Contemporary Pediatric and Adolescent Sports Medicine Series Editor: Lyle J. Micheli Lyle J. Micheli Laura Purcell Editors The Adolescent Athlete A Practical Approach Second Edition Contemporary Pediatric and Adolescent Sports Medicine Series Editor Lyle J. Micheli Division of Sports Medicine Boston Children’s Hospital Boston, MA USA More information about this series at http://www.springer.com/series/11729 Lyle J. Micheli • Laura Purcell Editors The Adolescent Athlete A Practical Approach Second Edition Editors Lyle J. Micheli Laura Purcell Division of Sports Medicine Department of Pediatrics Boston Children's Hospital McMaster University Boston, MA Hamilton, ON USA Canada Additional material to this book can be downloaded from http://extras.springer.com. ISSN 2198-266X ISSN 2198-2678 (electronic) Contemporary Pediatric and Adolescent Sports Medicine ISBN 978-3-319-56187-5 ISBN 978-3-319-56188-2 (eBook) https://doi.org/10.1007/978-3-319-56188-2 Library of Congress Control Number: 2018939545 © Springer International Publishing AG, part of Springer Nature 2007, 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland The Micheli Center for Sports Injury Prevention The mission of the Micheli Center for Sports Injury Prevention is at the heart of the Contemporary Pediatric and Adolescent Sports Medicine series. The Micheli Center uses the most up-to-date medical and scientific infor- mation to develop practical strategies that help young athletes reduce their risk of injury as they prepare for a healthier future. The clinicians, scientists, activists, and technologists at the Micheli Center advance the field of sports medicine by revealing current injury patterns and risk factors while develop- ing new methods, techniques, and technologies for preventing injuries. The Micheli Center, named after Lyle J. Micheli, one of the world’s pio- neers in pediatric and adolescent sports medicine, had its official opening in April 2013. Thus far, the Micheli Center has served more than 2800 athletes and has published more than 100 studies. Dr. Micheli is the series editor of Contemporary Pediatric and Adolescent Sports Medicine. Consistent with Dr. Micheli’s professional focus over the past 40 years, the Micheli Center conducts world-class medical and scientific research focused on the prevention of sports injuries and the effects of exercise on v vi The Micheli Center for Sports Injury Prevention health and wellness. In addition, the Micheli Center develops innovative methods of promoting exercise in children. The Micheli Center opens its doors to anyone seeking a healthier lifestyle, including those with medical conditions or illnesses that may have previously limited their abilities. Fellow clinicians, researchers, and educators are invited to collaborate and discover new ways to prevent, assess, and treat sports injuries. Series Editor Biography Dr. Lyle J. Micheli is the series editor of Contemporary Pediatric and Adolescent Sports Medicine. Dr. Micheli is regarded as one of the pioneers of pediatric and adolescent sports medicine, a field he has been working in since the early 1970s when he co-founded the USA’s first sports medicine clinic for young athletes at Boston Children’s Hospital. Dr. Micheli is now director of the Division of Sports Medicine at Boston Children’s Hospital, and Clinical Professor of Orthopedic Surgery at Harvard Medical School. He is a past president of the American College of Sports Medicine and is currently the Secretary General for the International Federation of Sports Medicine. Dr. Micheli co-chaired the International Olympic Committee consensus on the health and fitness of young people through physical activity and sport. In addition to many other honors, Dr. Micheli has served as Chairperson of the Massachusetts Governor’s Committee on Physical Fitness and Sports, on the Board of Directors of the United States Rugby Football Foundation, as Chairman of the USA Rugby Medical and Risk Management Committee, and on the advisory board of the Bay State Games.  He served as Attending Physician for the Boston Ballet from 1977 to 2016 and is Medical Consultant to the Boston Ballet School. Dr. Micheli received his undergraduate degree from Harvard College in 1962 and his medical degree from Harvard Medical School in 1966. As an The Micheli Center for Sports Injury Prevention vii undergraduate student, Dr. Micheli was an avid athlete, competing in rugby, gridiron football, and boxing.  Since graduating, Dr. Micheli has played prop for various Rugby clubs including the Boston Rugby Football Club, the Cleveland Blues Rugby Football Club, Washington Rugby Club, and Mystic Valley Rugby Club, where he also served as team coach. Dr. Micheli has authored over 300 scientific articles and reviews related to sports injuries, particularly those sustained by children. His present research activities focus on the prevention of sports injuries in children. Dr. Micheli has edited and authored several major books and textbooks. Preface It is with great pleasure that we introduce the second edition of The Adolescent Athlete: A Practical Approach. This updated edition is inspired by the popularity of the first volume—and the amount of new information in the field that warrants a place in these pages. All the chapters have been updated. Some of the more important additions are updated references, color figures, and inclusion of cutting-edge discus- sion of management of such high publicity sport injuries as concussions, ACL tears, and femoroacetabular impingement. This new information makes this second edition an important contribution to the literature. Yet the fundamental reasons for this book remain the same. We still believe strongly that good health should be a goal of all children and adolescents, as well as the parents and guardians who care for them. Regular physical activity is part of achieving this goal. Sports can provide manifold benefits, including fitness, motor skill development, teamwork, and of course, fun. As with any pursuit that provides such benefits, however, there are risks involved, particularly for growing athletes. Physicians and other health pro- fessionals caring for active children should be able to provide appropriate care and advice for sport and fitness-related medical issues. We received very positive feedback on the first edition’s emphasis on being a practical guide for those who provide sports care for young athletes. The focus in this updated edition remains musculoskeletal injuries that occur in this unique population, as well as conditions that may present as a muscu- loskeletal injury, but may have more serious consequences. The first section of the book focuses on rehabilitation and diagnostic imaging of musculoskel- etal conditions in adolescents. The second section—organized according to anatomical region—addresses specific injuries that adolescents may sustain as a result of sport/activity participation. Each of these body part–specific chapters begins with a review of the relevant anatomy, followed by details of clinical evaluation. Specific injuries, such as acute and chronic injuries, are described in detail, including the management/treatment of each condition. Prevention of injuries and return to play guidelines are given full attention, as befits a book published under the Micheli Center for Injury Prevention. Each chapter concludes with “clinical pearls” that provide an insight into the way each of our expert authors practice their craft. We thank all those who donated their time and expertise to making this second edition possible. Revising and updating chapters is a time-consuming ix x Preface and painstaking process, and we are very grateful to the chapter authors for their commitment. We also appreciate the effort and attention to detail of our editors at Springer. Without these contributions, this new and updated version of a very valuable resource would not have come to fruition. Boston, MA, USA Lyle J. Micheli Hamilton, ON, Canada Laura Purcell Contents 1 Current Pediatric and Adolescent Sports Medicine: An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Laura Purcell and Lyle J. Micheli Part I Rehabilitation and Diagnosis 2 Principles of Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Michelina C. Cassella and Kathleen Richards 3 Diagnostic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Diego Jaramillo and Vernon M. Chapman Part II Anatomic Regions 4 Traumatic Head Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Laura Purcell 5 Cervical and Thoracic Spine Injuries . . . . . . . . . . . . . . . . . . . . . 65 Pierre d’Hemecourt and Jessica Flynn Deede 6 Lumbar Spine Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Merrilee Zetaruk 7 Thoracoabdominal Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Hamish Kerr, Brady Bowen, and Deborah Light 8 Adolescent Shoulder Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Nathaniel Cohen and Treg Brown 9 Elbow and Forearm Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Anthony Luke, Margaret Lo, and Marc R. Safran 10 Injuries to the Wrist, Hand, and Fingers . . . . . . . . . . . . . . . . . . 179 Praveen G. Murthy and Donald S. Bae 11 Pelvic, Hip, and Thigh Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Jason H. Nielson and Tyler J. Kent 12 Knee Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Michelle McTimoney xi