Physical health problems encountered during
adolescence can affect the development of the body, if
not treated. There are few anatomic regions, such as
spine, knee and ankle, in adolescents which can get
orthopedic problems such as Osgood-Schlatter disease,
and Slipped Capital Femoral Epiphysis.
Osgood-Schlatter disease is caused due to injury or
overuse of the knee which causes swelling and pain in
the area below the knee, above the shin bone. The
patellar tendon and the soft tissues surrounding it gets
inflamed, because of the constant pulling of the area
where the tendon joins the below knee. Usually,
adolescents who participate in sports actively and are
athletic, such as football, basketball, soccer, ballet
and gymnastics, tend to get the Osgood-Schlatter
disease. Boys of age eleven to fifteen and girls of age
eight to thirteen are at greater risk. The reason why
adolescents get this problem is that their bones grow
faster when compared to the tendons and muscles in this
age and because of this the muscles and tendons stretch
and become tight.
The symptoms of Osgood-Schlatter disease are swelling of
knee, tenderness below knee area and limping. The doctor
will check the medical history of the patient and will
conduct physical examination and diagnostic procedures
such as taking an X-ray. The physician will decide on
the treatment to be done by studying the overall health,
age, medical history, tolerance for certain medications
and extent of the disease. Treatment will include
medications, rest, compression, elevation, neoprene knee
sleeve and physical therapy. The main aim will be to
control and limit the knee pain by cutting down on the
adolescent’s physical activities. Usually the Osgood-Schlatter
disease gets healed over a period of time and in very
rare cases is a surgery required.
Slipped capital femoral epiphysis is a problem which
affects the hip joint. The ball or head of the thigh
bone, also known as femoral head slips from the thigh
bone’s neck. Because of this the hip joint becomes stiff
and painful. Slipped capital femoral epiphysis is the
most common disorder of the hip which can happen in both
the hips or one and it is more common in boys when
compared to girls. Basically, adolescents of the age ten
to eighteen years and who are overweight can be affected
by this condition. The condition can arise over a time
interval of few weeks or years. The condition, if
resulted because of trauma and is also called acute slip
and if results after a period of time is called chronic
slip. Slipped capital femoral epiphysis is caused
because of medications, radiation treatment, thyroid
problems, and chemotherapy.
There are three degrees of intensity of slipped capital
femoral epiphysis, mild, moderate and severe. In mild
slipped capital femoral epiphysis, only one third of
femoral head slips from the thigh bone. In moderate, one
third to half slips and in severe, more than half of the
femoral head slips. The symptoms of this condition are
pain in hip which increases upon movement, pain in
thigh, knee & groin and limpness in the leg. When an
adolescent walks there will be a clicking sound in the
hip and his/her legs will be turned outwards.
Apart from studying the medical history of the patient,
the doctor will recommend diagnostic procedures such as
bone scans, X-ray, magnetic resonance imaging and blood
test. The bone scans will determine the arthritic
changes and degenerative changes in the joints, which
helps to detect tumors & bone diseases and the cause of
pain and inflammation. The X-ray will give the inside
picture of the bones, tissues and organs. The magnetic
resonance imaging provide detailed image of the
structures within the body with the help of large
magnets. It is best if slipped capital femoral epiphysis
is determined in the early stages, so that the femur
bone’s head doesn’t slip off any further. The adolescent
may need to undergo a surgery along with physical
therapy.
Scoliosis in Adolescents
Normally, a spine when viewed from rear should appear
straight but if the spine is lateral or curved or
sideways or rotated then it is affected by scoliosis. It
gives an appearance as if the person has leaned to a
side. According to Scoliosis Research Society the
definition of scoliosis is the curving of the spine at
an angle greater than 10 degrees on an x-ray. Scoliosis
is a kind of spinal deformity and shouldn’t be confused
to poor posture. Usually there are 4 common kinds of
patterns of curves experienced in Scoliosis which are:
Thoracic wherein the right side has ninety percent
curves, lumbar wherein left side has seventy percent
curves, thoracolumbar wherein right side has eighty
percent curves and double major where both right and
left sides have curves.
In majority of the cases, as high as eight to eighty
five percent, the cause of the deformity is unknown,
this is also known as idiopathic scoliosis. It is
observed that females have scoliosis more commonly than
males. According to some established facts 3 to 5
children per 1000 has chances of developing spinal
curves which is a number big enough requiring medical
treatment. There are three types of scoliosis that can
develop in children namely congenital, neuromuscular and
idiopathic. Congenital scoliosis is seen in 1 out every
1,000 births which is caused due to vertebrae’s failure
in normal formation, vertebrae is absent, vertebrae is
formed partially and vertebrae is not separated.
Neuromuscular scoliosis is linked with various
neurological conditions and particularly in children who
don’t walk like cerebral palsy, muscular dystrophy,
spina bifida, tumors in spinal cord, paralytic
conditions and neurofibromatosis. The cause of third
type of scoliosis called Idiopathic scoliosis is still
unknown. It is further divided into infantile, juvenile
and adolescent scoliosis. Infantile scoliosis occurs up
to the age of 3 years from birth wherein the vertebrae
curve is towards left and is more frequently observed in
boys. The curve takes normal shape with the growth of
child. Juvenile scoliosis is common in children of age
three to nine. Adolescent scoliosis is common in kids of
age ten to eighteen and this is also the most common
form of scoliosis occurring more in girls than boys.
The other possible causes of the deformity include
hereditary reasons, different lengths of legs, injuries,
infections and tumors. There are numerous symptoms
attributed to scoliosis which can vary from individual
to individual. The symptoms are: Difference in heights
of the shoulders, off-centered head, difference in the
height or position of the hip, difference in the
position or height of shoulder blade, different arm
lengths in straight standing position and lastly
different height back sides when the body is bent
forward. Other symptoms include leg pain, back pain and
change in bladder and bowel habits do not belong to the
symptoms of idiopathic scoliosis and require medical
checkup by a doctor. The symptoms may be similar to
other problems related to spinal cord or other
deformities or could result from an infection or injury
and consulting a doctor is the best bet in this
situation who may conduct diagnosis to know what exactly
it is.
The diagnosis of scoliosis requires thorough medical
history of the teenager, diagnostic tests and also
physical examination. The doctor asks for entire
prenatal history, birth history and also would want to
know if anyone in the family has scoliosis. The doctor
may also ask for the milestones related with the
development of the teenager since some kinds of
scoliosis are known to be related to neuromuscular
disorders. The delay in development may need additional
medical evaluation. Doctor may also prescribe x-ray, CT
scan and MRI scan of the back to measure the degree of
curvature in the spinal. There are various treatments
available for scoliosis which is decided by the
physician depending on teenager’s age, medical history
and health in general. The method of treatment also
depends on the extent to which disease has reached. The
tolerance of the teenager to certain medicines,
therapies and procedures are also taken into
consideration. Expectations and opinion of the parents
or teenager is also the criteria in deciding the type of
treatment. The main aim of the treatment is stop the
curve from progressing and avert deformity. The
treatments include observation and repetitive
examinations, bracing and surgery to correct the defect.
Sprains and Strains in Adolescents
Sprains and strains are among the majority of the
injuries caused while playing sports. Sports injuries
can be caused by small trauma which involves ligaments,
muscles and tendons including bruises, sprains and
strains. The body part which is most commonly involved
in spraining or straining is the ankle. The 3 ligaments
that are involved during ankle sprain or strain include
anterior talofubular ligament, posterior talofibular
ligament and calcaneofibular ligament.
An injury caused to the soft tissue as a result of a
direct force like fall, kick and blow is called a
contusion or a bruise. A sprain is nothing but a
ligament injury which is wrenched or twisted. Sprains
usually affect knees, wrists and ankles. On the other
hand a strain is an injury caused to a tendon or muscle
which usually results from force, stretching and
overuse.
Sprains/Strains are usually diagnosed by a physician
after a physical examination. The physician asks for
thorough medical history of the adolescent and asks
various questions that lead to the cause of the injury.
Various diagnostic procedures are also available which
also helps in evaluating the problem. X-ray is one of
the oldest and common diagnostic tests done to know the
extent and exact location of the injury. An x-ray uses
electromagnetic waves to get photos of internal tissues,
organs and bones onto a film. MRI scan is one of the
recently evolved diagnostic procedures which also help
in evaluating a physical injury. This procedure actually
called Magnetic Resonance Imaging makes use of bug
magnets, computer and radio frequencies to get detailed
pictures of structures and organs inside the body.
Another diagnostic procedure called Computed Tomography
Scan or CT scan is also used to evaluate the extent and
location of injury. This procedure uses a blend of
computers and x-rays to get cross sectional pictures in
horizontal and vertical alignment. It shows thorough
pictures of any part of the body like muscles, bones,
fat and organs. They provide more information than
conventional x-rays.
There are various symptoms of strain and sprain
depending on each teen’s physical condition and they may
vary accordingly. One of the symptoms includes pain in
and around the area injury. There could also be a
swelling around the injured area. Some teens also
experience difficulty when they use or move the area of
the body that is injured. Some teenagers also undergo
bruises or redness in the area that is injured. Many
times the symptoms of sprains and strains may look
similar to other medical conditions and a doctor’s
advice is the best option in this scenario.
Depending on various factors the treatment of sprains
and strains will be prescribed by the teenager’s
physician that include teenager’s age, overall health of
the teenager, and medical history of the adolescent. To
what extent the teen is injured is also a factor in
determining the nature of treatment. A teenager’s level
of tolerance to certain medications, therapies and
procedures is also taken into consideration before
opting for a particular method of treatment. The
treatment also depends of what expectations one has and
also preference and opinion.
Various options available for treatment include things
like restriction of the activity after the injury,
application of cast/splint on the injured spot, crutches
or wheelchair, physical therapy which involves
stretching exercises to give strength to the muscles,
tendons and ligaments that are injured and last but not
the least is the surgery which is opted for in worst
case scenario.
In the long-term scenario bruises, sprains and strains
heal pretty quickly in kids and teenagers but it is
important that the adolescent sticks to the restrictions
imposed during the treatment and healing process like
restriction of activity and regularly attending physical
therapy sessions if any. It is noted that majority of
the sports related injuries results either due to
traumatic injury or excessive use of muscles and joints.
But, they can be avoided and prevented with right
training, by wearing right protective gears and by using
right equipment for training.
Tennis Elbow in Adolescents
Tennis elbow is a condition in which tendon fibers that
attach on epicondyle on the elbow’s exterior
degenerates. The tendons talked about here anchor the
muscles that help wrist and hand to lift. Although
tennis elbow occurs mostly in patients of thirty to
fifty years of age but it can happen to people of any
age. Also tennis elbow affects almost fifty percent of
teenagers who are in racquet sports thus the name
“tennis elbow”. But still most of the patients who
suffer with tennis elbow are people who don’t play
racquet sports. Majority if the times there isn’t any
specific injury before the symptoms start showing up.
Tennis elbow can also happen to people who use their
forearm muscles frequently and vigorously for day to day
work and recreational activities. Ironically some
patients develop the condition without any of the
activity related reasons that leads to the symptoms.
The symptoms of tennis elbow include severe burning pain
on the elbow’s exterior region. In majority of the cases
this starts as a slow and mild pain gradually worsening
with the passage of few weeks or sometimes months. The
pain worsens when one tries to lift objects. In some
cases it may pain even while lifting light objects like
a book or full coffee cup. In the severest cases it can
pain even at the movement of the elbow.
The diagnosis of the tennis elbow involves physician
inquiring about the medical history of the teenager and
a physical examination of the elbow by pressing directly
on the part where bone is prominent on the elbow’s
exterior to check if it causes any pain. The physician
may also ask the teenager to lift the fingers or wrist
and apply pressure to check if it causes any pain again.
X-rays are never opted for diagnosis. However a MRI scan
may be done to see changes in tendons at the attachment
to the bone.
There are many treatment options available and in
majority of the cases non-surgical treatment is given a
try. The ultimate goal of the 1st phase of the treatment
is pain relief. Be ready to hear from the physician to
stop any activity leading to the symptoms. The doctor
may also tell the teenager to apply ice to elbow’s
exterior and he/she may also tell the teenager to take
anti-inflammatory medicines for relief from pain.
The symptoms also diminished with the help of orthotics.
The physician may also want to go for counterforce
braces and also wrist splints which can greatly cut down
symptoms by providing rest to tendons and muscles. The
symptoms should show signs of recovery within 4 to 6
weeks otherwise next option would be to go for a
injection called corticosteroid in the vicinity of the
elbow. This greatly reduces pain and is also very safe
to use. There are many side affects involved if it is
overused.
Once there is a relief from pain the treatment’s next
phase starts which involve modification of activities in
order to prevent the symptoms from returning. The doctor
may also prescribe the teenager to go for physical
therapy which may include stretching exercises to
gradually increase the strength of the affected tendons
and muscles. Physical therapies have high success rates
and return your elbow back to normal working again.
Again non-surgical procedures are highly successful in
eighty five to ninety percent patients.
Surgical procedure is considered only when patients
undergo relentless pain that doesn’t improve even after
6 months of non-surgical treatment. The procedure
involves removal of affected tendon tissue and attaching
it back to bone. The surgery is done on outpatient basis
and does not need stay at the hospital. The surgery is
done by making a small incision on elbow’s exterior’s
bony prominence. In recent years a surgery known as
arthroscopic surgery has also been developed but no
major benefits have been seen using it over the
traditional method of open incision.
