Mather Hospital; Stony Brook University Hospital
Stony Brook University Hospital
Northwell Cohen Children’s Medical Center
Pediatric overuse injuries have become a growing problem in the last couple of decades. Children are being increasingly pushed physically each year by themselves, parents, and coaches. The repetitive motions typical of sports such as baseball, gymnastics, and soccer lead to abnormal stresses at the open physes. These injuries can lead to long-term deformities and disabilities if they are not recognized early and treated appropriately.
Educational Goals / Teaching Points
Highlight the common pediatric overuse injuries. Little leaguer’s shoulder and elbow, Osgood-Schlatter’s disease, gymnast’s wrist, stress fractures, etc. Importance of x-rays in the pediatric population with clinical suspicion. Importance of giving these injuries the appropriate time to heal to prevent long-term issues.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Little leaguer’s shoulder, or epiphysiolysis of the proximal humerus, is often caused by repetitive overhead motion such as is typical in throwers. The increased forces on the open physis lead to physeal separation, causing shoulder pain. Radiographs shows widening and irregularity of the proximal humeral physis as compared to the contralateral shoulder. Little leaguer’s elbow, or a medial epicondyle stress fracture, is also caused by repetitive throwing. This causes medial elbow pain and decreased throwing abilities. Radiographs may show widening of the physis and fragmentation of the medial epicondylar apophysis from repetitive valgus forces. Gymnast’s wrist, or distal radial physeal stress syndrome, is caused by constant weight bearing on the outstretched hands. This causes inflammation at the distal radial physis secondary to Salter-Harris type I injuries. The recurrent trauma at the physis may lead to early fusion and ultimately a shortened radius relative to the ulna. Radiographs often shows physeal widening and blurring of the physis. If left untreated, ulnar variance will become positive. Stress fractures commonly occur in the tibia from repetitive activities such as long-distance running. Radiographs may be initially negative and a strong clinical suspicion is critical for the proper diagnosis. In the subacute period, radiographs may show a periosteal reaction, sclerosis, or even a cortical break. The gold standard is magnetic resonance imaging, which will show edema. Osgood-Schlatter’s disease, or tibial tubercle apophysitis, occurs from increased stresses on the patellar ligament at the attachment at the tibial tuberosity, often associated with jumping and sprinting. Radiographs first may show subtle signs of soft tissue swelling at the tibial tuberosity. Later in the disease, fragmentation of the tibial tuberosity may be seen on the lateral radiograph.
As overuse injuries in the pediatric athletic population increase, elevated clinical suspicion and early recognition is imperative. This population is extremely susceptible to overuse injuries due to the fragility of open physes. It is important children do not overexert themselves in particularly in competitive sports. If diagnosed at an early stage, most overuse injuries will heal with adequate rest and time off from sport.