The most common musculoskeletal disorders in adolescents are related to injuries and congenital disorders. Athletic injuries, back pain, foot injuries, knee disorders, shin splints and stress fractures are discussed in other chapters. Congenital musculoskeletal disorders such as muscular dystrophy are discussed elsewhere.
It may be useful to review the injuries that adolescents may endure when they participate in certain sports:
- Gymnastics: overuse injuries including sprains to the ankle and overuse of the wrist and spine. The incidence of injuries increases with the level of skill for the adolescent and is most likely in floor exercises
- Swimming: injury to the shoulder is most common and is likely to be a rotator cuff tendonitis. The swimmer will have shoulder pain and tenderness in the region
- Baseball: the most common injuries are due to throwing and will involve the shoulder or elbow. This type of injury is especially common in pitchers.
- Ballet: injuries could include stress fractures of the foot, bunions, bleeding under the toenails and sprains to the ankle from twisting motions. Participants may also develop shin splints and stress fractures of the tibia or fibula. The knee may be affected by patellar misalignment as well as Osgood-Schlatter disease. Males may develop mild slipped capital femoral epiphysis producing hip pain.
- Wrestling: the forces or torques applied during competition may produce neck muscle strain or even spinal cord injury. Stretching of the nerves in the neck may produce pain, numbness or weakness in the arms. Meniscal tears may occur in the knee.
- Football: the most common injuries are neck sprains, concussion and injury to the brachial (nerve) plexus. Contusions to the arm and thigh muscles are common, and knee injuries are
Hockey: the hockey puck and stick may produce contusions, lacerations or concussions. Ankle and hip adductor sprains are common. - Basketball and volleyball: overuse of the knee and ankle problems are most common
- Running: problems due to this sport are usually related to muscle overuse that may be exacerbated by muscle imbalance or poor flexibility. Poorly absorbed foot impact may also exacerbate injury. Stress fractures may occur in a number of areas on the upper or lower leg Muscle strains frequently involve the hamstrings, quadriceps, hips adductors and gastrocnemius. Knee pain and shin splints are not uncommon injuries.
- Soccer: the usual injuries include muscle contusions and strains, ligament sprains of the ankle and knee and abrasions.
- Tennis: the most common area of injury includes the muscles and tendons of the elbow, shoulder, back and abdomen. Tendonitis may affect the shoulder and elbow. Ganglion cysts may cause wrist discomfort.
- Skiing: injuries occur primarily from falls and these include contusions and lacerations. Thumb injuries may occur from falls where the thumb is abducted and hyperextended. Ankle and knee sprains are not uncommon and of course leg fractures can also occur.
There are a few important congenital musculoskeletal disorders. Myotonic dystrophy is a type of muscular dystrophy and has an incidence of one in thirty thousand in the general population. This is a congenital disorder with a genetic basis where a gene located on chromosome 19 is defective. The muscle fibers have areas of atrophy or even an arrest in their maturation. An infant may appear normal at birth, or show early signs of muscle wasting especially in the face. Subsequently, other skeletal muscles may become wasted and the child may have difficulty with climbing stairs.
Other organs may be involved including the heart and gastrointestinal tract. In addition, the endocrine system may be involved at any time during the course of the disease. Hypothyroidism and diabetes, disease of the endocrine system, are more likely in patients with Myotonic dystrophy. Patients with Myotonic dystrophy are at risk for cataracts involving their eyes. Interestingly, the onset of puberty may be delayed or sometimes it is early. It is not uncommon for adult males to have small testicles and deficient testosterone, and this could lead to male infertility. Baldness that occurs in the front of the scalp is also common in males with Myotonic dystrophy. The baldness often begins in adolescence.
Myotonic dystrophy may be diagnosed by muscle biopsy. In many cases, however, it may be diagnosed on the basis of the clinical manifestations. A molecular genetic diagnosis may be obtained prenatally.
There is no specific treatment for Myotonic dystrophy. Abnormalities due to the illness such as cataracts or diabetes can often be treated. Genetic counseling may help to prevent cases of Myotonic dystrophy since it is inherited in an autosomal dominant manner.
Marfan syndrome is a disorder that is transmitted in an autosomal dominant manner. This disorder occurs in one in ten thousand births, and thirty percent of affected newborns are new mutations. The disorder is due to a mutation of the fibrillin gene located on chromosome 15. This gene is responsible for the biosynthesis of fibrillin 1 which is a glycoprotein that is a major constituent of microfibrils that help form the structure of nonelastic tissue in various areas of the body. At least two hundred different mutations throughout the gene have been described.
Patients with Marfan syndrome may have low muscle tone, lax joints prone to dislocation, long spider like fingers and possible dislocation of the lens in the eye. As children develop into teenagers, they may have tall stature with a long and thin face. The stature may seem out of proportion with the legs and arms appearing to be excessively long. The chest may have a caved in or pushed out appearance. The musculoskeletal system may be noteworthy for long and thin limbs and fingers. There may be abnormalities of the heart including mitral valve prolapse, and dilation of the aortic root near the heart. Unfortunately, any life-threatening complications will be due to the heart and aorta problems.
Marfan syndrome is diagnosed on the basis of clinical findings including tall stature, heart defects and disproportion of the body segments. For example, measurements of the upper section of the body may be out of proportion to the lower segment of the body in individuals with Marfan syndrome.
Teens afflicted with Marfan syndrome will need to have any complications treated. Evaluations on a periodic basis by a cardiologist and ophthalmologist are usually recommended. There may be restrictions on exercise depending on the severity of cardiac complications. There is a concern that pregnant teens may have an exacerbation of their cardiac abnormalities.
Genetic counseling may help to prevent cases of Marfan syndrome. Each child of an affected parent has a fifty percent chance of inheriting the number 15 chromosome that contains the mutant gene. Up to thirty percent of the affected individuals are the first cases in their family. Studies have shown that the fathers of these sporadic cases have been on average up to ten years older than fathers in the general population suggesting there is a mutation in the sperm that may be associated with advancing paternal age.
Related topics:
Athletic injuries, back pain, body image, bone disorders, chronic illness, exercise, eye problems, foot injuries, genetic disease, hair loss, knee disorders, muscular dystrophy, posture, shin splints, stress fractures, testicular disorders
