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ERIC SMALL, MD, FAAP

ERIC SMALL, MD, FAAP. Assistant Clinical Professor of Pediatrics, Orthopedics, and Rehabilitation Medicine Mount Sinai School of Medicine New York, New York Director Sports Medicine Center for Young Athletes Blythedale Children’s Hospital.

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ERIC SMALL, MD, FAAP

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  1. ERIC SMALL, MD, FAAP Assistant Clinical Professor of Pediatrics, Orthopedics, and Rehabilitation Medicine Mount Sinai School of Medicine New York, New York Director Sports Medicine Center for Young Athletes Blythedale Children’s Hospital

  2. Common Knee Injuries in thePediatric Patient

  3. Differential Diagosis • Orthopedic/Musculoskeletal Condition • Medical Condition • Lyme Disease • JRA • SLE • RSD/Fibromyalgia

  4. History • Traumatic vs. Nontraumatic • Type of Treatment Given • Past Medical History • Family History

  5. History • Traumatic vs. Nontraumatic • Type of Treatment Given • Past Medical History • Family History

  6. History • Traumatic vs. Nontraumatic • Type of Treatment Given • Past Medical History • Family History

  7. History • Traumatic vs. Nontraumatic • Type of Treatment Given • Past Medical History • Family History

  8. History • Traumatic vs. Nontraumatic • Type of Treatment Given • Past Medical History • Family History

  9. Key Questions • Immediate Swelling? • Able to continue to play? • Full or Partial Weightbearing?

  10. Swelling • Immediate Swelling • Swelling Several hours later • Swelling Next Day

  11. Pain • Pain with activity • Pain after activity • Pain the next day

  12. Symptoms • Locking • Clicking • Giving Way

  13. Physical Exam • Swelling • Point Tenderness • Comparison with other knee

  14. Physical Exam • Swelling • Point Tenderness • Comparison with other knee

  15. Physical Exam • Swelling • Point Tenderness • Comparison with other knee

  16. Physical Exam • Swelling • Point Tenderness • Comparison with other knee

  17. Special Tests • Anterior Drawer Test • Lachman Test • McMurray Test • Apley Test

  18. COMMON DIAGNOSES • Patellafemoral Pain Syndrome • Osgood Schlatter Disease • Patella Tendonitis • Sinding Larsen Johannson Syndrome • Patella Subluxation/Dislocation • ACL Tear

  19. PATELLAFEMORAL PAIN SYNDROME • Chondromalacia Patellae • Anterior Knee Pain • Runner’s Knee

  20. PRESENTING SYMPTOMS • Pain in and around patella • Swelling only in severe cases • Pain walking up and down stairs • Positive theatre sign

  21. PFSS-Other findings • More common in Females • Q Angle • Patella Hypermobility • Shallow trochlear Groove • Patella Subluxation

  22. PHYSICAL EXAM • Patella Facet Pain • Positive Patella Compression Test • May have associated Plica • May have pain with hyperflexion

  23. MANAGEMENT • Decrease running by 30 - 50% • Straight leg raising to 10 pounds (VMO) • McConnell Taping • If fail conservative management lateral release and plica resection

  24. OSD BACKGROUND • First described in 1903 • Osgood (Boston) • Schlatter (Switzerland) • Immobilizaton • 5:1 in boys than in girls

  25. OSD HISTORY • In peak growth spurt • Pain with running and squatting

  26. OSD PHYSICAL • Pain at tibial tubercle • Extremely tight hamstrings (SLR 30 degrees)

  27. OSD MANAGEMENT • Hamstring Stretches 3 - 4 times per day • Cho-pat Osgood Schlatter Band • Neoprene Knee sleeve with patella cut-out • Do not immobilize • Biking and swimming encouraged

  28. Patella Tendonitis • More common in adolescence in association with Osgood Schlatter or SLJ

  29. Patella Tendonitis Treatment • Ice Massage • Hamstring/Quad Strengthening • Biking/Swimming • Decrease Impact activities by 30-50%

  30. SINDING LARSEN JOHANNSON SYNDROME • Pain at inferior pole of patella • juvenile osteochondrosis • jumper’s knee

  31. SLJ Treatment • Decrease Training by 30-50% • Hamstring/Quad Stretching • Biking/Swimming

  32. COMMON DIAGNOSES • Patellafemoral Pain Syndrome • Osgood Schlatter Disease • Patella Tendonitis • Sinding Larsen Johannson Syndrome • Patella Subluxation/Dislocation • ACL Tear

  33. COMMON DIAGNOSES • Patellafemoral Pain Syndrome • Osgood Schlatter Disease • Patella Tendonitis • Sinding Larsen Johannson Syndrome • Patella Subluxation/Dislocation • ACL Tear

  34. ACL Tear • Noncontact Injury • More common in females • Rise in skeletally immature population • Surgery is dependent on individual case

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