FAQ Category: Child

Turf toe is an injury to the big toe. The toe gets bent back so far the joint capsule gets torn. Jamming the toe or pushing off from the big toe are also common causes of this problem. The toe may be only sprained but fracture can also occur.

The most common cause of turf toe is when an athlete stubs or jams his toe on the field. Artificial turf is the culprit here. The playing surface gives players much better grip. The foot doesn’t slide and gets stuck more easily.

This type of injury can still occur on any surface, not just artificial turf. The special shoes worn by many players gives them such grip, they can’t always make quick direction changes. Football, soccer, or rugby players seem to be affected by turf toe the most often.

Poor shoe fit can also contribute to the problem. You can’t do much about the playing surface, but getting a proper shoe size can help. The toe box where the toes rest inside the shoe should not be so long or so wide that the foot slides in the shoe, pressing the toes up against the edge of the box.

The term SLAP lesion refers to a tear in the cartilage around the shoulder socket. A small, lip of cartilage around the rim of the socket is called the labrum.

SLAP refers to the location and extent of the tear. S stands for superior or the top of the shoulder. L is for labrum. A and P for anterior and posterior describe the location and length of tear from front to back.

SLAP injuries are ranked as Type 1 (mild) to Type 4 (severe). Most SLAP lesions are surgically repaired, especially in a high-level athlete. Type 1 is gently scraped or shaved free of any frayed edges. Types 2 and 3 may need to be stitched back into place. Type 4 usually indicates the biceps tendon has torn away from the labrum. It must be repaired, too.

The athlete will be involved in a shoulder rehab program with a physical therapist. Motion is gradually restored along with strength. Sport-specific exercises are added several months later. A javelin thrower would be able to start a throwing program after about four months of rehab.

Full return to the sport is possible but not usually in the first year. The earliest return to competition has been reported at seven months post-op. It usually takes about 18 months to restore full function.

A recent study from the Division of Child Psychiatry at the David Geffen School of Medicine in L.A. suggests a high percentage of children suffer from a variety of chronic pain.

Girls may suffer from problems slightly more often than boys (55 per cent girls, 45 per cent boys). The average age of the children studied was around 14 years old. Three-fourths were Caucasian. The most common type of pain was headache (48 per cent) followed by abdominal pain (40 per cent). Back, chest, foot, or limb pain made up a small proportion of reported pain.

Often there is a suspected behavioral, social, or psychologic reason for the reports of pain. Children are better able to manage their pain and function despite the pain when they have a high degree of self-efficacy.

Self-efficacy is the belief that a person has the ability to perform a behavior or action. Patients with a high sense of self-efficacy are more likely to respond to treatment with a positive outcome. Children with a low sense of their own abilities are more prone to anxiety, depression, and low levels of function.

It sounds like your son may have a condition called slipped capital femoral epiphysis (SCFE). In children, at the top of the femur (thighbone) there’s a growth plate. The growth plate is sandwiched between two special areas of the bone called the epiphysis and the metaphysis.

The growth plate is made of a special type of cartilage that builds bone on top of the end of the metaphysis and lengthens the bone as we grow. In this condition, the growth center of the hip (the capital femoral epiphysis) actually slips backwards on the top of the femur.

What happens to any condition that’s left untreated is called the natural history. The natural history of SCFE isn’t certain from patient to patient. It could remain stable without problems.

More likely complications and problems can occur. For example osteonecrosis can develop. This is a loss of blood supply to the bone with death of bone cells. The hip may also degenerate and develop arthritis so that the person is in great pain, loses function, and may not be able to walk.

Fortunately, the condition can be treated and the complications avoided or reduced if recognized early. Surgery now can stabilize the hip and prevent the situation from getting worse. Long-term studies show a good result with surgery done early to stabilize the hip.

In patients with a complete tear or rupture of a ligament or other soft tissue, the surgeon is able to pass the arthroscope right through the space between bones or joints. This is commonly referred to as the drive-through sign.

In any joint, a positive drive-through sign is diagnostic of multidirectional joint laxity or instability. Surgery is required to repair the damage and restore joint stability and function.

Repair may be possible arthroscopically at the time of the arthroscopic exam. Sometimes the surgeon completes the exam and then performs an open procedure to repair or reconstruct the damaged area.

It sounds like that’s what happened in your daughter’s case. Using arthroscopy to make a definitive diagnosis is important in choosing the right treatment for the problem.

Children have a remarkable ability to heal without surgery. A small amount of help in the right direction can save him from having unnecessary surgery. Recovery time is about the same (if not longer with surgery) but the expense is far greater with surgery.

So for a small amount of time invested, he should be back to his normal activities sooner than later! If the surgeon has not immobilized the wrist in a cast, the therapist may provide him with a splint to stabilize the wrist during the healing phase. This step may help decrease inflammation during the early phase of recovery.

Range-of-motion exercises will keep the wrist moving smoothly so that scar tissue won’t restrict motion. Exercises to strengthen the muscles on either side of the wrist will be slowly and gradually added. The goal of the exercises is to stabilize and protect the wrist while the ligaments are out of commission.

If your son is not able to regain his preinjury level of function pain free, then surgery may be the next step. An MRI will probably be ordered to identify specific areas of damage. This helps the surgeon prepare in advance the specific treatment needed.

Hopefully, with a small amount of therapy, your son’s symptoms will resolve, strength will improve, and he’ll be back on his roller blades once again. As a parent, you can help prevent future injuries by insisting he wear protective gear. This includes a helmet and wrist and kneepads.

Slipped capital femoral epiphysis (SCFE) is a fairly common hip problem. It affects teenagers between the ages of 12 and 16. In this condition, the growth center of the hip (the capital femoral epiphysis) actually slips backwards on the top of the femur (the thighbone).

Obesity is the biggest risk factor for SCFE because of the increased shear across the top of the femur from the extra weight on bone that hasn’t fully developed. Hormonal changes, rapid, growth, and endocrine factors may also play a role in SCFE.

The condition affects both hips in 50 to 60 per cent of all cases. Your physician will examine both hips and advise you. If there are signs of early changes in the other hip, then treatment of both hips may be needed. Studies show most children who have bilateral SCFE will develop a second slip within 18 months of the first one.

Treatment is most often with a long screw into the epiphysis to hold it in place. This can be done on both sides at the same time if needed. The surgeon will take into consideration your son’s age, endocrine status, X-ray findings, and your preferences when making this decision.

Research shows that screw fixation of the unaffected side is helpful. Unfortunately there’s no way to predict who needs this kind of preventive care or if it will always work.

Baker’s cyst (sometimes called a popliteal cyst) has been reported with Lyme disease. It is a rare presentation of this disease. Boys are affected more often than girls.

The cyst is located behind the knee. It fills with synovial fluid from the joint. There usually isn’t any infection present in the joint.

Antibiotic therapy is the main treatment for this problem. Treatment with oral antibiotics may not clear up the swelling. Sometimes two or three series of antibiotics are required. Intravenous antibiotics may be needed if the symptoms don’t go away with the oral antibiotics.

The Centers for Disease Control and Prevention (CDC) recently reported over 23,000 cases of Lyme disease in the United States. Most cases occur in the New England area, the mid-Atlantic states, Minnesota, and Wisconsin.

Only a handful of cases involving popliteal cyst have been reported. Because of its unusual presentation, it may be missed or misdiagnosed.

Bow legs or tibia vara are common in young children. The curvature develops from positioning in utero (in the uterus). This curvature remains until the muscles of the lower back and legs are strong enough to support them in the upright position.

By age five, there may be some improvement with growth but not much. The bowing could actually get worse as he gets larger and puts more weight through the growing but curved bones. The child may have trouble walking without tripping. The way the child walks may not look normal.

Correction of the deformity is about more than just the appearance. The angle, rotation, and length of the bone will be changed toward a more normal alignment. The goal is to restore the normal mechanical axis for the knee joint. The correction of angle will also affect the ankle and hip. Improved alignment can prevent future joint pain and problems from uneven wear.

If the bowing is only on one side or worse on one side, surgery will also equalize any differences in leg length present. Good correction now at a young age can prevent osteoarthritis and disability later.

Blount’s disease in children is an excessive bowing or curvature of the lower legs. If they don’t grow out of the condition, surgery may be needed to correct the deformity. Treatment is needed to improve alignment of the bone and keep an even leg length from side to side.

Once the repair has been made, the next step is to hold the bone in that position as it grows and lengthens. There are several ways to do this. The two devices you saw are likely the EBI external fixator and the Taylor Spatial frame.

The EBI is anchored to the bone with pins and clamps. It has a series of multiaxial joints that can be adjusted to change the curve, rotation, and length of the bone. The surgeon uses careful fluoroscopic (special X-ray) measurements and computer calculations to fix the device in just the right spot.

The disadvantages of this system are problems can occur from the pins if they get infected or if they damage nerves or blood vessels. If the device isn’t fixed in just the right position, a second operation may be needed to make necessary changes.

The second device (the Taylor frame) is a circular frame that fits around the lower leg. It has a series of interconnected struts that can be pulled and tightened to adjust the leg position. Any changes can be made without surgery. The advantage is the correction is more accurate and safe. The disadvantage is the correction is more gradual and may take longer.

You may be describing a condition called tigger thumb. The tip of the thumb snaps into a bent position and appears stuck. This is usually caused by the tendon getting caught inside its own sheath or lining. It can’t glide smoothly like it should.

The fact that you can move the joint back to a normal position is a good sign. It’s possible that just making this correction while you are holding or playing with your daughter will be enough to take care of the problem.

If there’s no change after a couple of months, then a splint can be used. The splint is made of plastic and is formed to your child’s hand. It holds the thumb in a neutral position and doesn’t allow it to bend.

This is worn all day for up to three months. A night splint is used after that to keep the problem from coming back. If there’s no correction and the trigger thumb remains, then surgery may be needed.

It’s not too uncommon for newborns or young infants to have a problem called developmental dysplasia of the hip or DDH. In this condition, there is a disruption in the normal relationship between the head of the femur (thigh bone) and the acetabulum (hip socket).

DDH can affect one or both hips. It can be mild to severe. In mild cases called unstable hip dysplasia, the hip is in the joint but easily dislocated. More involved cases are partially dislocated or completely dislocated. A partial dislocation is called subluxation.

Torticollis or wry neck is also known as congenital muscular torticollis (CMT). With CMT, the head and neck are turned and rotated to one side. The child may be stuck in this position. In other words, the baby may not be able to turn his head in the other direction. You might be able to passively turn his head from side to side. His tendency is to keep it turned in one direction.

These two conditions often occur together and especially in boys. Doctors aren’t sure exactly what causes these two problems. Position inside the uterus during pregnancy may be a big factor. There does seem to be a family history for some children suggesting a genetic trait. The fact that there is a difference between boys and girls also points to a possible hormonal cause.

Early diagnosis and intervention reduces the problems that can occur with DDH and CMT. We may not know what causes the problems but treatment is available. Talk to your pediatrician about all of your options. Make sure you continue with your well-baby check-ups. Your doctor may want to see your son more often during these early months of treatment.

Intrauterine packing phenomena refers to the position of the child inside the uterus during pregnancy. If the child does not move enough, muscles can get contracted (stuck in one position) or the hip can get dislocated.

Doctors aren’t sure what causes this to happen. Hip dislocation occurs in about one per cent of all newborns. Infants are routinely screened for hip problems at birth. When hip dislocation is present at birth, the risk of another problem called congenital muscular torticollis (CMT) is much higher.

In CMT, the sternocleidomastoid muscle (SCM) is contracted or stuck in a shortened position. This pulls the head and neck to one side. The head is often tilted and rotated. Boys are more likely than girls to have both DDH and CMT.

There could be a genetic factor as some of these problems tend to run in families. with the gender gap, there may also be a hormonal factor. Less often there is a movement disorder and the child is born with other developmental disabilities.

Hip dysplasia is also known as developmental dysplasia of the hip (DDH). An older, more outdated term would be congenital hip dysplasia. The change in name reflects the fact that DDH is a developmental process that occurs over time. It develops either in utero (in the uterus) or during the first year of life. It may or may not be present at birth.

DDH is a common disorder affecting infants and young children. In this condition the head of the femur (thigh bone) does not sit inside the acetabulum (hip socket) like it should. In mild cases called unstable hip dysplasia, the hip is in the joint but easily dislocated. More severe cases are partially dislocated or completely dislocated. A partial dislocation is called subluxation.

When hip dysplasia is present at birth, the parents or caregivers are shown how to double or triple diaper the baby. This will help hold the hip in good position. If after six weeks the hip remains unstable, then a special harness called the Pavlik harness may be used for the next three to nine months.

The harness keeps the hip in flexion (bent) and abduction (moved out and away from the body). If the hip still isn’t improved, surgery may be needed. Your doctor will work closely with you over the next few months to get started with treatment. Close follow-up is needed to ensure the best timing for any other treatment, especially surgery.

An unstable hip is one that is either already dislocated (out of the socket) or can be dislocated by the doctor when examining the child. Several hands-on tests can be done to determine whether or not a hip is stable or unstable.

The Pavlik harness is used most often to treat hip instability in young children. It is designed to keep the hip in a position of flexion and abduction (legs apart). This position keeps the ball (the femoral head) in the best position and allows the ligaments and joint capsule to tighten up.

The goal of treatment is to keep the femoral head in good contact with the acetabulum. A stable hip encourages the development of a normally shaped socket and rounded head of the femur. The proper hip position must be maintained for enough time to stabilize the joint.

The harness is usually worn until the doctor can no longer move the hip in and out of the socket. In the older child, x-rays may be used to confirm that the hip is stable. Ultrasound scanning has also been shown effective in keeping track of the hip’s progress.

Antibiotics are still the first line of treatment for bacterial infections. The overuse of antibiotics for all infections, including viral infections, which aren’t affected by antibiotics has led to antibiotic-resistant bacteria. Doctors are much more careful now in prescribing these drugs.

Joint infection frequently does not show up on X-rays. It may not be apparent on early MRIs either. Studies show that MRIs done after six days of symptoms are more likely to be positive when there is a joint infection than MRIs taken in the first six days.

If the lab tests show elevated white blood cells (WBCs), increased sed rate, and increased C-reactive protein, then treatment can proceed. If there’s any doubt, a second MRI can be done after six days. Depending on which joint is a problem, the doctor can also remove a little fluid from the joint and test it. This will identify the specific organism causing the infection.

You are safe to follow your pediatrician’s advice in treating this problem with an antibiotic.

Infections of the sacroiliac (SI) joint are most often caused by strep or staph bacterial infection. Trauma or some other type of infection in the body are the most common causes. The child may have had an earlier ear infection, strep throat, or skin infection. Even sinus infection or urinary tract infection can be the culprit.

Bacteria such as streptococcus or staphylococcus can travel through the bloodstream to the joint and cause a joint infection. This may be what happened in your son’s case.

Usually the immune system kills these invading bacteria. But in the young child whose immune system is still developing, the bacteria may survive. It then travels across the protective layers of the joint through the blood.

Antibiotics almost always take care of this problem. Only rarely (usually if the infection comes back) will surgery be needed. A quick visit to the pediatrician is needed any time a child develops fever, joint pain, and starts to limp. Early diagnosis of most infections can prevent further problems from developing.

Abnormal force on the tibia or lower leg bone from obesity causes a slowing down or even puts a stop to bone growth in some children. When the force exceeds the maximum amount that the growth plate can handle, then bone growth on one side of the bone is affected. The natural result is a condition called Blount disease or abnormal bowing of the lower leg.

At what point this happens remains unclear. Sometimes it occurs in the young child (under the age of three). In other cases, it doesn’t show up until the teen years. How much force is too much may vary from child to child. It’s not always clear at what point a child crosses over from being overweight to being obese.

It’s likely that Blount disease is multifactorial. This means that more than one cause combined together brings it on. Studies show that race, gender, and size are all part of the mix. More studies are needed to narrow down the exact cause and sequence of biologic or mechanical events that lead to this condition.

Blount disease is an excessive bowing of the lower leg in some children. The condition can occur early on in life (before age three) or later in the teen years. Being overweight seems to be a risk factor for this condition.

Male African-American children seem to be the most likely to develop Blount disease. More than 90 per cent of the children and adolescents with this condition in the U.S. are obese, African-American males. Large-sized parents seem to contribute to the risk for Blount disease. A specific genetic trait hasn’t been linked with this problem yet.

Obesity and poor nutrition are two modifiable risk factors. This means you can do something about them. Maintaining a normal weight for height is the first step to possibly preventing Blount disease. Your pediatrician can help track this by calculating your child’s BMI or body-mass index.

A good diet with healthy nutrition will help your child maintain his BMI within a normal range for his age. An active lifestyle is also helpful. Working closely with your pediatrician and a nutritionist will give your sons the best means to avoid this condition.

There are many different ways to assess the results of clubfoot deformity. Some doctors look at X-rays and how much the foot can be moved from the deformed position back to normal.

Others use the patient’s report as the best measure of results. Pain, satisfaction, and function are included. Function often includes range of motion and walking pattern. Participation in sports or other similar activities can also be part of the grading system.

Results will vary depending on which scoring system the physician uses. If the patient’s subjective report of satisfaction is the focus of the response, the results will be very different when compared with a scoring system that focuses on function instead.

A recent study compared 50 children with clubfoot using five different scoring systems. Like your experience, they found a wide range of results for individual children from poor to excellent.

When consulting with physicians, ask what kind of scoring system was used to assess the results. Perhaps using more than one will help give an overall picture of your child’s function, progress, and what to expect in the future. Using that approach may be the best way to view each child until a standard test tool is devised for this condition.