SOS Elbow

Background

Physical activity generally leads to improved cognitive performance and lower risk of obesity in children. If excessive, however, physical activity may be associated with adverse outcomes such as overuse injury, which make up about 50% of all pediatric injuries. Overuse is defined as exceeding demands relative to the physiologic ability to compensate. It is thought that repetitive micro trauma results in loss of function, slowly progressing inflammation and pain. Children and adolescents may be particularly at risk for sports-related overuse injuries as a result of improper technique, unbalanced training hours, and an immature musculoskeletal system. 

Commonly reported overuse injuries include; stress fractures, apophysitis, physeal stress injuries and osteochondritis dissecans (OCD), which may manifest if adequate recovery is not incorporated in training schedules. Although overuse injuries can occur in many different parts of the body, the elbow is specifically susceptive to this form of injury. Overuse elbow injuries are common among children who perform elbow-loading sports, such as baseball, gymnastics, golf, squash, tennis, judo, javelin throwing or volleyball. The most commonly diagnosed overuse injuries in the pediatric elbow are OCD (mostly of the capitellum), insufficiency of the medial collateral ligament (MCL) and damage of the growth plates. 

Diagnosis of overuse injuries is often delayed in pediatric athletes. The clinical presentation differs per athlete and prompt diagnosis therefore requires a high level of suspicion from the physician. It is essential to signal these injuries in a timely manner to avoid functional limitations, potential progressive degeneration later on in life, and reduce recovery time  and return-to-play. 

A detection instrument of overuse injury in the pediatric elbow does not exist to the best of our knowledge. A short, validated questionnaire may be a useful and effective clinical tool. 

Objectives

The aim of this study is to develop such an instrument for signaling overuse sports injuries in the pediatric elbow (SOS-Elbow). 

Design

In part 1, data on presence and severity of overuse elbow injuries in pediatric patients is collected by a focus group of 13 physicians involved in the management of these injuries. Signals and functional limitations of pediatric athletes with overuse elbow injuries are discussed and rated in order of importance.

In part 2, 25 young overhead athletes will be included and interviewed about overuse injuries.

In part 3, both studies will be combined with data from the literature to develop the SOS-elbow, which can be further tested in a validation study.