MIAMI — In young children, think apophysitis instead of tendonitis, Dr. Teri McCambridge said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.
Dr. McCambridge of Johns Hopkins University, Baltimore, emphasized that excessive participation in a single sport is often a culprit. The American Academy of Pediatrics recommends restricting organized sports participation to children at least 6 years of age, while specialization in one sport should be reserved for adolescents.
The way a young tennis player grips the racket or the placement of cleats on a soccer player's shoes can contribute to an overuse injury such as apophysitis. Dr. McCambridge recommended that physicians look for these fixable causes and consult with a coach or other knowledgeable person if they do not know what to look for in a particular sport.
The last apophyseal centers to close in the lower extremity are those in the hips, and, therefore, physicians should watch for apophysitis of the hip in older athletes.
Calcaneal apophysitis, or Sever's Disease, tends to occur early in the growth spurt. It's most common in sports in which children wear cleats or do not wear shoes. Children with calcaneal apophysitis often complain of ankle pain, although upon closer examination the source turns out to be the heel.
Dr. McCambridge said that x-rays are generally not warranted except in certain instances, such as in children with atypical features or nighttime pain, those on the extremes of the expected age range, and those who do not improve after treatment.
Physicians should be aware of other potential causes of joint pain in children, including tendonitis and, rarely, stress fractures, osteomas, tumors, or rheumatologic conditions. Rest is a critical treatment for apophysitis. Children with calcaneal apophysitis also can use ice and should avoid walking barefoot. Dr. McCambridge suggested that when a child has no pain with daily living, they can return to their sport with modifications.
Another common traction apophysitis is Osgood-Schlatter disease (OSD), which occurs at the tibial tuberosity in children aged 11–15 years. Children often present with pain over the anterior tibia, pain with activity, and pain with full flexion. They also tend to have swelling and palpable tenderness at the tibial tuberosity. Chronic OSD carries the risk of long-term problems due to the formation of painful, nonunited ossicles resulting from fragmentation of the tibial tuberosity.
Because of this risk, Dr. McCambridge tends to radiograph OSD more than any other apophyseal injury.