Dr. John A. Schlechter - Pediatric Orthopedic Surgeon - Fracture Care, Sports Medicine and Arthroscopy for Children and Adolescents
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Dr. John A. Schlechter - Pediatric Orthopedic Surgeon - Fracture Care, Sports Medicine and Arthroscopy for Children and Adolescents: (714) 633-2111
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Dr. John A. Schlechter
Dr. John A. Schlechter - Pediatric Orthopedic Surgeon

Patient Info

Hip

Hamstring strain

A hamstring strain is an excessive stretch or tearing of hamstring muscles which are located at the back of the thigh. It is a common injury particularly seen in athletes who participate in sports activities that requires running, jumping, and kicking. During growth spurt the bones grow faster than the muscles. As a result the muscle becomes tight and a sudden jump or stretch can tear the muscle away from its connection to the bone resulting in strain.

In the severe case of hamstring strain a tendon can also be torn away from its bony attachment, which is called an avulsion injury.

Hamstring strain is usually caused when a muscle is stretched beyond its limit. Some of the factors that increase the risks of developing muscle strain include tight muscles, muscle fatigue, muscle imbalance, athletic activities, poor running technique and insufficient warm-up.

A person who experiences a muscle strain in the thigh will have a sudden sharp pain in the affected muscle. Sometimes a popping or snapping sensation is felt in the back of the thigh as the muscle tears.. Other additional symptoms such as swelling, bruising and muscle weakness may be noticed.

Hamstring strain is diagnosed by physical examination and history. Some of the diagnostic tests such as X-ray and MRI scan may be required by the doctor to confirm the condition.

Treatment

Immediately following an injury and before being evaluated by a doctor, you should initiate the R.I.C.E. method of treatment.

  • Rest: Rest from the activity which caused the muscle strain. Crutches may be recommended to avoid putting weight on your legs
  • Ice: Ice packs applied to the injured area will help to control swelling and reduce pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin
  • Compression: An elastic wrap or compression stocking applied to the injured area help to minimize the swelling
  • Elevation: Elevating the knee above heart level will also help to reduce swelling

Your doctor may prescribe nonsteroidal anti-inflammatory drugs to reduce pain and inflammation. Once the pain has subsided your doctor may recommend physical therapy which involves range of motion exercises that include gentle stretching and strengthening exercises to regain strength which will help to speed up the recovery. These exercises should be carried out regularly as it helps to regain the flexibility and improve the restricted motion.

Surgery is very rarely performed in children with hamstring strain. Your doctor may recommend surgery only when the hamstring muscle is completely ruptured.

Iliotibial Band (ITB) Syndrome

Iliotibial band syndrome is an overuse injury resulting from the inflammation of iliotibial band. Iliotibial band is a tough group of fibers that begins at the iliac crest of hip and runs along the outside of the thigh, to get attached to the outer side of the shin bone just below the knee joint. Its function is to coordinate with the thigh muscles and provide stability the knee joint. Iliotibial band syndrome occurs when the iliotibial band and the lower outside portion of the thigh bone at the knee joint rub against each other. It commonly occurs in athletes, cyclists, and runners.

Iliotibial band syndrome can occur from quickly increasing distances with running or biking type activities. Other predisposing factors associated with the injury include running on uneven surfaces, wearing improper fitting shoes, uneven leg length, muscle imbalance, over pronation of foot, and bowed legs.
Children with iliotibial band syndrome may have pain on the outer side of the knee, swelling at the site of injury, and popping sensation may be felt when the knee is bent and then straightened. Pain may worsen after running, climbing stairs, and walking and reduced when your child is at rest.

The goal of the treatment is to reduce the inflammation and to relieve the pain. The treatment options include:

  • Rest: Allow the joint to rest to reduce the inflammation. Do not encourage your child to run or participate in any physical activity that may worsen the pain.
  • Ice application: Ice packs should be applied to the site of injury which will help to diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
  • Medications: Your doctor may prescribe nonsteroidal anti-inflammatory drugs to reduce the pain and swelling.
  • Foam Roller Myofacial Release- A foam roller is used underneath the tight iliotibial band to loosen it. Although this is painful, it is one of the most useful stretches to relieve the tissues.
  • Physical therapy: Physiotherapists will teach your child stretching exercises and techniques to loosen the tight structures. This exercise is done by holding the affected knee close to opposite armpit while keeping the other leg straight on the floor. These exercises help to strengthen the iliotibial band and the surrounding muscles.

Your doctor suggests you to ensure that your child wears appropriate shoes while running to prevent further damage to iliotibial band.

Periacetabular osteotomy

Periacetabular (Ganz) Osteotomy

Periacetabular osteotomy is the surgical procedure indicated in hip dysplasia and it involves cutting the bone around the acetabulum so as to fit the head of the femur bone into acetabular socket. This method was developed and performed by Professor Reinhold Ganz and therefore it is also called as Ganz osteotomy.

Ganz osteotomy is performed in children, adolescents and young adults in whom growth plate around the hip socket has been closed.

The technique involves exposure of the pelvic bone through smaller incisions. A skin incision is made and the underlying subcutaneous fat and muscles are retracted to expose the ilium. In Ganz osteotomy, five bone cuts are made in the pelvic bone around the socket. Then the pelvic bone along with the hip socket is rotated into a more stable, horizontal position of coverage on top of the femoral head so as to cover the femoral head in an adequate manner. Once the position is corrected, it is maintained with the help of 2 to 3 small cortical screws.

Click on the topics below to find out more from the Orthopaedic connection website of American Academy of Orthopaedic Surgeons.

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