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Sports Medicine

, Volume 30, Issue 2, pp 117–135 | Cite as

Upper Extremity Injuries in the Paediatric Athlete

  • Mininder S. Kocher
  • Peter M. Waters
  • Lyle J. Micheli
Review Article

Abstract

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Keywords

Rotator Cuff Radial Head Medial Epicondyle Ulnar Collateral Ligament Elbow Dislocation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Culpepper MI, Niemann KMW. High school football injuries in Birmingham, Alabama. South Med J 1983; 76: 873–8PubMedGoogle Scholar
  2. 2.
    Goldberg B, Rosenthal PP, Nicholas JA. Injuries in youth football. Physician Sports Med 1984; 12: 122–32Google Scholar
  3. 3.
    Olson OC. The Spokane study: high school football injuries. Physician Sports Med 1979; 7: 75–82Google Scholar
  4. 4.
    Consumer Product Safety Commission. Bicycle related injuries: data from the National Electronic Injury Surveillance System. JAMA 1987; 257: 3334–7Google Scholar
  5. 5.
    Kirburz D, Jacobs R, Reckling F, et al. Bicycle accidents and injuries among adult cyclists. Am J Sports Med 1986; 14: 416–9Google Scholar
  6. 6.
    Kocher MS, Feagin Jr JA. Shoulder injuries during alpine skiing. Am J Sports Med 1996; 24: 665–9PubMedGoogle Scholar
  7. 7.
    Requa R, Garrick JG. Injuries in interscholastic wrestling. Physician Sports Med 1981; 9: 44–51Google Scholar
  8. 8.
    Snook GA. Injuries in intercollegiate wrestling: a 5 year study. Am J Sports Med 1982; 10: 142–4PubMedGoogle Scholar
  9. 9.
    Gainor BJ, Piotrowski G, Puhl J, et al. The throw: biomechanics and acute injury. Am J Sports Med 1980; 8: 114–8PubMedGoogle Scholar
  10. 10.
    Tullos HS, Fain RH. Little league shoulder: rotational stress fracture of proximal humeral epiphysis. J Sports Med 1974; 2: 152–3PubMedGoogle Scholar
  11. 11.
    Tullos HS, King JW. Lesions of the pitching arm in adolescents. JAMA 1972; 220: 264–71PubMedGoogle Scholar
  12. 12.
    Albright JA, Jokl P, Shaw R, et al. Clinical study of baseball pitchers: correlation of injury to the throwing arm with method of delivery. Am J Sports Med 1978; 6: 15–21PubMedGoogle Scholar
  13. 13.
    Barnett LS. Little league shoulder syndrome: proximal humeral epiphysis in adolescent baseball pitchers. J Bone Joint Surg Am 1985; 67: 495–6PubMedGoogle Scholar
  14. 14.
    Cahill BR, Tullos HS. Little league shoulder. J Sports Med 1974; 2: 150–3PubMedGoogle Scholar
  15. 15.
    Dotter WE. Little leaguer’s shoulder: a fracture of the proximal epiphyseal cartilage of the humerus due to baseball pitching. Guthrie Clin Bull 1953; 23: 68–72PubMedGoogle Scholar
  16. 16.
    Lipscomb AB. Baseball injuries in growing athletes. J Sports Med 1975; 3: 25–34PubMedGoogle Scholar
  17. 17.
    Torg JS, Pollack H, Sweterlitsch P. The effect of competitive pitching on the shoulders and elbows of preadolescent baseball players. Pediatrics 1972; 49: 267–72PubMedGoogle Scholar
  18. 18.
    Priest JD, Nagel DA. Tennis shoulder. Am J Sports Med 1976; 4: 28–42PubMedGoogle Scholar
  19. 19.
    Richardson AB, Jobe FW, Collins HR. The shoulder in competitive swimming. Am J Sports Med 1980; 8: 159–63PubMedGoogle Scholar
  20. 20.
    Fulton NN, Albright JP, El-Khoury GY. Cortical desmoid-like lesion of the proximal humerus and its occurrence in gymnasts. Am J Sports Med 1979; 7: 57–61PubMedGoogle Scholar
  21. 21.
    Goldberg MJ. Gymnastic injuries. Orthop Clin North Am 1980; 11: 717–32PubMedGoogle Scholar
  22. 22.
    Snook GA. Injuries in women’s gymnastics: a 5 year study. Am J Sports Med 1979; 7: 242–4PubMedGoogle Scholar
  23. 23.
    Brooks AL, Henning GD. Injury to the proximal clavicular epiphysis. J Bone Joint Surg Am 1972; 54: 1347–51Google Scholar
  24. 24.
    Denham RH, Dingley AF. Epiphyseal separation of the medial clavicle. J Bone Joint Surg Am 1967; 49: 1179–83Google Scholar
  25. 25.
    Lewonowski K, Bassett GS. Complete posterior retrosternal epiphyseal separation: a case report and review of the literature. Clin Orthop 1992; 281: 84–8PubMedGoogle Scholar
  26. 26.
    Winter J, Sterner S, Maurer D, et al. Retrosternal epiphyseal disruption of medial clavicle: case and review in children. J Emerg Med 1989; 7: 9–13PubMedGoogle Scholar
  27. 27.
    Destouet JM, Gilula LA, Murphy WA, et al. Computed tomography of the sternoclavicular joint and sternum. Radiology 1981; 138: 123–8PubMedGoogle Scholar
  28. 28.
    Selesnick FH, Jablon M, Frank C, et al. Retrosternal dislocation of the clavicle. J Bone Joint Surg Am 1984; 66: 287–91PubMedGoogle Scholar
  29. 29.
    Clark RL, Milgram JW, Yawn DH. Fatal aortic perforation and cardiac tamponade due to Kirschner wire migrating from the right sternoclavicular joint. South Med J 1974; 67: 316–8PubMedGoogle Scholar
  30. 30.
    Mazet R. Migration of a Kirschner wire from the shoulder region into the lung: a report of two cases. J Bone Joint Surg Am 1943; 25: 477–83Google Scholar
  31. 31.
    Bowen A. Plastic bowing of the clavicle in children: a report of two cases. J Bone Joint Surg Am 1983; 65: 403–5PubMedGoogle Scholar
  32. 32.
    Nogi J, Heckman JD, Hakala M, et al. Non-union of the clavicle in a child: a case report. Clin Orthop 1975; 110: 19–21PubMedGoogle Scholar
  33. 33.
    Howard FM, Shafer SJ. Injury to the clavicle with neurovascular complications: a study of fourteen cases. J Bone Joint Surg Am 1965; 47: 1335–46PubMedGoogle Scholar
  34. 34.
    Zenni EJ, Krieg JK, Rosen MJ. Open reduction and internal fixation of clavicular fractures. J Bone Joint Surg Am 1981; 63: 147–51PubMedGoogle Scholar
  35. 35.
    Black GB, McPherson JA, Reed MH. Traumatic pseudodislocation of the acromioclavicular joint in children. Am J Sports Med 1991; 19: 644–6PubMedGoogle Scholar
  36. 36.
    Eidman DK, Siff SJ, Tullos HS. Acromioclavicular lesions in children. Am J Sports Med 1981; 9: 150–4PubMedGoogle Scholar
  37. 37.
    Falstie-Jensen S, Mikkelsen P. Pseudodislocation of the acromioclavicular joint. J Bone Joint Surg Br 1982; 64: 368–9PubMedGoogle Scholar
  38. 38.
    Havranek P. Injuries of the distal clavicular physis in children. J Pediatr Orthop 1989; 9: 213–5PubMedGoogle Scholar
  39. 39.
    Ogden JA. Distal clavicular physeal injury. Clin Orthop 1984; 188: 68–73PubMedGoogle Scholar
  40. 40.
    Rockwood CA. Fractures of outer clavicle in children and adults. J Bone Joint Surg Br 1982; 64: 642–9Google Scholar
  41. 41.
    Bjerneld H, Hovelius L, Thorling J. Acromioclavicular separations treated conservatively. Acta Orthop Scand 1983; 54: 743–45PubMedGoogle Scholar
  42. 42.
    Galpin RD, Hawkins RJ, Grainger RW. A comparative analysis of operative versus nonoperative management of grade III acromioclavicular separations. Clin Orthop 1985; 193: 150–5PubMedGoogle Scholar
  43. 43.
    Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation. J Bone Joint Surg Am 1986; 68: 552–5PubMedGoogle Scholar
  44. 44.
    Cahill BR. Atraumatic osteolysis of the distal clavicle: a review. Sports Med 1992; 13: 214–22PubMedGoogle Scholar
  45. 45.
    Scavenius M, Iversen BF. Nontraumatic clavicular osteolysis in weight lifters. Am J Sports Med 1992; 20: 463–7PubMedGoogle Scholar
  46. 46.
    Larson RL, Singer KM, Bergstrom R, et al. Little League survey: the Eugene study. Am J Sports Med 1976; 4: 201–9PubMedGoogle Scholar
  47. 47.
    Kohler R, Trillaud JM. Fracture and fracture separation of the proximal humerus in children: report of 136 cases. J Pediatr Orthop 1983; 3: 326–32PubMedGoogle Scholar
  48. 48.
    Baxter MP, Wiley J. Fractures of the proximal humeral epiphysis: their influence on humeral growth. J Bone Joint Surg Br 1986; 68: 570–3PubMedGoogle Scholar
  49. 49.
    Dameron TB, Reibel DB. Fractures involving the proximal humeral epiphyseal plate. J Bone Joint Surg Am 1969; 51: 289–97PubMedGoogle Scholar
  50. 50.
    Neer CS, Horowitz BS. Fractures of the proximal humeral epiphyseal plate. Clin Orthop 1965; 41: 24–31PubMedGoogle Scholar
  51. 51.
    Nilsson S, Svartholm F. Fracture of the upper end of the humerus in children. Acta Chir Scand 1965; 130: 433–9PubMedGoogle Scholar
  52. 52.
    Sherk H, Probst C. Fractures of the proximal humeral epiphysis. Orthop Clin North Am 1975; 6: 401–13PubMedGoogle Scholar
  53. 53.
    Williams DJ. The mechanisms producing fracture separation of the proximal humeral epiphysis. J Bone Joint Surg Br 1981; 63: 102–7PubMedGoogle Scholar
  54. 54.
    Asher MA. Dislocations of the upper extremity in children. Orthop Clin North Am 1976; 7: 583–91PubMedGoogle Scholar
  55. 55.
    Hovelius L. Anterior dislocation of the shoulder in teenagers and young adults. J Bone Joint Surg Am 1987; 69: 393–9PubMedGoogle Scholar
  56. 56.
    Marans HJ, Angel KR, Schemitsch EH, et al. The fate of traumatic anterior dislocation of the shoulder in children. J Bone Joint Surg Am 1992; 74: 1242–4PubMedGoogle Scholar
  57. 57.
    Rowe CR. Anterior dislocation of the shoulder: prognosis and treatment. Surg Clin North Am 1963; 43: 1609–14PubMedGoogle Scholar
  58. 58.
    Rowe CR. Prognosis in dislocation of the shoulder. J Bone Joint Surg Am 1956; 38: 957–77PubMedGoogle Scholar
  59. 59.
    Wagner KT, Lyne ED. Adolescent traumatic dislocations of the shoulder with open epiphysis. J Pediatr Orthop 1983; 3: 61–2PubMedGoogle Scholar
  60. 60.
    Aronen JG, Regan K. Decreasing the incidence of recurrence of first time anterior shoulder dislocation with rehabilitation. Am J Sports Med 1984; 12: 283–91PubMedGoogle Scholar
  61. 61.
    Burkhead WZ, Rockwood CA. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am 1992; 74: 890–6PubMedGoogle Scholar
  62. 62.
    Simonet WT, Cofield RH. Prognosis in anterior shoulder dislocation. Am J Sports Med 1984; 12: 19–24PubMedGoogle Scholar
  63. 63.
    Carter C, Sweetnam R. Recurrent dislocation of the patella and the shoulder: their association with familial joint laxity. J Bone Joint Surg Br 1960; 42: 721–7PubMedGoogle Scholar
  64. 64.
    Neer CS, Foster DR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. J Bone Joint Surg Am 1980; 62: 897–908PubMedGoogle Scholar
  65. 65.
    Bigliani LU, D’Alessandro DF, Duralde XA, et al. Anterior acromioplasty for subacromial impingement in patients younger than 40 years of age. Clin Orthop 1989; 246: 111–6PubMedGoogle Scholar
  66. 66.
    Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med 1980; 8: 151–7PubMedGoogle Scholar
  67. 67.
    Tibone JE. Shoulder problems of adolescence. Clin Sports Med 1983; 2: 423–6PubMedGoogle Scholar
  68. 68.
    Tibone JE, Elrod B, Jobe FW, et al. Surgical treatment of tears of the rotator cuff in athletes. J Bone Joint Surg Am 1986; 68: 887–91PubMedGoogle Scholar
  69. 69.
    Pappas AM. Elbow problems associated with baseball during childhood and adolescence. Clin Orthop 1982; 164: 30–41PubMedGoogle Scholar
  70. 70.
    Aronen JG. Problems of the upper extremity in gymnastics. Clin Sports Med 1985; 4: 61–71PubMedGoogle Scholar
  71. 71.
    Otsuka NY, Kasser JR. Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg 1997; 5: 19–26PubMedGoogle Scholar
  72. 72.
    Skaggs DL. Elbow fractures in children: diagnosis and management. J Am Acad Orthop Surg 1997; 5: 303–12PubMedGoogle Scholar
  73. 73.
    Bernstein SM, McKeever P, Bernstein L. Percutaneous reduction of displaced radial neck fractures in children. J Pediatr Orthop 1993; 13: 85–8PubMedGoogle Scholar
  74. 74.
    Gill TJ, Micheli LJ. The immature athlete: common injuries and overuse syndromes of the elbow and wrist. Clin Sports Med 1996; 15: 401–23PubMedGoogle Scholar
  75. 75.
    Dias JJ, Johnson GV, Hoskinson J, et al. Management of severely displaced medial epicondyle fractures. J Orthop Trauma 1987; 1: 59–62PubMedGoogle Scholar
  76. 76.
    Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children: 35 year follow-up of 56 unreduced cases. Acta Orthop Scand 1986; 57: 313–5PubMedGoogle Scholar
  77. 77.
    Woods GW, Tullos HS. Elbow instability and medial epicondyle fractures. Am J Sports Med 1977; 5: 23–30PubMedGoogle Scholar
  78. 78.
    Carlioz H, Abols Y. Posterior dislocation of the elbow in children. J Pediatr Orthop 1984; 4: 8–12PubMedGoogle Scholar
  79. 79.
    Jackson DW, Silvino N, Reiman P. Osteochondritis in the female gymnasts’s elbow. Arthroscopy 1989; 5: 129–36PubMedGoogle Scholar
  80. 80.
    Brogdon BG, Crow NE. Little Leaguer’s elbow. Am J Roentgenol 1960; 83: 671–5Google Scholar
  81. 81.
    Gugenheim JJ, Stanley RF, Wood GW, et al. Little League survey: the Houston study. Am J Sports Med 1976; 4: 189–200PubMedGoogle Scholar
  82. 82.
    Hang YS. Little League elbow: a clinical and biomechanical study. Int Orthop 1982; 3: 70–8Google Scholar
  83. 83.
    Slager RF. From Little League to the big league, the weak spot is the arm. Am J Sports Med 1977; 5: 37–48PubMedGoogle Scholar
  84. 84.
    Smith MGH. Osteochondritis of the humeral capitellum. J Bone Joint Surg Br 1964; 46: 50–4PubMedGoogle Scholar
  85. 85.
    Tiynon MC, Anzel SH, Waugh TR. Surgical management of osteochondritis dissecans of the capitellum. Am J Sports Med 1976; 4: 121–8Google Scholar
  86. 86.
    Chambers RB. Orthopedic injuries in athletes (ages 6 to 17). Am J Sports Med 1979; 7: 195–7PubMedGoogle Scholar
  87. 87.
    Watson AW. Sports injuries during one academic year in 6,799 Irish school children. Am J Sports Med 1984; 12: 65–71PubMedGoogle Scholar
  88. 88.
    Zaricznyj B, Shattuck LJ, Mast TA, et al. Sports-related injuries in school-aged children. Am J Sports Med 1980; 8: 318–24PubMedGoogle Scholar
  89. 89.
    Blitzer CM, Johnson RJ, Ettlinger CF, et al. Downhill skiing injuries in children. Am J Sports Med 1984; 12: 142–7PubMedGoogle Scholar
  90. 90.
    Garrick JF, Regua RK. Epidemiology of women’s gymnastic injuries. Am J Sports Med 1980; 8: 261–4PubMedGoogle Scholar
  91. 91.
    Sullivan JA, Gross RH, Grana WA, et al. Evaluation of injuries in youth soccer. Am J Sports Med 1980; 8: 325–7PubMedGoogle Scholar
  92. 92.
    Mann DC, Rajmaira S. Distribution of physeal and non-physeal fractures in 2650 long bone fractures in children aged 0–16 years. J Pediatr Orthop 1990; 10: 713–6PubMedGoogle Scholar
  93. 93.
    Friberg K. Remodeling after distal forearm fractures. Acta Orthop Scand 1970; 50: 731–50Google Scholar
  94. 94.
    Roy S, Caine D, Singer KM. Stress changes of the distal radius epiphysis in young gymnasts. Am J Sports Med 1985; 13: 301–8PubMedGoogle Scholar
  95. 95.
    Mandelbaum BR, Bartolozzi AR, Davis CA, et al. Wrist pain syndrome in the gymnast. Am J Sports Med 1989; 17: 305–17PubMedGoogle Scholar
  96. 96.
    Vender MI, Watson HK. Acquired Madelung-like deformity in a gymnast. J Hand Surg 1988; 13A: 19–21Google Scholar
  97. 97.
    Terry CL, Waters PM. Triangular fibrocartilage injuries in pediatric and adolescent patients. J Hand Surg 1998; 23A: 626–34Google Scholar
  98. 98.
    Mintzer CM, Waters PM, Simmons BP. Nonunion of the scaphoid in children treated withHerbert screw fixation and bone grafting: a report of five cases. J Bone Joint Surg Br 1995; 77 (1): 98–100PubMedGoogle Scholar
  99. 99.
    Riester JN, Baker BE, Mosher JF, et al. A review of scaphoid fracture healing in competitive athletes. Am J Sports Med 1985; 13: 154–61Google Scholar
  100. 100.
    Southcott R, Rosman MA. Non-union of carpal scaphoid fractures in children. J Bone Joint Surg Br 1977; 59: 20–3PubMedGoogle Scholar
  101. 101.
    Hanks GA, Kalenak A, Bowman LS, et al. Stress fractures of the carpal scaphoid: a report of four cases. J Bone Joint Surg Am 1989; 71: 938–41PubMedGoogle Scholar
  102. 102.
    Manzione M, Pizzutillo PD. Stress fracture of the scaphoid waist. Am J Sports Med 1981; 9: 268–9PubMedGoogle Scholar
  103. 103.
    Burton RI, Eaton RG. Common hand injuries in the athlete. Orthop Clin North Am 1973; 4: 809–38PubMedGoogle Scholar
  104. 104.
    Hastings H, Simmons BP. Hand fractures in children. Clin Orthop 1984; 188: 120–30PubMedGoogle Scholar
  105. 105.
    McCue FC, Baugher WH, Kulund DN, et al. Hand and wrist injuries in the athlete. Am J Sports Med 1979; 7: 275-86PubMedGoogle Scholar
  106. 106.
    Posner MA. Injuries to the hand and wrist in athletes. Orthop Clin North Am 1977; 8: 593–617PubMedGoogle Scholar
  107. 107.
    Simmons BP, Lovallo JL. Hand and wrist injuries in children. Clin Sports Med 1988; 7: 495–512PubMedGoogle Scholar
  108. 108.
    Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. J Hand Surg 1977; 2: 66–9Google Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Mininder S. Kocher
    • 1
  • Peter M. Waters
    • 1
  • Lyle J. Micheli
  1. 1.Division of Sports Medicine, Department of Orthopaedic SurgeryChildren’s Hospital, Harvard Medical SchoolBostonUSA

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