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Athletic Training Services Team
Texas Medical Center/San Jacinto
Jeff Collins, LAT
Jace Duke, ATC, LAT
Emery Hill, ATC, LAT
Terry King, LAT
Michelle Leget, ATC, LAT
Scott Tidwell, LAT
Jerry Meins, ATC, LAT
Stephen Melancon, ATC, LAT
Brandon Roberts, ATC, LAT
Bill Wissen, ATC, LAT
Richard Gregoire, ATC, LAT
Layne Schramm, ATC, LAT
Dwight Adsit, ATC, LAT
Paula Douglas, ATC, LAT
Keith Jahn, ATC, LAT
Mike Pace, ATC, LAT
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Osgood-Schlatter's Disease: A Catastrophe Waiting to Happen?
Osgood-Schlatter's Disease (OSD) has been described in the literature since the early 1900s and is classified as an apophysitis of the anterior tibial tuberosity (ATT). OSD is a common condition in an active youth population experiencing rapid growth (girls ages 10-13 and boys ages 12-15) and is said to be responsible for a significant number of days lost from training and competition. OSD occurs during early adolescence and is exacerbated with increased physical activity. As a result of pain, adolescent athletes affected with OSD often miss training time, and performance on the court or field can be diminished during active inflammatory and painful periods.
Clinical examination, X-ray, doppler ultrasound and MRI investigation help establish the OSD diagnosis. The initial mechanism of injury is repetitive traction of the patellar tendon on its distal insertion at the ATT epiphysis. Fragmentation of the ATT at the epiphysis has been questioned as a definitive sign of OSD, but has subsequently been seen as a normal development of OSD. Fragmentation of the ATT is found in symptomatic as well as asymptomatic knees and cannot be used to discriminate between the normal and abnormal radiologic findings.
During adolescent growth spurts, the cartilage cells of the physis not only become more active but also become more prone to injury. Hypertrophy and weakening of the hypertrophic zone of cartilage are thought to be the cause. Open epiphyses (growth plates) provide additional injury sites not seen in mature skeletons. Adolescents are frequently injured during a traumatic event, thereby avulsing the physes. Apophysitis is a tuberosity stressed in traction, whereas epiphysitis is a compression or shear injury; epiphyseolysis is the widening of a growth plate under stress.
Although little research has identified exact mechanisms of overuse injuries in children and adolescents, these injuries can be caused by training errors, improper technique, excessive sports training, inadequate rest, muscle weakness and imbalances, and early specialization. More than half of all reported overuse injuries are speculated to be preventable, but little data supports this claim.
Once the diagnosis of OSD is confirmed, treatment of the injury is often based on symptoms. When the athlete is symptomatic and normal body mechanics are altered due to pain, rest is the preferred treatment through the inflammatory phase of the growth spurt. Ice and anti-inflammatory medication can help alleviate pain, but if separation of the physis is present, the risk of an avulsion fracture is possible. Activity can usually be resumed after symptoms resolve.
What is a Stinger?
As high school football enters mid-season, many young athletes are probably feeling the physical effects of the rigorous practice and game schedules. One of the injuries about which I am often asked by parents is what is a "stinger" and is this something that should cause concern?
Football season is a time of new and colorful injuries for the uninitiated. A stinger has nothing to do with wasps or bees. A stinger or burner, as it is also called, is a brief feeling of paralysis of the arm after a blow to the shoulder or neck. Typically this injury happens when a football player hits another player with his shoulder pads and his head is pushed away from the shoulder. This collision causes a stretch to the nerves that supply the arm just after they come out of the neck. Those nerves lie just underneath the trapezius, the muscle that lies between the shoulder and the neck.
Some authors believe that it is a stretch to those nerves, while others feel it is a hit directly on the nerve that causes the symptoms. Players typically come off the field with one arm just hanging at the side. They have some pain, but mostly just notice that they can't move their arm. The symptoms go away within a few minutes and there are no long lasting effects. Linemen, linebackers and running backs probably sustain this injury most frequently.
Stingers are very common and are not concerning as long as the symptoms go away. This is very important and coaches, parents and athletes should not take this injury lightly. If an athlete complains of numbness or weakness in an arm after a collision, they must be held out until the symptoms resolve and their strength is the same as the other side. If the symptoms do not resolve, or the athlete experiences recurrent stingers, they need to be evaluated for neck problems. Usually this can be accomplished with neck X-rays, flexion and extension views (looking down and looking up) – but may require further advanced imaging to ensure there are no other problems with the neck.
One other important point to remember is that stingers are always on one side only. If an athlete complains of pain or weakness or numbness in both arms after a collision, they should be evaluated by a doctor prior to return to sport. Symptoms on one side or the other is okay, but both sides at the same time may indicate something more serious than a simple stinger injury and requires further evaluation.