Kathryn (Katie) Lucas

Youth participation in sports is growing at an exponential rate. Current estimates suggest greater than 30–45 million youths between the ages of 5 and 17 years of age participate in community-sponsored athletic programs. More than 7.6 million teenagers regularly participate in competitive high school team sports. Participation in athletics is a means for our youth to remain physically active and reap the many health benefits of activity. Despite these many benefits, injuries may occur, limiting participation and potentially restricting long-term potential to engage in physical activity. This chapter reviews some of the most common pediatric sports injuries experienced by young athletes and recommendations for the management of these conditions.

This chapter reviews common congenital and acquired orthopedic conditions of the upper and lower extremities (LEs) in infants, children, and adolescents. Etiology, pathology, conservative and medical interventions, prognosis, and expected outcomes are discussed for each condition. Information regarding differential diagnoses is shared and essential for the pediatric physical therapist who practices under direct access. Specific recommendations for history, examination, outcome measures, and evidence-based interventions provided by a physical therapist are included when appropriate. Indications for referral to another clinician or specialist are provided. Socioeconomic factors which may impact outcomes are discussed for several conditions. Patient and family access to orthopedic specialists, imaging and specialized physical therapy, medical and surgical interventions should be considered for individual conditions. Upper extremity conditions described include shoulder subluxation and dislocation, nursemaid’s elbow, and fractures. Atypical postural alignment and torsional conditions of the LE are also reviewed. Systemic conditions such as Ehlers–Danlos syndrome, achondroplasia, vascular malformations, and infections are also included in this chapter. Lower extremity conditions presented include, but are not limited to, leg length discrepancy, developmental dysplasia of the hip, Legg–Calvé–Perthes disease, slipped capital femoral epiphysis, discoid meniscus, apophysitis, and idiopathic toe walking. Video-based case studies, available in the electronic book resource, reinforce the learning objectives and content from the chapter.

Pediatric physical therapists routinely evaluate and treat children who have medical conditions which directly or indirectly influence the growth and development of their musculoskeletal system. The musculoskeletal system demonstrates a remarkable ability to adapt to the physical demands, or lack of physical demands, placed on the system. Pathologic conditions and atypical motor or postural patterns may adversely influence the structure and function of any component of the system and may lead to impairments. The normal process of adaptation can either enhance function or lead to impairment, activity restriction, participation limitation, and decreased quality of life. The development and function of the musculoskeletal system and the neurologic system are intertwined. A neurologic condition such as cerebral palsy is often associated with muscle weakness and the development of muscle contractures. Therapeutic interventions are often designed to promote musculoskeletal adaptations to prevent or correct physical impairments, with the hope of enhancing function and participation. Accordingly, knowledge of normal growth and development and the principles of adaptation of the musculoskeletal system are essential for understanding the efficacy of interventions and preventing secondary impairments of this system. This chapter describes the typical growth and development of muscle and bone and provides a foundation for future chapters to describe the adaptations of muscle and bone during abnormal loading or developmental conditions that alter musculoskeletal development.