Awards & Grants

Paediatric Sport Medicine Grant

2008 Paediatirc Sports Medicine Grant - Final Report

Submitted by: Michelle Jackman, MSc, MD, FRCPC, Pediatrician, Division of Pediatric Endocrinology, Children’s Hospital of Western Ontario, London, Ontario

I would like to thank the CPS Paediatric Sports and Exercise Medicine Section for awarding me the 2008 resident bursary. This award allowed me to pursue an exceptional elective experience in paediatric sports medicine.

I had the opportunity to work with highly trained sports medicine physicians across the country. My preceptors included Dr. Laura Purcell in London, Ontario, Dr Claire Leblanc at the Stollery Children’s hospital in Edmonton, Alberta and Dr Connie Lebrun, medical director of the Glen Sather Sports Medicine Clinic at the University of Alberta.  My preceptors offered unique perspectives through their expertise in paediatric sport medicine, paediatric emergency medicine, paediatric rheumatology and adult sports medicine. This exposed me to the true depth and diversity of paediatric sports medicine as a specialty.

You may ask, “How will an elective in sports medicine help me be a better paediatrician?”  Thanks to some of the patients that I assessed during my rotation, I’ve compiled a fun quiz to illustrate that sports medicine is much more than examining knees and diagnosing Osgood- Schlatters!

1. On your first day of the elective, you meet Justina, a 16-year-old competitive soccer player referred to you for a six month history of right knee pain, made worse with activity and relieved with ibuprofen, rest and icing. There is no history of trauma, fevers, and weight loss, diarrhea or morning stiffness. The knee exam is consistent with patello-femoral syndrome and X-rays are normal.  What do you do next?
   1. Give her a corticosteroid injection.
   2. Send her to a physiotherapist with specific orders.
   3. Tell her to take up swimming instead of soccer.
   4. Give her crutches and advise non-weight bearing for six weeks.
      
      
2. You meet JD, a 15-year-old native boy who has been experiencing right knee pain and swelling for 6 weeks. In addition, pain started in both his heels three weeks ago. Some relief is provided with ibuprofen, rest and icing. He reports a one week history of red, painful eyes. What mode of imaging would likely be most helpful in this case?
   1. MRI of sacroiliac joints
   2. CT of sacroiliac joints
   3. plain X-rays of shoulders and knees
   4. bone scan
      
      
3.  Austin is an 8-year-old boy who has had bilateral ankle pain since his soccer season started 4 weeks ago. The pain is worse with running. Your diagnosis is:
   1. Bilateral sprained ankles
   2. Calcaneal Apophysitis or Severs disease
   3. Allergy to exercise
   4. Tendonitis
      
      
4. Suzanne is a 10–year-old girl who presents with a 10 day history of bilateral foot pain, swelling and heat. She has experienced two similar episodes in the past year. One episode occurred two weeks after she fell on her outstretched right hand. She has visited the emergency on three occasions for persistent pain despite no fracture on x-ray.  What is your diagnosis?
   1. Systemic Lupus erythematosus
   2. Complex regional pain syndrome
   3. Peripheral neuropathy
      
      
5. You are asked to assess Jonah, a 14-year-old boy regarding tall stature and advise re: safety of strength training.  What are the contraindications to strength training in this age group?
   1. Marfan’s syndrome with aortic root pathology
   2. Pectus excavatum
   3. Ehler’s Danlos
   4.  > 6 hours/week of watching the World Wrestling Federation
      
      
6. Liz is a 14-year-old girl who fell off her horse and sustained a concussion. Two weeks later, she asks you when she can resume horseback riding. What is your approach? 
   1. Perform the SCAT concussion symptom score
   2. Sell the horse
   3. Start riding but get a new helmet
      
      
7. Andrea is a 10-year-old competitive swimmer whose best stroke is the butterfly. She comes in to see you because of left shoulder pain. What will be an important part of her management plan?
   1. Shoulder girdle stabilizer strengthening program
   2. Local physical therapy modalities including ultrasound
   3. Anti-inflammatories
   4. All of the above
      
      
8. Lara is a 15-year-old competitive gymnast who has had amenorrhea for one year. On dietary history you find she is restricting her calories to only 30% of her required daily intake. What is the most important investigation to perform before she leaves the office?
   1. Orthostatic vitals and a 12-lead EKG
   2. CBC, Electrolytes, renal and liver function studies
   3. Beta HCG 
   4. Dexa bone scan

ANSWERS: 1:b, 2:a, 3:b, 4:b, 5:a, 6: a, 7:d, 8:a

Since completing my exams in paediatrics, I have taken a position in the Pediatric Endocrinology division at Children’s Hospital of Western Ontario, in London, Ontario.  I work with a variety of children including those with Type I and 2 diabetes, obesity, eating disorders and other endocrinopathies. Exercise and healthy diet is one of the management cornerstones to all of these conditions. This approach has given me many opportunities to help my patients through my sports medicine experience.

I hope this article has stimulated your interest in paediatric sports medicine, and I encourage you to set up an elective. You will gain valuable knowledge and experience to bring with you to any subspecialty or practice of paediatrics. 

References:
Metzl, Jordan D.  Sports Medicine in the Pediatric Office, American Academy of Pediatrics.  2007.
Micheli, Lyle J and Purcell, Laura. The Adolescent Athlete: A Practical Approach, 2007. 

Posted: March 2009