas for Medical Sciences

Arkansas Children’s Hospital

Apophysitis

Inflamation of the apophysis that is usually caused by overuse or repetitive traction to the physis

Usually no bruising or ecchymosis Insidious

Little League Elbow

Epiphysitis of medial epicondyle caused by repetitive strain of throwing damage to radiocapitellum osteochondrosis of capitellum increase valgus stress rest, modified activity, limit throws, mechanics

Osgood- Schlatter

Boys (12 1/2-13), girls (11 1/2 years) Tensile stresses acting across the junction of

the immature patellar tendon and the tibia tubercule

Pain, tenderness, swelling - Bilat 56% Rest, ice, activity modification, pain mgmt,

hamstring stretches, padding

Osgood-Schlatters Disease

Sinding-Larsen-Johannson

Osgood - Schlatter of the inferior pole of the patella

Achilles Tendonitis

Frequently recurrent problem tight achilles with recurrent traction rare rupture in young athlete rest, ice, heel cord stretching, strengthening

Sever’s Disease

Osgood-Schlatter’s of the heel - Bilat 61% Girls - 8-10y/o, Boys 10-12y/o activity related heel pain X-rays may not be helpful because

fragmentation and sclerosis of the calcaneal apophysis is normal

calf stretches, heel lifts, strengthen dorsiflexors, activity modification

Pelvic Apophysitis

Iliac ASIS AIIS Symphysis Ishial tuberosity Greater Trochanter Lesser Trochanter

Apophysitis vs Apophyseal Avulsion Fractures

Apophysitis

Inflamation of the apophysis that is usually caused by overuse or repetitive traction to the physis

Usually no bruising or ecchymosis Insidious

Avulsion Fracture

Sudden pain with activity Can recall specific activity Most severe with activity Improves with rest +/- Swelling – tenderness with palpation Passive stretch may reproduce pain

Avulsion Fracture

Soccer 74 cases Gymnastics 55 cases

– Rossi, Dragoni

Avulsion Fx – Hip/Pelvis

Ishial Tuberosity 54% AIIS 22% ASIS 19% Pubic symphysis 3% Iliac Crest 1 %

– Rossi, Dragoni

Pelvic Apophysitis – D/D

Pelvic Avulsion Fractures Snapping Hip Syndrome Spondylolysis Femoral Neck Stress Fracture Sports Hernia

Imaging

Xray CT MRI U/S

Avulsion Fx – Hip/Pelvis

ASIS – Sartorius Ishial Tuberosity – Hamstring AIIS- Rectus Femoris – Lesser Trochanter – Iliac Crest – obliques

– Metzmaker, Pappus

Avulsion Fx – Hip/Pelvis

ASIS – Sartorius Ishial Tuberosity – Hamstring AIIS- Rectus Femoris – Lesser Trochanter – Iliac Crest – obliques

– Metzmaker, Pappus

Avulsion Fx – Hip/Pelvis

ASIS – Sartorius Ishial Tuberosity – Hamstring AIIS- Rectus Femoris – Lesser Trochanter – Iliac Crest – obliques

– Metzmaker, Pappus

Avulsion Fx – Hip/Pelvis

ASIS – Sartorius Ishial Tuberosity – Hamstring AIIS- Rectus Femoris – Lesser Trochanter – Iliac Crest – obliques

– Metzmaker, Pappus

Avulsion Fx – Hip/Pelvis

ASIS – Sartorius Ishial Tuberosity – Hamstring AIIS- Rectus Femoris – Lesser Trochanter – Iliac Crest – obliques

– Metzmaker, Pappus

Surgery

? Consider if >2cm displacement