FAQ Category: Child

Not knowing the exact cause of the problem we can only offer some general guidelines. It would be best to get back with the doctor by phone and ask this question for your son specifically.

Most musculoskeletal problems heal in about six weeks’ time. Rest is the key to avoid re-injury or microtrauma during the healing stage of recovery. If there’s a bone fracture such as occurs with spondylolysis then healing may take a little longer.

A recent study of soccer players with back pain from spondylolysis tried using three months as their time period. Everyone who took three months off got better but some got better sooner.

The authors say it’s not possible to say how long kids should stop sports activity. When they are pain free then exercise and activity can be added back gradually.

It looks like that’s what most doctors suggest right now. But it’s not based on any research results or studies of children who have worn the harness. Even the use of the harness varies from doctor to doctor and region to region.

In a recent opinion column Dr. Carl Stanitski from the Medical University of South Carolina (MUSC) called for a study to look at the long-term results of current treatment with the harness. The hope is to come up with objective clinical and imaging guidelines.

Until that information is available continue to ask your physician this question and watch for any updates on the topic.

There are a couple of treatment options for this problem. All involve putting the head of the femur (thigh bone) into the hip socket and keeping it there. The concept is called docking.

The idea is that pressure from the bone inside the hip socket will help stimulate normal growth and development. Without this, the socket remains shallow and the hip is in danger of dislocation.

One way to hold this position is with the use of a special device called a Pavlik harness. This is used with the infant or young child who has not started walking yet. It looks like a sling the fits around the outside of the clothing. It holds the legs open and hips rotated out. That’s the position of greatest stability in the hip.

If the harness fails a special trunk and hip brace can be used. Sometimes surgery is needed to reform the hip. The child is put in a body-cast for six weeks afterwards.

Studies suggest earlier may not be better for this type of problem. Surgery too early before major bone growth occurs can disrupt the surgery done. Surgery too late may not be able to change the muscular imbalances that have formed.

The best results seem to occur on children operated on between the ages of seven and twelve. They seem to get the best motion back. They also have the best correction of the leg length difference from side to side. X-rays show fewer arthritic changes later in life.

Surgery for this problem in children between three and six often requires another operation later. Waiting until the child is older than 12 can lead to worse outcomes. It’s likely that at the older ages the bone is less able to adapt and remodel.

Your surgeon will be able to advise you given your child’s case. Let him or her know your concerns about the timing in relation to school and see what’s suggested.

Interruption of the blood supply to the bone is called ischemia. This must be treated right away or the bone can start to die, a process called necrosis. Usually surgery is the next step.

The surgeon will reform the angle of the bone so that the top of the femur (thigh bone) fits into the socket. Sometimes it’s necessary to build a little bridge or cap over the edge of the socket to keep the bone in place. The operation is called an osteotomy for short or the full name: derotational valgus osteotomy.

The results of this operation are usually very good. The changes made help restore the leg length and allow the muscles to function normally again. Many children are able to walk without a limp. Later in life mild arthritic changes may occur. Studies show much more involved arthritis for those who don’t have this surgery.

All three of those imaging methods are equally accurate for measuring limb length. X-rays do expose the person to some radiation. For a single X-ray that isn’t much but if he will need repeated X-rays over time then an MRI might be better (no radiation).

MRIs also give detailed information about the bones and soft tissues. That might be helpful in your son’s case. MRIs are more expensive than X-rays. You might want to check your insurance coverage as part of your decision-making process.

CT scans have decreased radiation exposure compared to X-rays. Their only other real advantage is in assessing leg length difference when the knee can’t straighten out all the way. If that’s not a problem, then X-ray or MRI may be your best bet.

You’re right to ask about the exposure to radiation with repeated X-rays during childhood. X-rays are the most accurate and reliable means of measuring limb length. But researchers at Cornell University are looking at the accuracy and reliability of other imaging methods.

They compared X-rays to CT scans and MRIs. The results from all three imaging techniques were checked against direct measurement of the bone with electronic calipers. CT scans and MRIs were just as good as X-rays. They are more expensive and require the child to hold still longer but there is no exposure to radiation.

Feel free to bring this concern up to your physician. Perhaps the X-rays could be taken less often (for example, every two years instead of every six months) with other means of imaging in between.

At this age plain X-rays are usually enough to rule out serious problems like infection, fracture, or tumor. Occasionally a stress-related injury can cause a fracture in the vertebral bone. This is called spondylolysis.

Other imaging studies may be helpful. Bone scans can be used to show any defects that might not appear clearly on X-rays. MRI or CT scan are sometimes ordered after normal X-rays. It’s not clear which testing is best. Scientists are actively trying to find the best test for this problem.

Most sports medicine physicians will advise caution when playing while having back pain until the problem is clearly identified. Pain-free sports competition is the goal.

Treatment for this condition of temporary blood loss to the head of the femur (thigh bone) depends on the condition of the hip. Any imaging study that can show the shape of the femoral head and locate any partial or full dislocations would be helpful.

An MRI is useful because it clearly shows all three parts of the child’s femoral head. The very top of the bone that fits into the hip socket is called the epiphysis.

Just below the epiphysis is the physis. This is the growth center of the femur. It’s here that bone forming cells help the bone grow in length.

The third portion is the metaphysis, the upper part of the femoral neck. Any softening or spongy changes in this area shows a loss of blood supply. An MRI can show if the blood supply has been cut off to one, two, or all three parts of the bone.

Long-term results of this disease vary based on the age of the child at diagnosis and severity of damage to the bone. In this disease the blood supply to the top of the thigh bone (femur) is temporarily turned off. Without blood, the bone starts to die. This process is called bone necrosis.

Some doctors use a formula to predict a good, fair, or poor prognosis for Perthes’ disease. Points are given based on the child’s age and the appearance of their X-rays.

In the normal hip, the head of the femur is a round ball or in children, a round cap. In Perthes’ disease this shape changes. The still growing cap of the femur can get dislodged or dislocated. Either of these events predicts a worse outcome.

Having a formula like this will help doctors advise families about medical treatment. Surgery may be avoided if the prognosis is good. Early treatment for children with a poor prognosis may improve the final results.

Loss of blood to the head of the femur (thigh bone) is called Perthes’ disease. There are four stages to this condition. Treatment depends on which stage the child is in when the diagnosis is made.

Stage one (initial stage) is often unnoticed as often there are no symptoms. Many children are diagnosed in stage two (sclerotic stage) when pain and a limp become obvious. It’s best if treatment can be started in this stage. The goal is to decrease inflammation, pain, and muscle spasm around the hip. Drugs, rest, and physical therapy are used to do this.

Stage three (necrotic stage) ends with stage four called reossification. During this and the final healing stage the goal is to keep the femoral head as round as possible and in the hip socket. It may be necessary to use casts, braces, or even surgery during this stage.

Surgical treatment may be needed much later if there is a leg length difference from lack of growth on the Perthes’ side.

In layperson’s terms, you’re talking about Little League shoulder. Some call this a stress fracture of the growth plate at the top of the upper arm. It occurs when a large rotational force or load is placed on the bone during the act of throwing.

Damage of this type to the growth plate occurs with repeated trauma. A local inflammatory reaction is set up in the area of the growth plate. Eventually a fatigue fracture occurs.

Doctors prefer to use a term that describes the lesion. In this case proximal refers to the top of the humerus. The humerus is the upper arm. The growth plate is called the epiphysis. Separation of the epiphysis from the bone is an epiphysiolytic fracture or epiphysiolysis.

It could be a fluke or there may be one or more specific reasons. Young baseball pitchers often are on the bench for overuse injuries. Many times it’s because of poor throwing techniques. In other cases the boys’ muscles and bones just aren’t developed enough to keep up with the number of pitches required in a season of games.

A recent study of 12-year old youth baseball pitchers in Colorado is starting to shed some light on this topic. Using two high-speed video cameras the boys were filmed from the front and side while throwing 50 mph fastballs.

The movements of the arm and ball were analyzed. They found the arm-cocking position preparing for the pitch puts a lot of rotational force through the bone. The forward release of the ball causes a distractive force on the bone. Without enough muscle bulk to protect the joint, damage can occur.

The coaches can review throwing mechanics and other factors such as quantity and frequency of pitches. Pitchers should be limited in the number of pitches they throw each week. This includes both practice and game time. Some coaches only count the game playing time.

Injuries can occur as a result of overuse or trauma. Overuse or overtraining is an example of a noncontact injury. The player develops a sore shoulder or tendinitis that keeps them out of the game.

Traumatic injuries are most often caused by direct contact with another player. Noncontact injuries can be caused by trauma, too. For example the player who changes direction suddenly on a muddy field and tears the anterior cruciate ligament in her knee — that’s a noncontact traumatic injury.

Sometimes a sudden increase in training time can lead to an increased number of noncontact injuries. Returning to training or game play too soon after an injury can also lead to re-injury. If possible find out the cause of your daughter’s injury. She can work with the coach and trainer to design a training program for her specific needs and avoid future injuries.

Various sports injuries have been reported. Researchers always try to find a link or connection to explain what’s happening. When it comes to elbow problems, there’s no doubt the number is on the rise. Before organized baseball, many of these conditions never even
existed.

Repetitive play, long practices, and younger athletes combine together to create this new problem. Growing bone is especially at risk for damage from physical stress, high loads, and repeated motions. In many places, the warm climate allows for year-round practice and play. Some players are so dedicated, they practice hours every day in and out of season.

He will probably miss the entire season either way. If the surgery is done, rehab takes several more months after recovery. It’s best to listen to your doctor’s advice. Studies
show that if the growth plate is disturbed, deformities, fractures, and stunted growth of the limb can occur.

A recent report from the University of Texas advises strict use of a brace and reduced activities while waiting for the growth plates to close up. Surgery to repair the torn ACL can be done within a month after plate closure. The patient can continue to maintain
motion and strength, but twisting or jumping are not allowed.

A study of 13 teenagers with open growth plates and an ACL tear showed no further damage or injury to the joint while waiting for skeletal maturity when following these guidelines. Delaying surgery will likely protect your son for a lifetime of sports and recreation pleasure.

X-ray is the number one tool for determining skeletal maturity. In children and some teens, there are growth plates (physes) at the ends of bones that aren’t fused
solid yet. This allows for bone growth and expansion. The physes are visible on X-ray as dark areas called radiolucency.

In the knee, the physes of the tibial tubercle is the last physis of the knee to fuse. The tibial tubercle is the large bump on the front of the knee, just below the kneecap. Age, height, hair growth, and other signs of sexual development are also part of the picture.

Children who are close to the same height (or taller) than the tallest family member may be close to full bone growth. Also, the smaller the openings between the physes and the main bone (on X-ray), the closer the child is to full maturity.

It’s a term used to describe injury to the inside of the elbow. It happens so often in pre-teens and young teens from pitching the name has caught on. When the pitcher throws the ball, the elbow is in a position called valgus. This means the angle of the elbow puts the force on the inside edge of the elbow.

Sports experts think a breaking pitch requires more force and twist on the wrist compared with the standard straight pitch. The force through the wrist travels to the elbow causing this problem.

Doctors from a clinic specializing in shoulder and elbow problems offer a guess on this one. In younger children, the medial epicondyle (boney bump on the inside of the elbow) isn’t fully formed yet. There’s a slight separation between the epicondyle and the
main bone. This allows for bone to fill in as the child grows.

As the bone fuses together, the force of the load gets shifted to the outside of the bone. That’s why older players have more symptoms of soreness around the lateral epicondyle (outside of the elbow).

A large study of students in Greece reports the carrying method doesn’t make a difference in the amount or kind of back pain students experience. They suggest age, height, and gender are the key factors.

Girls nearing puberty have the highest amount of back pain. Shorter children carry more of a load compared to taller children of the same age carrying the same weight. Adding sports to the picture seems to increase the number of students who suffer from back pain.

Although backpack weight varies from day to day, boys and girls carry about the same amount year round. These researchers suggest girls aged 11 to 12 should carry light backpacks. Girls at the same age shouldn’t join strenuous sports activities. Shorter children should carry lighter backpacks, too. The backpack can be carried on one or both shoulders.