Non sono i pesi a farti diventar grossa! - ItalianShredStyle
A more recent article on apophysitis and osteochondrosis is available. These disorders result from abnormal growth, injury, or overuse of the developing growth plate and surrounding ossification centers. The exact etiology of these disorders is unknown, but genetic causes, repetitive trauma, vascular abnormalities, mechanical factors, and male da osteocondrosi imbalances may all play a role. Legg-Calvé-Perthes disease is a hip disorder that causes hip pain, male da osteocondrosi atraumatic limp, and knee pain.
Osgood-Schlatter and Sinding-Larsen—Johannson diseases are common causes of anterior knee pain that is aggravated by jumping activities and kneeling. Sever disease causes heel pain that is exacerbated by activity male da osteocondrosi wearing cleats.
It often mimics Achilles tendinitis and is treated with activity and shoe modifications, heel cups, and calf stretches. Freiberg disease and Köhler bone disease often cause foot pain and are disorders of the metatarsal head and navicular bone, respectively. Radiographs show sclerosis, flattening, and fragmentation of bone in both diseases. Elbow pain can male da osteocondrosi caused by medial epicondyle apophysitis or Panner disease. Medial epicondyle apophysitis is exacerbated by frequent throwing and is treated with throwing cessation and acetaminophen or nonsteroidal anti-inflammatory drugs.
Panner disease is the most common cause of lateral-sided elbow pain in children younger than 10 years. It may or may not be associated with frequent throwing, and it resolves spontaneously. Scheuermann disease causes back pain and a humpback deformity from vertebral bone anterior wedging. The term osteochondrosis is used to describe a group of disorders that affect patients with an immature skeleton. The etiology of joint pain in these patients is often from osteochondrosis, although traumatic, inflammatory, or infectious origins should be ruled out as well.
Osteochondrosis results from abnormal development, injury, or overuse of the growth plate and surrounding ossification centers. Overall, boys are more affected and symptoms generally appear between 10 and 14 years of age. Areas of the body most often affected include the hip, knee, foot, elbow, and back Figure 1.
Osgood-Schlatter disease is a self-limited process that responds well to activity modification and nonsteroidal anti-inflammatory drugs.
Physical therapy may help reduce symptoms in recalcitrant cases. Sever disease responds well to nonoperative treatment consisting of activity male da osteocondrosi shoe modifications, padded heel cups, and calf stretches. Medial epicondyle apophysitis is best treated with prevention. Parents, coaches, and players should adhere to the guidelines set forth by the Little League Association of America to maintain the health of male da osteocondrosi, throwing athletes.
The primary indications for surgical treatment of Scheuermann disease are to alleviate pain and to improve cosmesis. However, the deformity is of little functional consequence and does not progress severely after skeletal maturity. A distinction between osteochondrosis and osteochondritis dissecans lesions should be made, which can be a common source of confusion for physicians. Osteochondritis male da osteocondrosi is an inflammatory condition of bone and overlying articular cartilage that affects the joints of patients with immature and mature skeletons alike.
Either condition may present with activity-related pain, but osteochondritis dissecans may also cause joint catching and locking. Lesions from osteochondritis dissecans may or may not resolve with nonoperative treatment, whereas osteochondrosis eventually resolves when the growth plates have closed and skeletal maturity has been reached.
Legg-Calvé-Perthes disease is a hip disorder that results from a partial interruption of the blood supply to the immature femoral head. The exact cause of the vascular interruption is unknown. It occurs in children between four and eight years of age. Boys are four to five times more likely to be affected than girls.
Limited hip abduction, internal rotation, and leg-length discrepancies are commonly found on physical examination. Anteroposterior and frog-leg lateral radiographs will demonstrate varying degrees of fragmentation, flattening, and sclerosis of the proximal femur growth center with joint space widening.
Other conditions, including septic arthritis and osteomyelitis of the proximal femur, should be ruled out in equivocal cases.
If patients are treated early, they have a lower risk of developing arthritis at a young age, and range of motion can be preserved. Poor prognostic factors include age older than six years at onset of disease, greater extent of femoral head deformity, hip joint incongruity, and decreased hip range of motion.
Osgood-Schlatter disease, an inflammatory condition, is a common cause of anterior knee pain in male da osteocondrosi and adolescents. It is caused by repetitive traction of the patellar tendon on the tibial tubercle ossification center or apophysis, which may cause substantial inflammation and pain. Symptomatic patients are usually between 10 and 14 years of age, and up to 30 percent of patients will have bilateral involvement. Patients have moderate to severe tenderness, swelling, and male da osteocondrosi over the tibial tubercle.
The diagnosis is often made clinically, although plain radiographs should be obtained to rule out fractures, tumors, male da osteocondrosi osteomyelitis if the presenting signs and symptoms are atypical. Radiographs of patients with Osgood-Schlatter disease may show anterior soft tissue swelling and fragmentation male da osteocondrosi the tibial tubercle. Magnetic male da osteocondrosi imaging and ultrasonography are not routinely necessary. Osgood-Schlatter disease is a self-limited process that responds well to activity modification and acetaminophen or nonsteroidal anti-inflammatory drugs NSAIDs.
Stretching and physical therapy to improve flexibility of lower-extremity muscles can help reduce symptoms. Some case series have shown that operative treatment can alleviate symptoms in patients with mature skeletons who continue to have disabling symptoms. Sinding-Larsen—Johansson disease is another common cause of anterior knee pain in children and adolescents.
It is similar to Osgood-Schlatter disease, except that Sinding-Larsen—Johansson disease occurs at the inferior pole of the patella.
Affected patients are male da osteocondrosi 10 and 13 years of age and are often involved in athletic male da osteocondrosi. Point tenderness is localized to the inferior pole of the patella. Although it is diagnosed clinically, radiographs should be obtained to rule out other pathology. Radiographs may show soft-tissue swelling and calcification of an avulsed portion of the patella. Knee immobilization is only necessary in severe cases.
Exercises to improve flexibility of the hamstrings, quadriceps, and heel cords can help reduce symptoms. Sever disease, or calcaneal apophysitis, is a common cause of heel pain in young athletes.
The Achilles tendon exerts tensile male da osteocondrosi on the calcaneal apophysis with physical activity. Most patients associate their symptoms with a particular sport, with soccer being the most common. Weight-bearing activity and shoes, particularly soccer cleats, can aggravate the symptoms. Physical examination often reveals point tenderness at the insertion of the Achilles tendon, tight heel cords, and heel pain with medial-lateral compression.
Nonoperative treatment includes activity and shoe modifications, padded heel cups, and calf stretches. Patients with persistent symptoms despite activity modification and a stretching program should have other conditions considered, such as Achilles tendinitis, plantar fasciitis, or a calcaneal stress fracture. Freiberg disease is a painful condition of the forefoot occurring most often in adolescent girls who participate in ballet and dance.
Possible causes include trauma, repetitive stress, disruption in blood supply, or improper shoe wear. Point tenderness and swelling are commonly found over the affected metatarsal head. Plain radiographs show sclerosis and varying degrees of flattening of the affected articular surface. In most patients, nonoperative treatment consisting of activity modification, metatarsal pads, and well-padded shoes facilitates regeneration of the metatarsal head and spontaneous resolution of symptoms.
Köhler bone disease is an osteochondrosis of the navicular bone in the foot. Patients often present between two and eight years of age, and boys are three to five times more likely to be affected. Mid-foot pain and a limp are the most common presenting symptoms. There is point tenderness over the navicular bone on examination. Medial epicondyle apophysitis affects throwing athletes, such as pitchers.
Frequent throwing results in repetitive stress across the medial epicondyle growth plate. Tenderness may be mild in early apophysitis, but can be severe if there is an avulsion fracture. The shoulder also should be examined because this condition can be male da osteocondrosi symptom of shoulder pathology.
Plain radiographs may show fragmentation of the medial epicondyle. Prevention is the best treatment for this condition and should include pitch limits, with limitation of curveballs and sliders in particular. It may or may not be associated with athletic activity. Patients present with vague, lateral-sided elbow pain without point tenderness.
Plain radiographs often show fragmentation and fissuring of the entire humeral capitellum. Panner disease is self-limited male da osteocondrosi generally resolves spontaneously with rest and conservative management, including acetaminophen or NSAIDs. Scheuermann disease is a common cause of back pain with a rigid kyphosis or humpback deformity. Disturbance of the vertebral end plates causes anterior vertebral body wedging that results in kyphosis during a growth spurt.
The exact etiology male da osteocondrosi this growth disturbance is unknown. Pain and increasing back deformity are the most common presenting symptoms. Physical examination findings include a rigid, male da osteocondrosi deformity that does not correct with back extension Figure 2. Signs of nerve compression are rare. Disk space narrowing, end plate irregularities, and scoliosis also may be seen.
The deformity increases during adolescent growth spurts, but progression after skeletal maturity is not severe. Patient with typical Scheuermann disease presentation: prominent posterior humpback deformity A that does not correct with hyperextension B. Lateral thoracolumbar radiograph of an adolescent with Scheuermann disease showing vertebral end plate abnormalities asterisks and anterior vertebral body wedging arrows. A recent evidence-based review found that most patients with Scheuermann disease do not need surgical intervention, which should be reserved only for patients with mature skeletons male da osteocondrosi have a curve greater than 75 degrees, pain, a rigid deformity, and unacceptable appearance.
Patients with osteochondrosis should be referred to an orthopedic surgeon for further evaluation if nonoperative treatment has not been effective. Patients with Osgood-Schlatter disease, Sinding-Larsen—Johannson disease, or Sever disease who have mature skeletons and disabling symptoms should be referred. Those with Freiberg male da osteocondrosi and loose joint fragments should be referred for possible joint debridement. Patients suspected of having Köhler male da osteocondrosi disease who have male da osteocondrosi recent trauma, illness, or elevated inflammatory markers should be referred to rule out infection or occult fracture.
Referral is also indicated male da osteocondrosi those with medial epicondyle apophysitis or Panner disease who have acute trauma, pain despite several weeks of rest, or loose joint fragments.