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Snap, Crackle, Apophysitis ArAFP 66 th Annual Scientific Assembly June 15, 2013 Elton R. Cleveland, DVM, MD. University of Arkansas for Medical Sciences.

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Presentation on theme: "Snap, Crackle, Apophysitis ArAFP 66 th Annual Scientific Assembly June 15, 2013 Elton R. Cleveland, DVM, MD. University of Arkansas for Medical Sciences."— Presentation transcript:

1 Snap, Crackle, Apophysitis ArAFP 66 th Annual Scientific Assembly June 15, 2013 Elton R. Cleveland, DVM, MD. University of Arkansas for Medical Sciences Arkansas Childrens Hospital

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

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

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9 Osgood- Schlatter n Boys (12 1/2-13), girls (11 1/2 years) n Tensile stresses acting across the junction of the immature patellar tendon and the tibia tubercule n Pain, tenderness, swelling - Bilat 56% n Rest, ice, activity modification, pain mgmt, hamstring stretches, padding

10 Osgood-Schlatters Disease

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

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

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14 Severs Disease n Osgood-Schlatters of the heel - Bilat 61% n Girls y/o, Boys 10-12y/o n activity related heel pain n X-rays may not be helpful because fragmentation and sclerosis of the calcaneal apophysis is normal n calf stretches, heel lifts, strengthen dorsiflexors, activity modification

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

18 Apophysitis vs Apophyseal Avulsion Fractures

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

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

21 Avulsion Fracture n Soccer 74 cases n Gymnastics55 cases –Rossi, Dragoni

22 Avulsion Fx – Hip/Pelvis n Ishial Tuberosity 54% n AIIS22% n ASIS19% n Pubic symphysis 3% n Iliac Crest 1 % –Rossi, Dragoni

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

24 Imaging n Xray n CT n MRI n U/S

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

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

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

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

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

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38 Surgery n ? n Consider if >2cm displacement


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