Physeal Stress Injuries in Young Athletes

Participation in youth sports is increasingly popular and has important and wide-ranging health benefits. However, year-round involvement in youth sport involves high levels of repetitive movement which may foster an environment where overuse injuries are likely to occur. Of particular concern are physeal stress injuries (PSIs) which are unique to skeletally immature athletes and are becoming common in youth sports. These injuries may be associated with substantial injury burden, especially at advanced levels of training and competition. In extreme cases, PSIs can progress to produce skeletal growth disturbance, which may necessitate surgical intervention and correction. This book summarizes the status of our knowledge on the occurrence, underlying pathophysiologic mechanisms, diagnosis, treatment, and prevention of PSIs affecting children and adolescents involved in various sports. Physeal Stress Injuries in Young Athletes: Diagnosis, Treatment and Prevention is organized into three parts. Part I, Introduction opens with a chapter that provides a foundation and basic framework on bone growth for readers to better understand and anticipate potential complications and growth disturbance that can arise from PSIs. This is followed by two chapters that provide an overview of the two anatomically distinct types of PSIs epiphyseal and apophyseal PSIs. In addition to providing a general sense of the occurrence and distribution of these injuries, these chapters also provide a novel framework for understanding the underlying pathophysiologic mechanisms of these injuries. Part II, Diagnosis and Treatment consists of 8 chapters covering common sites of epiphyseal and apophyseal PSIs, anatomically divided into those occurring at the shoulder, elbow, wrist, hand and fingers, spine, pelvis and hip, knee, ankle and foot. Each chapter follows a similar outline and provides detail on location-specific patterns of PSIs, available demographic and epidemiologic data, known or postulated injury mechanisms, underlying pathophysiologic mechanisms, typical clinical presentation, key diagnostic imaging findings, management, and factors that impact prognosis and outcome. Part III, Prevention consists of a chapter that begins with a discussion on risk factors common to epiphyseal and apophyseal PSIs. This is followed by a review of practical preventive measures that are generally applicable to patients diagnosed with PSI. Finally, the last section of this chapter takes a closer look and reviews evidence-based strategies designed to target prevention of specific PSIs at various anatomical locations. Primary care sports medicine physicians, urgent and emergency care physicians, orthopedic surgeons, physical and athletic therapists, and athletic trainers who provide care for pediatric athletes will find this book helpful in identifying and treating young athletes with physeal stress injuries, identifying knowledge gaps, and implementing appropriate preventive measures that can reduce future incidence and severity of these injuries. Sport governing bodies and coaches can also use the information gathered within this book to guide the development and optimization of injury prevention programs and to reduce underdiagnosis and undertreatment of physeal stress injuries.