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

Knees & Legs

Knee sprain :: Meniscal injuries :: Shin splints :: Quadriplegia

Knee sprain

Knee sprain is a common injury that occurs from overstretching of the ligaments that support the knee joint. A knee sprain occurs when the knee ligaments are twisted or turned beyond its normal range causing the ligaments to tear.

Some of the common causes of a knee sprain include forceful twisting of the knee, sudden stop while running, direct blow to the knee, and fall that results in landing on your knees. The factors that increase the risk of knee sprain include participation in sports activities such as skiing, poor coordination, poor balance, and inadequate flexibility and strength in muscles and ligaments.

The most common symptoms include pain, swelling, bruising, warmth and redness of the skin, and restricted movements. Pain will occur soon after injury and may increase upon moving the knee.

Your doctor will evaluate your child's condition by physical examination and medical history. Diagnostic tests such as X-ray and MRI scan may be required to confirm the condition and provide treatment.

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

  • Rest: You must ensure that your child takes rest, as more damage could result from putting pressure on the injured area.
  • Ice: Ice packs should be applied over the injury to decrease swelling and pain. Ice should never be placed on the skin directly instead it should be applied over a towel to the affected area for 15-20 minutes four times a day for several days.
  • Compression: Wrap the knee with an elastic bandage or compress it with the help of a stocking to minimize the swelling and support the knee.
  • Elevation: Elevate your child's knee above heart level which will help to decrease swelling and pain.

After the RICE treatment, your doctor may suggest your child to wear sling, cast, or a brace which immobilizes the knee joint to prevent it from further movement until healing happens. Medicines are prescribed such as nonsteroidal anti-inflammatory drugs to decrease pain and swelling. Physical therapy includes range of motion exercises such as strengthening and stretching exercises which helps to regain normal functioning of the knee.

There are few preventive measures to reduce your child's risk of knee sprain.

  • Ensure that your child does warm up exercises or stretches before starting any physical activity or sports.
  • Ensure that your child learns proper techniques for sports and exercises which help to decrease stress on muscles, ligament, and tendons.
  • Make sure that your child wears proper protective equipments during sports activity which will protect them from injuries.
  • Encourage your child to take a break from sports when tired.

Younger children usually respond well to non-surgical treatments and if the pain persists over a long time, then surgery may be needed to repair the torn ligaments. Knee arthroscopy is a surgical procedure done to repair the torn ligament.

Meniscal injuries

The knee is one of the most complex and largest joint in the body, and is more susceptible to injury. Meniscal tears are one among the common injuries to the knee joint. It can occur at any age, but are more common in athletes playing contact sports.

The meniscus is a small, "c" shaped piece of cartilage in the knee. Each knee consists of two menisci, medial meniscus on the inner aspect of the knee and the lateral meniscus on the outer aspect of the knee. The medial and lateral meniscus act as cushion between the thigh bone (femur) and shin bone (tibia). The meniscus has no direct blood supply and for that reason, when there is an injury to the meniscus, healing cannot take place. The meniscus acts like a "shock absorber" in the knee joint.

Meniscal tears often occur during sports. These tears are usually caused by twisting motion or over flexing of the knee joint. Athletes who play sports such as football, tennis and basketball are at a higher risk of developing meniscal tears. They often occur along with injuries to the anterior cruciate ligament, a ligament that crosses from the femur (thigh bone) to the tibia (shin bone).

Various types of meniscal tears that can occur are longitudinal, bucket handle, flap, parrot -beak and mixed or complex.

The symptoms of a meniscal tear include:

  • Knee pain when walking
  • A "popping "or "clicking" may be felt at the time of injury
  • Tenderness when pressing on the meniscus
  • Swelling of the knee
  • Limited motion of the knee joint
  • Joint locking can occur if the torn cartilage gets caught between the femur and tibia preventing straightening of the knee

A careful medical history and physical examination can help diagnose meniscal injury. The McMurray test is one of the important tests for diagnosing meniscal tears. During this test, your doctor will bend the knee is, then straighten and rotate it in and out. This creates pressure on the torn meniscus. Pain or a click during this test may suggest a meniscal tear. Your doctor may order imaging tests such as knee joint X-ray and knee MRI to help confirm the diagnosis.

The treatment depends on the pattern and location of the tear. If the meniscal tear is not severe, your child's doctor may begin with non-surgical treatments that may include:

  • Rest: Avoid activities that may cause injury. Your child may need to use crutches temporarily to limit weight bearing.
  • Ice: Ice application to reduce swelling
  • Pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce swelling and pain
  • Physical Therapy: Physical therapy may be recommended for muscle and joint strengthening.

If the symptoms are still persisting and conservative treatment fails, your child may need a knee arthroscopic surgery to repair the torn meniscus. Knee arthroscopy is a minimally invasive surgery where several small incisions are made around the knee. Through one of the small incision, a miniature camera is inserted to see inside of the knee. Tiny surgical instruments are inserted through other small incisions to repair the tear.

After surgery, rehabilitation exercises may help your child to restore knee mobility, strength and to improve range of motion.

Shin splints

"Shin splints" is used to describe the pain and inflammation of the tendons, muscles and bone tissue around the tibia or shine bone (a large bone in the lower leg). It occurs as a result of vigorous physical activity such as exercise or sports. The condition is also referred to as medial tibial stress syndrome (MTSS).

The common cause of shin splints is overuse of muscles and bone tissue of the tibia because of repetitive sports activity and a sudden change in the physical activity level. The other causes of shin splints include:

  • Stress fractures (tiny, hairline breaks) of the leg bone may cause sharp pain.
  • Tendonitis caused by partial tear in the tendon.
  • Chronic exertional compartment syndrome: Swelling of muscles with exertion as a result, pressure is increased within the muscle compartment. Pain is severe because of loss of blood supply to the muscle.

Flat feet or a rigid arch and use of improper or worn-out footwear while exercising may increase the risk of developing shin splints. Runners and dancers are at a higher risk of developing shin splints.

The most commonly occurring symptoms include pain in front side of the lower leg. Some of the children experience pain during or after exercises. Mild swelling may be accompanied in the lower leg because of which your child may feel weak or numb.

Your doctor will diagnose the condition through physical examination of the lower leg. In some cases, an X-ray or other tests may be required to detect stress fractures of the tibia bone.

The treatment for shin splints consists of non-surgical and surgical procedures. The non-surgical or conservative procedure includes:

  • Rest: Ensure that your child takes adequate rest and avoid activity that causes pain for at least 2-4 weeks. They can try low-impact exercises, such as swimming, bicycling or water running.
  • Nonsteroidal anti-inflammatory medicines are given to reduce pain and swelling.
  • Ice: Apply ice packs wrapped over a cloth to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
  • Compression: Wrap the leg with an elastic bandage which helps to reduce swelling.
  • Flexibility exercises: It involves exercises to stretch the leg muscles to reduce pain and improve the muscle strength.
  • Supportive shoes: Ensure that your child wear shoes that provide good cushioning and support the feet as it helps reduce the stress on the shin bone.

Surgical treatment is an option that is considered only in very severe cases when the conservative methods fail to relieve pain. Surgery may be needed in conditions where the pain becomes severe due to compartment syndrome. Fasciotomy is a surgical procedure where the tough and fibrous tissue is split to relieve the pressure built up within muscle compartments.

Shin splints can be prevented by following these measures:

  • Ensure that your child always wear a proper fitting athletic shoe with good support
  • Make sure that your child is aware of warm up exercises or stretching the leg muscles before starting any vigorous activity
  • Avoid running on hard surfaces like concrete or hard surface
  • Ensure that your child starts any new activity slowly and progress gradually by increasing the duration and frequency of exercise regimen

Quadriplegia

Quadriplegia, also called tetraplegia, is a condition which results in loss of function or paralysis of the muscles in arms and legs.

Quadriplegia is caused by spinal cord injury, stroke, Bell's palsy, nerve disease such as amyotrophic lateral sclerosis, and autoimmune disorder such as Guillain-Barré syndrome.

One of a type of quadriplegia is spastic quadriplegia which is a severe form of cerebral palsy. Spastic refers to muscle stiffness. Cerebral palsy is a neurological disorder that occurs in early childhood which affects body movements, balance, posture, and muscle coordination. It is a result of damage to one or more brain parts that controls muscle movements. Cerebral palsy is caused by fetal brain injuries, infections at birth or during pregnancy, severe jaundice during birth, infections of the brain such as bacterial meningitis or viral encephalitis, or head injury following an accident, fall, or child abuse. Birth injuries can also lead to cerebral palsy in some cases.

Children affected with quadriplegia have difficulty in walking, swallowing, and speaking. Muscles may become very stiff or unusually relaxed. Body movements may be jerky, abrupt, or slow and uncontrolled. The child may not react to sound or may have a delayed speech and some may also have moderate to severe mental retardation.

Your doctor will discuss with you and your family members and gather information if any problem has occurred during pregnancy and labor and may order some of tests such as:

  • Ultrasound of the brain - Detect any abnormality such as bleeding or brain damage
  • CT scan of the brain - Reveals any abnormalities.
  • MRI of the brain - Captures the internal structure of the brain more clearly than other methods. Imaging of the spinal cord with MRI is suggested in children with spastic leg muscles and lack of bladder and bowel control.

Treatment

Treatment options include non-surgical and surgical treatment. Non-surgical treatment includes:

  • Physical therapy involves stretching exercises and other activities that develop flexibility and strengthen the muscles.
  • Occupational therapy teaches physical skills to function independently in life such as eating, dressing, and teeth brushing.
  • Speech/language therapy enables the child to improve speech and overcome problems of communication
  • Medicines are recommended to relax the muscle spasms.
  • Special equipments such as walkers, positioning devices, wheelchairs help to improve function in children with cerebral palsy. Braces and other orthotic devices may be required to neutralize the muscle imbalance and improve posture and walking.

Surgery is recommended when the conservative treatments has not reduced spasticity and pain. Surgical treatment includes:

  • Dorsal rhizotomy: It is a surgical procedure performed to reduce spasticity and improve the muscle movements. In this procedure, a few nerves are cut at the roots where they divide from the spinal cord.
  • Intrathecal baclofen therapy: In this procedure, Baclofen–a muscle relaxant is injected into the spine to reduce muscle spasticity. A tiny pump is placed in the abdominal wall to pump the drug to the spastic muscles of the limbs.
  • Tendon transfer surgery: It is performed to restore the function of the hand after spinal cord injury. In this procedure, the origin of the functioning muscle is detached and reinserted into a different bone or different tendon to improve function.

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

Sports Medicine - Dr. John A. Schlechter - Pediatric Orthopedic Surgeon
Arthroscopy - Dr. John A. Schlechter - Pediatric Orthopedic Surgeon
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