2025 – PAGE 413 – ORTHOPEDICS AND SPORTS MEDICINE

PROXIMAL HUMERAL EPIPHYSIOLYSIS (AKA LITTLE LEAGUE SHOULDER)

This is an overuse injury resulting in the separation of the epiphysis from the metaphysis (epiphysiolysis) at the proximal humerus. This results in a Salter Harris Type I fracture. It typically occurs in adolescent baseball or softball pitchers. Diagnose with an x-ray and prescribe rest for 6 weeks.

LATERAL EPICONDYLITIS (TENNIS ELBOW)

Lateral epicondylitis is an overuse injury involving the extensor tendons in the forearm. Symptoms can include pain with resisted supination or wrist dorsiflexion especially when the arm is fully extended. There can also be pain with gripping activities. Pain is usually located at the lateral elbow. Diagnosis is based on the physical exam. There is no definitive treatment, but rest and limiting repetitive use of the arm.

KNEE INJURIES

• MEDIAL COLLATERAL LIGAMENT(MCL) injury is a sprain or tear to the ligament. It is very common and results from valgus stress to the knee. This can be in contact sports or non-contact (skiing) sports. There’s usually pain along the medial joint line and there is difficulty ambulating. Diagnose with an MRI and treat with NSDAIDS, bracing, rest and possibly surgical repair.
• ANTERIOR CRUCIATE LIGAMENT(ACL) injuries are amongst the most common knee injuries and typically occur during sports that involve sudden stops or changes in direction (e.g., soccer, basketball, skiing, football). History may include the patient hearing a “pop” at the time of injury, followed by immediate swelling. An effusion may be noted, and the patient may have difficulty with full extension. Perform a Lachman’s test to look for instability and order an MRI for definitive diagnosis. Treat with NSDAIDS, bracing, rest and possibly surgical repair.
• MENISCAL INJURYtypically occur during squatting and twisting motions (usually during sports) when there is a torsional motion in which the patient’s knee is flexed while the foot is planted on the ground. Because of compressive forces, the meniscus can tear as it’s caught between the tibial and femoral condyles. Medial tears more common than lateral tears. Symptoms can include locking and clicking when squatting. If the knee locks and doesn’t release, the patient should seek immediate medical attention. Maneuvers to assess for meniscal injury include the Apley compression test and the  McMurray test. Treat with surgery to repair or remove the meniscus unless the tear is minor.

OSTEOGENESIS IMPERFECTA

Children with osteogenesis imperfecta have a collagen defect leading to extremely fragile bones, lots of fractures, and BLUE sclera, and can have BAD TEETH.

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VALGUS DEFORMITY

A valgus deformity is an outward angulation of the distal part of a bone or joint.

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MNEMONIC: The distal part of the bone points away from midline, “like the L” in vaLgus.

VARUS

A varus deformity is an inward angulation of the distal part of a bone or joint.

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