![]() Patients with a confirmed or suspected diagnosisįlattening and fragmentation of humeral capitellum No weight-bearing activities (e.g., sports, dance) until reossification Sclerosis, flattening and fragmentation of the femoral head Pain in hip, limping child, possible referred knee pain Patients with recent trauma, illness, or elevated inflammatory markers Sclerosis, flattening, and fragmentation of navicular boneĬast immobilization for up to four to six weeks Patients with metatarsophalangeal joint arthritis and loose joint fragments Sclerosis, flattening and fragmentation of metatarsal headĪctivity modification metatarsal pads well-padded shoes limited NSAIDs for pain Plain radiography results are usually normalĪctivity and shoe modifications heel cups calf stretches acetaminophen or NSAIDs Posterior heel pain with activity and shoe wear Soft tissue swelling and fragmentation of tibial tubercleĪctivity modification acetaminophen or NSAIDs Pain at anterior tibial tubercle with activity and kneeling Throwing cessation acetaminophen or NSAIDs as needed May show fragmentation or widening of medial epicondyle Localized pain over medial epicondyle with throwing Medial epicondyle apophysitis (i.e., thrower's elbow) Patients with a mature skeleton who have persistent symptoms Soft tissue swelling and calcification of inferior pole of patellaĪctivity modification short course of acetaminophen or NSAIDs Pain at inferior patellar pole with activity and kneeling Patients with acute avulsions or continued symptoms despite rest ![]() Rest, stiff-soled shoe for protected weight-bearing Normal or widened apophysis of the proximal metatarsal Insidious onset of pain over base of fifth metatarsal head Patients with persistent pain despite conservative management Normal or widened apophysis compared with contralateral side Pain over affected apophysis (seven sites in pelvis) However, physicians should have a low threshold to refer to a pediatric orthopedist, especially if the condition persists longer than four to six months. Osteochondrosis disorders are rare and many are self-limiting. ![]() 23 – 25īased on a small randomized controlled trial Sever disease treatment should include relative rest, heel cups initially, and heel cord stretches to prevent recurrence. 4, 9, 16īased on expert opinion and consensus guidelines in the absence of clinical trials Treatment of Osgood-Schlatter disease should include relative rest and quadriceps and hamstring stretching and strengthening. Major League Baseball position statement for adolescent baseball pitchers Preventive measures for medial epicondyle apophysitis should include taking at least four months off from competitive pitching per year, avoiding use of radar guns, and avoiding the combination of pitching and catching. Surgery is rarely needed for either apophysitis or osteochondrosis. Osteochondrosis generally resolves with relative rest, but close monitoring is needed to ensure resolution. Radiography results may be normal initially magnetic resonance imaging is more sensitive to early changes. Other locations of osteochondrosis include the second metatarsal head (i.e., Freiberg disease), the navicular bone (i.e., Köhler bone disease), the femoral head (i.e., Legg-Calvé-Perthes disease), and the capitellum (i.e., Panner disease). Multiple possible etiologies have been explored, including genetic causes, hormonal imbalances, mechanical factors, repetitive trauma, and vascular abnormalities. Unlike apophysitis, the etiology of osteochondrosis is unknown. Osteochondrosis presents less commonly and refers to degenerative changes in the epiphyseal ossification centers of growing bones. Treatment includes stretching the affected muscle groups, relative rest, offloading the affected tendon, icing after activity, and limited use of nonsteroidal anti-inflammatory drugs. Radiography can be helpful in evaluating for other pathologies but is usually not necessary. ![]() Other locations include the medial epicondyle, which is common in patients who throw or participate in racket sports, and more rarely at the base of the fifth metatarsal (i.e., Iselin disease). Although apophysitis occurs in upper and lower extremities, it occurs more often in the lower extremities, with common locations including the patellar tendon attachment at the patella or tibia (i.e., Larsen-Johansson and Osgood-Schlatter diseases), the calcaneus (i.e., Sever disease), and multiple locations around the hip, including the anterior inferior iliac spine. Most often it is an overuse injury in children who are growing and have tight or inflexible muscle tendon units. Apophysitis results from a traction injury to the cartilage and bony attachment of tendons in children and adolescents. Apophysitis and osteochondrosis are common causes of pain in growing bones but have differing etiologies and required management.
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