Apophyseal injuries in the young athlete - includes patient information sheet

Athletic participation continues to gain popularity among adolescents. Twenty million youngsters in the United States participate in organized sports, and athwart 50 percent of school-aged children participate in a certain quantity of sort of school-based or community-based sports program.(1)

Over the past 15 years, a of recent origin population of young single-sport athletes has unfolded These athletes start participating when they are as young as four or five years of age and resign intensive training to their sport year-round. This dispose of athletes is at increasd risk for evolution of apophyseal injuries.

The normal growing skeleton has three main extension sites: the physeal plate, the joint surface and the apophysis.(2) The apophysis is the extension cartilage site where a major tendon inserts forward the growing bone (Figure 1) The apophysis has its avow growth plate that is separate from the physeal plate. The sprouting rate of the apophysis is slower than that of the nearby epiphyseal plate. This slower rate of sprouting is believed to be related to the increased number of collagen fibers construct in the apophysis, which are wanted to support the greater tensile forces in succession this structure.(3) Some common sites of apophyses are the tibial tubercle and the insertion of the Achilles tendon forward the calcaneus.

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Apophyseal injuries are unique to patients with skeletal immaturity. Apophyseal injuries involve inflammation at the site of a major tendinous insertion onto a bony prominence that is undergoing active growing Several theories have been postulated to account for the evolution of apophyseal injuries. The first theory is that injury evolves from a major traumatic marked occurrence to the apophysis, such as a violent contraction that avulses a portion of the apophysis and is followed through inflammation. A second theory is that injury lay opens from repetitive microtrauma to the apophyseal area, which causes multiple tiny avulsion fractures. This proces is followed by way of an inflammatory cycle, which is believed to disentangle from repetitive running and jumping in in the same state [i]or[/i] condition sports as soccer, basketball and distance running. A third theory is that injury is proper to a macrotraumatic event that is either preced or followed according to multiple episodes of repetitive microtrauma to the apophysis.

Another factor in the incident of apophyseal injury is the component of growth.(4) In athletes with skeletal immaturity who are going from one side a growth spurt, significant muscle-tendon imbalance commonly discloses Muscle-tendon imbalance manifests as tight and inflexible muscle arranges Such a muscle-tendon imbalance meet the eyes because muscle development lags behind bony exhibition This relative inflexibility can adversely affect the developing apophysis by the agency of increasing the traction forces in succession this site. This sequence of incidents sets up an environment that is conducive to the disentanglement of apophyseal injuries, especially with the addition of repetitive microtrauma from sports activity.

The actual incidence of apophyseal injuries is unknown. the same study found 139 apophyseal injuries in a population of 445 patients who at handed to the Sports Medicine Clinic at Boston Children's Hospital from 1980 to 1990(5) Other investigators studied 85 patients with a diagnosis of calcaneal apophysitis and establish that the average age at presentation was 11 years, with bilateral involvement occurring in 61 percent of cases.(6)

Apophyseal injuries fall out at many different anatomic sites. This article reviews the diagnosis and treatment of Sever's disease, Osgood-Schlatter disease, Sindig-Larsen-Johansson syndrome apophyseal injuries of the hip, and medial epicondylitis (Table 1)

TABLE 1 Apophyseal Injuries

Injury

Sever's disease

Age (years)

8 to 13

Site

Posterior calcaneus

Presentation

Heel pain with activity

Differential diagnosis

Achilles tendinitis, stres fracture

Treatment

Heel potions RICE, decrease activity, NSAIDs

Injury

Osgood-Schlatter disease

Age (years)

Boys: 10 to 15

Girls: 8 to 13

Site

Tibial tuberosity

Presentation

Anterior knee pain

Differential diagnosis

PFD OCD stres fracture(*)

Treatment

RICE, activity modification, knee strap, NSAIDs

Injury

Sindig-Larsen-Johannson syndrome

Age (years)

10 to 13

Site

Inferior rod of patella

Presentation

Anterior knee pain

Differential diagnosis

PFD OCD stres fracture(*)

Treatment

RICE, activity modification, NSAIDs

Injury

Apophysitis of the hip

Age (years)

9 to 13

Site

ASIS, AIIS, iliac armorial bearings ischial tuberosity

Presentation

Dull ache around the hip

Differential diagnosis

Muscle strain, stres fracture

Treatment

RICE, stretching program, NSAIDs

Injury

Medial epicondylitis

Age (years)

9 to 13

Site

Humeral medial epicondyle

Presentation

Medial push pain with activity

Differential diagnosis

Flexor tendinitis, UCL sprain

Treatment

RICE, activity modification, NSAIDs

NSAIDs = nonsteroidal anti-inflammatory drugs; PFD = patellofemoral dysfunction; OCD = osteochondritis dessicans; RICE = interval ice, compression and elevation; ASIS = anterior superior iliac spine; AIIS = anterior inferior iliac spine; UCL = ulnar collateral ligament.