Snap, Crackle, Apophysitis ArAFP 66 th Annual Scientific Assembly June 15, 2013

1. Snap, Crackle, ApophysitisArAFP 66thAnnual Scientific AssemblyJune 15, 2013 Elton R. Cleveland, DVM, MD. University of Arkansas for Medical Sciences Arkansas Children’s Hospital

2. Apophysitis • Inflamation of the apophysis that is usually caused by overuse or repetitive traction to the physis • Usually no bruising or ecchymosis • Insidious

4. 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

9. 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

10. Osgood-Schlatters Disease

11. Sinding-Larsen-Johannson • Osgood - Schlatter of the inferior pole of the patella

12. Achilles Tendonitis • Frequently recurrent problem • tight achilles with recurrent traction • rare rupture in young athlete • rest, ice, heel cord stretching, strengthening

14. 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

17. Pelvic Apophysitis • Iliac • ASIS • AIIS • Symphysis • Ishial tuberosity • Greater Trochanter • Lesser Trochanter

18. ApophysitisvsApophyseal Avulsion Fractures

19. Apophysitis • Inflamation of the apophysis that is usually caused by overuse or repetitive traction to the physis • Usually no bruising or ecchymosis • Insidious

20. 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

21. Avulsion Fracture • Soccer 74 cases • Gymnastics 55 cases • Rossi, Dragoni

22. Avulsion Fx – Hip/Pelvis • Ishial Tuberosity 54% • AIIS 22% • ASIS 19% • Pubic symphysis 3% • Iliac Crest 1 % • Rossi, Dragoni

23. Pelvic Apophysitis – D/D • Pelvic Avulsion Fractures • Snapping Hip Syndrome • Spondylolysis • Femoral Neck Stress Fracture • Sports Hernia

24. Imaging • Xray • CT • MRI • U/S

26. Avulsion Fx – Hip/Pelvis • ASIS – Sartorius • Ishial Tuberosity – Hamstring • AIIS- Rectus Femoris – • Lesser Trochanter – • Iliac Crest – obliques • Metzmaker, Pappus

28. Avulsion Fx – Hip/Pelvis • ASIS – Sartorius • Ishial Tuberosity – Hamstring • AIIS- Rectus Femoris – • Lesser Trochanter – • Iliac Crest – obliques • Metzmaker, Pappus

30. Avulsion Fx – Hip/Pelvis • ASIS – Sartorius • Ishial Tuberosity – Hamstring • AIIS- Rectus Femoris – • Lesser Trochanter – • Iliac Crest – obliques • Metzmaker, Pappus

34. Avulsion Fx – Hip/Pelvis • ASIS – Sartorius • Ishial Tuberosity – Hamstring • AIIS- Rectus Femoris – • Lesser Trochanter – • Iliac Crest – obliques • Metzmaker, Pappus

36. Avulsion Fx – Hip/Pelvis • ASIS – Sartorius • Ishial Tuberosity – Hamstring • AIIS- Rectus Femoris – • Lesser Trochanter – • Iliac Crest – obliques • Metzmaker, Pappus

38. Surgery • ? • Consider if >2cm displacement