Common Childhood Orthopedic Concerns – Medical Update

Nursemaid’s Elbow:
Children between the ages of 2 and 4 are susceptible to certain injury patterns because of the stage of skeletal development. A common injury that is seen frequently in the ER is nursemaid’s elbow.
More specifically the injury is subluxation of the radial head. This means that one of the bones in the elbow called the radial head becomes partially dislocated. The injury has been described most often when adults are simply playing with the child and while swinging the child by the arms the injury occurs. The child will complain of elbow pain, often the injury mechanism is not recognized because of the playful nature of the event.

The child will not use the arm and often hold the arm in a straightened position. Most often the child is taken to the ER. The treatment consists of x-rays to rule out a fracture. Many times the radial head subluxation will reduce during the x-ray positioning. If not, the doctor will perform a simple reduction maneuver that moves the bone back into place. Usually within minutes the child uses the arm with no pain.

Growing Pains:
Have you ever taken your child to the doctor with knee pain or ankle pain and been told, “Oh, it’s just growing pains?” You may have felt like you were just getting brushed off, but it actually is a common source of pain in the growing skeleton.

The two most common locations are pain in the front of the knee on the shin bone, and over the heel in the back. These disorders have fancy names that are grouped into a medical term “apophysitis”, which refers to strain at the attachment site of a tendon to an open growth plate.

In the knee, the specific diagnosis is called Osgood Slaughter’s disease. This refers to an apophysitis at the attachment of the Patellar tendon to the Tibia (shin). What causes the problem is that as the long bones grow longer, it puts more strain on the tendons as they stretch to stay up. The weak link is the tendon attachment on the bone. A layperson’s way to think of this is the long bones outgrow the tendons. Once growth reaches maturity, the pain is gone and the problem is solved.

In the ankle, this is called Sever’s disease and occurs where the Achilles tendon attaches to the heel bone (calcaneus). Again, the long bones grow too fast and it puts a strain on the attachment of the Achilles, on the heel bone. These kids will complain of possible heel or ankle pain and often times walk on their toes to get relief.

Treatment for both disorders is stretching, stretching, stretching, and anti-inflammatory medication. It rarely has any long-term consequences.

Knee Cap Pain:
A very common complaint during the adolescent years is anterior knee pain. Especially common in girls, this pain is often attributed to knee cap pain. The condition is called patella femoral syndrome. This name describes the knee cap (patella) and its relationship to the leg bone (femur).

It is a disorder where the knee cap does not move, or track, correctly in its groove on the femur bone. If you feel your knee cap when you move your knee through range of motion, you will feel your knee cap move up and down as your knee moves. To make this happen, there is a joint in the front of the knee called the patellofemoral joint. When the knee cap tracks improperly it produces pain.

It has to do with the attachment of the quadriceps muscle to the knee cap. As the quad contracts, it moves the knee cap up and down within the knee joint. The problem arises when the knee cap pulls too hard toward the lateral side of the knee. In the short term this causes pain and in the long term it causes abnormal wear underneath the knee cap.

Earlier we said that females experience this problem more than males. This is because God created the female pelvis in a different shape in preparation for childbirth. Because the quad muscle is anchored from the pelvis, it creates a more lateral pull on the knee cap and thus more knee cap pain.

Treatment for Patellofemoral Syndrome is physical therapy, bracing, and avoiding deep knee bend exercises. In difficult cases, sometimes arthroscopic surgery is performed to release the lateral knee structures to assist in improved tracking. Left untreated, it will develop into arthritis often times as early as the mid-40’s. Injections can be used to treat symptoms, but they do not correct the underlying mechanics, so therefore are often not used. Bracing can be very effective when performing certain activities that are known to aggravate symptoms.

If you think your child may be experiencing these or other issues, give Dr. Boyett’s office a call at OrthoSports in Athens at (256) 233-2332.
By: Patrick Boyett