Display options
Cite
Caine D, Meyers R, Nguyen J, et al. Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review. Sports Med. 2021;doi: 10.1007/s40279-021-01511-z.
Caine, D., Meyers, R., Nguyen, J., Schöffl, V., & Maffulli, N. (2021). Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review. Sports medicine (Auckland, N.Z.), . https://doi.org/10.1007/s40279-021-01511-z
Caine, Dennis, et al. "Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review." Sports medicine (Auckland, N.Z.) vol. (2021). doi: https://doi.org/10.1007/s40279-021-01511-z
Caine D, Meyers R, Nguyen J, Schöffl V, Maffulli N. Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review. Sports Med. 2021 Aug 09; doi: 10.1007/s40279-021-01511-z. Epub 2021 Aug 09. PMID: 34370212.
Copy Download .nbib Format: NLM
Share it on

Sports Med. 2021 Aug 09; doi: 10.1007/s40279-021-01511-z. Epub 2021 Aug 09.

Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review.

Sports medicine (Auckland, N.Z.)

Dennis Caine, Rachel Meyers, Jie Nguyen, Volker Schöffl, Nicola Maffulli

Affiliations

  1. Department of Education, Health and Behavior Studies, College of Education and Human Development, University of North Dakota, 231 Centennial Dr Stop 7189, Grand Forks, ND, 58202-8235, USA. [email protected].
  2. Physical Therapy Division, Duke Health Interprofessional Education, Duke University School of Medicine, 311 Trent Drive, Durham, NC, 27710, USA.
  3. Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
  4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
  5. Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany.
  6. School of Clinical and Applied Sciences, Leeds Becket University, Leeds, England, UK.
  7. School of Medicine, University of Colorado, Denver, CO, USA.
  8. Department of Trauma and Orthopedic Surgery, Friederich Alexander University, Erlangen-Nuremburg, Germany.
  9. Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, Via Salvador Allended, 43, 84081, Baronissi, SA, Italy.
  10. Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Largo Città di Ippocrate, 84131, Salerno, Italy.
  11. Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E14DG, England, UK.
  12. Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK.

PMID: 34370212 DOI: 10.1007/s40279-021-01511-z

Abstract

BACKGROUND: Overuse injuries are common in sporting children and adolescents. These injuries are a particular concern when they involve the epiphyseal-physeal-metaphyseal (EPM) complex given their potential to disturb skeletal growth. Specifically, the limits of mechanical tolerance of the EPM complex to repetitive stress may be exceeded by the intense and continuous training characteristic of many youth sports today.

OBJECTIVE: This article describes the present status of knowledge on the occurrence and outcome of primary periphyseal stress injuries (PPSIs) affecting the EPM complex in the extremities of children and adolescents involved in youth sports.

METHODS: A comprehensive review of the sports medicine literature was conducted to determine the nature and extent of PPSIs affecting the EPM complex of the extremities among youth sports participants and the potential for consequent skeletal growth disturbance and resultant limb deformity associated with these injuries.

RESULTS: Our initial search uncovered 128 original published scientific articles reporting relevant data on PPSIs. There were 101 case reports/series, 19 cross-sectional, 1 case-control, and 7 cohort studies with relevant data. The case reports/series studies reported 448 patients with PPSIs involving the extremities. Children and adolescents representing a variety of high impact repetitive youth sports activities-including baseball, badminton, climbing, cricket, dance, gymnastics, rugby, soccer, swimming, tennis, and volleyball-may sustain PPSIs involving the shoulder, elbow, hand and wrist, knee, and ankle and foot. Although incidence data from prospective cohort studies are lacking, data arising from cross-sectional studies suggest that PPSIs may be common in select groups of youth athletes-including the shoulder in baseball players (0-36.6%), wrist in gymnasts (10-83%) and platform divers (52.6%), and fingers in rock climbers (5-58%). Notably, not all stress-related skeletal changes detected on imaging were symptomatic in these studies. When diagnosed and treated with an appropriate period of rest and rehabilitation, most patients studied were able to return to their sport activities. However, our data also show that 57/448 PPSIs (12.7%) produced growth disturbance, and that 28/448 patients (6.2%) underwent surgery for their injuries. Absence of treatment, delayed presentation and diagnosis, and non-compliance with a rest regimen were common in cases that produced growth disturbance.

CONCLUSIONS: PPSIs may affect the extremities of children and adolescents engaged in a variety of youth sports, especially at advanced levels of training and competition. Most skeletally immature patients with PPSIs respond well to timely treatment; however, in extreme cases, PPSIs can progress to produce skeletal growth disruption which may necessitate surgical intervention. Clearly, establishing the early diagnosis of PPSIs and providing timely treatment of these injuries are needed to ensure the skeletal health of youth sports participants. Rigorous prospective longitudinal epidemiological and imaging studies designed to provide incidence rates of PPSIs and to determine the effect of PPSIs on long-term skeletal health are also necessary.

© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

References

  1. Caine DJ. Are kids having a rough time of it in sports? Br J Sports Med. 2010;44:1–3. - PubMed
  2. Caine DJ, Provance AJ. Pediatric and adolescent injury in adventure and extreme sports. Res Sports Med. 2018;26:5–19. - PubMed
  3. Maffulli N. Children in sport: questions and controversies. In: Maffulli N, editor. Color Atlas and Text of Sports Medicine in Children and Adolescence. London: Mosby-Wolfe; 1995. p. 7–14. - PubMed
  4. Maffulli N, Caine D. The epidemiology of children’s team sports injuries. In: Maffulli N, Caine D, editors. Epidemiology of pediatric sports injuries: team sports. Med sport sci, vol 49. Basel: Karger; 2005. p. 1–8. - PubMed
  5. Schöffl V, Hoffmann P, Imhoff A, Kupper T, Schöffl I, Hochholzer T, et al. Long-term radiographic adaptations to stress of high-level and recreational rock climbing in former adolescent athletes. An 11-year prospective longitudinal study. Orthop J Sports Med. 2018;6:1–9. - PubMed
  6. Steffen K, Engebretsen L. More data needed on injury risk among elite young athletes. Br J Sports Med. 2010;44:485–9. - PubMed
  7. Youth Olympic Games. https://www.olympic.org/youth-olympic-games . Accessed 1 Mar 2020 - PubMed
  8. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd Edition. Washington, DC: U.S. Department of Health and Human Services; 2018. https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf . Accessed 1 Feb 1 2020. - PubMed
  9. Emery CA. Injury prevention in kids’ adventure and extreme sports: future directions. Res Sports Med. 2018;26(Supple. 1):199–211. - PubMed
  10. DiFiori JP. Overuse injury of the physis: a “growing” problem. Clin J Sport Med. 2010;20:336–7. - PubMed
  11. Armstrong N, McManus AM. Preface. The elite young athlete. Med Sport Sci. 2011;56:1–3. - PubMed
  12. Sabato T, Walch T, Caine D. The elite young athlete: strategies to ensure physical and emotional health. Open Access J Sports Med. 2016;7:99–113. - PubMed
  13. DiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry JL, et al. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Clin J Sport Med. 2014;24:3–20. - PubMed
  14. Maffulli N, Longo UG, Gougoulias N, Loppini M, Denaro V. Long-term health outcomes of youth sports injuries. Br J Sports Med. 2010;44:21–5. - PubMed
  15. Caine D, DiFiori J, Maffulli N. Physeal injuries in children’s and youth sports: reasons for concern? Br J Sports Med. 2006;40:749–60. - PubMed
  16. Schöeffl L, Schöeffl V. Epiphyseal stress fractures in the fingers of adolescents: biomechanics, pathomechanisms, and risk factors. Eur J Sports Med. 2015;3:27–37. - PubMed
  17. Hochholzer Th, Schöffl V. Epiphyseal fractures of the finger middle joints in young sport climbers. Wilderness Environ Med. 2005;16:139–42. - PubMed
  18. Ogden JA. Skeletal injury in the child. New York: Springer; 2000. - PubMed
  19. Caine D, Howe W, Ross W, Bergman G. Does repetitive physical loading inhibit radial growth in female gymnasts. Clin J Sport Med. 1997;7:102–8. - PubMed
  20. Moher D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Ann Intern Med. 2013. https://doi.org/10.7326/0003-4819-151-4-200908180-00135 . - PubMed
  21. Laor T, Wall EJ, Vu LP. Physeal widening in the knee due to stress injury in child athletes. Am J Roentgenol. 2006;186:1260–4. - PubMed
  22. Bedoya MA, Jaramillo D, Chauvin NA. Overuse injuries in children. Top Magn Reson Imaging. 2015;24:67–81. - PubMed
  23. Jaramillo D, Laor T, Zaleske DJ. Indirect trauma to the growth plate: results of MR imaging after epiphyseal and metaphyseal injury in rabbits. Radiology. 1993;187:171–8. - PubMed
  24. Nguyen JC, Markhardt BK, Merrow AC, Dwek JR. Imaging of pediatric growth plate disturbances. RG. 2017;17:1791–812. - PubMed
  25. Dotter WE. Little leaguer’s shoulder. Guthrie Clin Bull. 1953;23:68–72. - PubMed
  26. Roy S, Caine D, Singer K. Stress changes of the distal radial epiphysis in young gymnasts. A report of twenty-one cases and a review of the literature. Am J Sports Med. 1985;13:301–8. - PubMed
  27. Shih C, Chang CY, Penn IW. Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology. 1995;195:855–9. - PubMed
  28. Dwek JR, Chung CB. Lower extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings and treatment. Clin Imaging. 2013;37:836–46. - PubMed
  29. Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Jt Surg. 1963;45A:587–622. - PubMed
  30. Cummings P, Weiss NS. Case series and exposure series: the role of studies without controls in providing information about the etiology of injury or disease injury prevention. Inj Prev. 1998;4:54–7. - PubMed
  31. Heyworth BE, Kramer DE, Martin DJ, Kocher MS, Bae DS. Trends in the presentation, management, and outcomes of little league shoulder. Am J Sports Med. 2016;44:1431–8. - PubMed
  32. Hansen NM Jr. Epiphyseal changes in the proximal humerus of an adolescent baseball pitcher: a case report. Am J Sports Med. 1982;10:380–4. - PubMed
  33. Adams JE. Little league shoulder: osteochondrosis of the proximal humeral epiphysis in boy baseball pitchers. Calif Med. 1966;105:22–5. - PubMed
  34. Torg JS. The little league pitcher. Am Fam Phys. 1972;6:71–6. - PubMed
  35. Cahill BR. Little league shoulder: rotational stress fracture of proximal epiphysis. J Sports Med. 1974;2:150–2. - PubMed
  36. Tullos HS, Fain RH. Little leaguer shoulder: lesions of the proximal epiphyseal plate. J Sports Med. 1974;2:152–3. - PubMed
  37. Lipscomb AB. Baseball pitching injuries in growing athletes. J Sports Med. 1975;3:25–34. - PubMed
  38. Barnett LS. Little league shoulder syndrome. Proximal humeral epiphysiolysis in adolescent baseball pitchers—a case report. J Bone Jt Surg (USA). 1985;67:495–6. - PubMed
  39. Albert MJ, Drvaric DM. Little league shoulder: case report. Orthopaedics. 1990;13:779–81. - PubMed
  40. Carson WG, Gasser SI. Little leaguer’s shoulder. A report of 23 cases. Am J Sports Med. 1998;26:575–80. - PubMed
  41. Ricci AR, Mason DE. Little league shoulder: case report and literature review. Del Med J. 2004;76:11–4. - PubMed
  42. Flemming JL, Hollingsworth CL, Squire DL, Bisset JS. Little leaguer’s shoulder. Skelet Radiol. 2004;33:352–4. - PubMed
  43. Hatem SF, Recht MP, Profitt B. MRI of little leaguer’s shoulder. Skelet Radiol. 2006;35:103–6. - PubMed
  44. Song JC, Lazarus ML, Song AP. MRI findings in little leaguer’s shoulder. Skelet Radiol. 2006;35:107–9. - PubMed
  45. Popkin CA, Posada A, Clifford PD. Little leaguer’s shoulder. Clin Imaging. 2006;30:365–7. - PubMed
  46. Obembe O, Gaskin CM, Taffoni MJ, Anderson MW. Little leaguer’s shoulder (proximal epiphysiolysis): MRI findings in four boys. Pediatr Radiol. 2007;37:885–9. - PubMed
  47. Anton C, Podberesky DJ. Little league shoulder: a growth plate injury. Pediatr Radiol. 2010;40(Supple 1):S54. - PubMed
  48. Domes CM, Petering R, Chesnutt JC, Mirarchi A. Concurrent little leaguer’s elbow and shoulder in a 15-year-old baseball pitcher and football quarterback. Orthop. 2012;35(1):e10–97. - PubMed
  49. Reeder MT, Smith B. Little league shoulder. J Am Osteopath Assoc. 2015;115:522. - PubMed
  50. Wasylynko D. Chronic pain due to little leaguer’s shoulder in an adolescent baseball pitcher: a case report. Can Chiropr Assoc. 2015;59:383–9. - PubMed
  51. Hosokawa Y, Mihata T, Yasuo Itami Y, Neo M, Doi M. Little leaguer’s shoulder can cause severe three-dimensional humeral deformity. Clin Orthop Surg. 2017;9:537–41. - PubMed
  52. Zipser MC, Sum JC, Wilcox AG. Little league shoulder in a 15-year-old male baseball pitcher. J Orthop Sports Phys Ther. 2018;48:51. - PubMed
  53. Greenburg EM, Turner C, Huse C, Ganley TJ, McClure T, Lawrence JT. Salter–Harris fracture of the proximal humerus in an adolescent gymnast. J Orthop Sports Phys Therap. 2018;48(9):729. - PubMed
  54. Boyd KT, Batt ME. Stress fracture of the proximal humeral epiphysis in an elite junior badminton player. Br J Sports Med. 1997;31:252–3. - PubMed
  55. Kirimura K, Nageo M, Sugiyama M. High incidence of posterior glenoid dysplasia of the shoulder in young baseball players. J Shoulder Elbow Surg. 2019;28:82–7. - PubMed
  56. Drescher WR, Falliner A, Zantop T, et al. Little league shoulder syndrome in an adolescent cricket player. Br J Sports Med. 2004;38:E14. - PubMed
  57. Daldorf PG, Bryan WJ. Displaced Salter–Harris type 1 injury in a gymnast. A slipped capital humeral epiphysis. Orthop Rev. 1994;23:538–41. - PubMed
  58. Ejnisman B, Andreoli V, Pochini ADC, et al. Proximal humeral epiphysiolysis in a gymnast. Acta Orthop Bras. 2007;15(5):290–1. - PubMed
  59. Kosnik M, Paulseth S, Abzug A. Salter–Harris fracture of the proximal humerus in an adolescent gymnast. J Orthop Sports Phys Ther. 2018;48(9):729. - PubMed
  60. Johnson JN, Houchin G. Adolescent athlete’s shoulder. A case series of proximal humeral epiphysiolysis in nonthrowing athletes. Clin J Sports Med. 2006;16:84–6. - PubMed
  61. Jenkinson E, Roush MB. Shoulder pain in a female volleyball player. Syllabus of the 6th American Medical Society for Sports Medicine Annual Meeting; 1996. - PubMed
  62. Carson JT, McCambridge TM, Carrino JA, McFarland EG. Case report: bilateral epiphyseal clavicular stress-related lesions in a male gymnast. Clin Orthop Relat Res. 2012;470:307–11. - PubMed
  63. Ellman H. Anterior angulation deformity of the radial head. An unusual lesion occurring in juvenile baseball players. J Bone Jt Surg Am. 1975;57:776–8. - PubMed
  64. Podestra L, Sherman MF, Bonamo JR. Distal humeral epiphyseal separation in a young athlete. A case report. Arch Phys Med Rehabil. 1993;74:1216–8. - PubMed
  65. Chan D, Aldridge MJ, Maffulli N, Davies AM. Chronic stress injuries of the elbow in young gymnasts. Br J Radiol. 1991;64:1111–8. - PubMed
  66. Maffulli N, Chan D, Aldridge MJ. Derangement of the articular surfaces of the elbow in young gymnasts. J Ped Orthop. 1992;12:344–50. - PubMed
  67. Huckaby MC, Kruse D, Gibbs LH. MRI findings of proximal radial physeal injury in a gymnast. Pediatr Radiol. 2012;42:1395–400. - PubMed
  68. Oda R, Fujiwara H, Ichimaru K, Morihara T, Ikeda T, Kubo T. Chronic slipping of bilateral humeral epiphyses in a gymnastist. J Pediatr Orthop B. 2015;24:67–70. - PubMed
  69. Miller SM, Wyatt CW, Ellis HB, Wilson PL. Proximal radial epiphyseal injuries in gymnasts. Pediatric Research in Sports Medicine Annual Meeting, Dallas, TX, January 26–28; 2017. - PubMed
  70. Santelli J, McCambridge T, Valasek AE, Standford K. Proximal radial head fractures in young gymnasts. Clin J Sport Med. 2019;29:e1–3. - PubMed
  71. Inagaki H, Inoue G. Stress fracture of the scaphoid combined with the distal radial epiphysiolysis. Br J Sports Med. 1997;31:256–7. - PubMed
  72. Kwon SW, Hong SJ, Nho JH, Moon S, Jung KJ. Physeal fracture in the wrist and hand due to stress injury in a child climber. Med. 2018;97:34. - PubMed
  73. Gerber SP, Griffin PP, Simmons BP. Case Report: Breakdancer’s wrist. J Ped Orthop. 1986;6:98–9. - PubMed
  74. Read MT. Stress fractures of the distal radius in adolescent gymnasts. Br J Sports Med. 1981;15:272–6. - PubMed
  75. Fliegel CP. Stress related widening of the radial growth plate in adolescents. Ann Radiol. 1986;29:374–6. - PubMed
  76. Carter SR, Aldridge MJ. Stress injury of the distal radial growth plate. J Bone Jt Surg (GB). 1988;70:834–6. - PubMed
  77. Carter SR, Aldridge MJ, Fitzgerald R, Davies AM. Stress changes of the wrist in gymnasts. Br J Radiol. 1988;61:109–12. - PubMed
  78. Resnick DL. Case 6: a12-year-old gymnast with intermittent pain in the wrist. Radiographics. 1988;8(2):246–8. - PubMed
  79. Yong-Hing K, Wedge JN, Bowen CV. Chronic injury to the distal ulnar and radial growth plates in an adolescent gymnast. J Bone Jt Surg (USA). 1988;70:1087–9. - PubMed
  80. Vender MI, Watson K. Acquired Madelung-like deformity in a gymnast. J Hand Surg (USA). 1988;13:19–21. - PubMed
  81. Albanese SA, Palmer AK, Kerr DR, Carpenter CW, Lisi D, Levinsohn M. Wrist pain and distal growth plate closure of the radius in gymnasts. J Ped Orthop. 1989;9:23–8. - PubMed
  82. Ruggles DL, Peterson HA, Scott SG. Radial growth plate injury in a female gymnast. Med Sci Sports Exerc. 1991;23:393–6. - PubMed
  83. Li DK, Lloyd-Smith R. Wrist pain in an adolescent gymnast. Clin J Sports Med. 1991;1:259–61. - PubMed
  84. Tolat AR, Sanderson PL, DeSmet L, Stanley JK. The gymnast’s wrist: acquired positive ulnar variance following chronic epiphyseal injury. J Hand Surg. 1992;17:678–81. - PubMed
  85. Carek PJ, Fumich RM. Stress fracture of the distal radius. Not just a risk for elite gymnasts. Phys Sportsmed. 1992;20(5):115–8. - PubMed
  86. Nattiv A, Mandelbaum BR. Injuries and special concerns in female gymnasts. Detecting, treating, and preventing common problems. Phys Sportsmed. 1993;21:66–82. - PubMed
  87. De Smet L, Claessens A, Fabrey G. Gymnast wrist. Acta Orthop Belg. 1993;59:377–80. - PubMed
  88. Liebling MS, Berdon WE, Ruzal-Shapiro C, Levin TL, Roye D, Wilkinson R. Gymnast’s wrist (pseudorickets growth plate abnormality) in adolescent athletes: findings on plain films and MR imaging. AJR. 1995;164:157–9. - PubMed
  89. DiFiori JP, Mandelbaum BR. Wrist pain in a young gymnasts: unusual radiographic findings and MRI evidence of growth plate injury. Med Sci Sports Exerc. 1996;28:1453–8. - PubMed
  90. Bak K, Boeckstyns M. Epiphysiodesis for bilateral irregular closure of the distal radial physis in a gymnast. Scand J Med Sci Sports. 1997;7:363–6. - PubMed
  91. Frizzell JB, Brunet G. Stress changes of the distal radial physis. Can Assoc Radiol J. 1997;48:54–5. - PubMed
  92. Howe WB, Caine D, Bergman GD, Keeler LW. Wrist pain—gymnastics. Med Sci Sports Exerc. 1997;29:S151. - PubMed
  93. Brooks TJ. Madelung deformity in a collegiate gymnast: a case report. J Athl Train. 2001;36:170–3. - PubMed
  94. Barkdell T, Annunziata CC. Acquired Madelung-type deformity in a gymnast. Med Sci Sports Exerc. 2007;39(5):S133–4. - PubMed
  95. Dwek JR, Cardoso F, Chung CR. MR Imaging of overuse injuries in the skeletally immature gymnasts: spectrum of soft-tissue and osseous lesions in the hand and wrists. Pediatr Radiol. 2009;39:1310–6. - PubMed
  96. Poletto ED, Pollock AN. Radial epiphysitis (aka Gymnast Wrist). Pediatr Emerg Care. 2012;28(5):484–5. - PubMed
  97. Ashwell ZR, Richardson ML. Case report: gymnast’s wrist in a 12-year-old female with MRI correlation. Radiol Case Rep. 2019;14:360–4. - PubMed
  98. Mauck B, Kelly D, Sheffer B, Rambo A, Calandruccio JH. Gymnast’s wrist (distal radial physeal stress syndrome). Orthop Clin N Am. 2020;51:493–7. - PubMed
  99. Hochholzer T, Schöffl V, Krause R. Finger-epiphysen-verletzungen jugendlicher sportkletterer. Sport Orthop Traumatol. 1997;13:100–3. - PubMed
  100. Chell J, Stevens K, Preston B, Davis TRC. Bilateral fractures of the middle phalanx of the middle finger in an adolescent climber. Am J Sports Med. 1999;27:817–9. - PubMed
  101. Bayer T, Schöffl VR, Lenhart M, Herold T. Epiphyseal stress fractures of finger phalanges in adolescent climbing athletes: a 3.0-Teslas magnetic resonance imaging evaluation. Skelet Radiol. 2013;42:1521–5. - PubMed
  102. Schöffl V, Popp D, Kupper T, Schöffl I. Injury trends in rock climbers: evaluation of a case series of 911 injuries between 2009–2012. Wildern Environ Med. 2015;26:62–7. - PubMed
  103. Desaldeleer AS, Le Nen D. Bilateral fracture of the base of the middle phalanx in a climber: literature review and a case report. Orthop Traumatol Surg Res. 2016;102(3):409–11. - PubMed
  104. El-Sheikh Y, Lutter C, Schöffl I, Schöffl V. Surgical management of proximal interphalangeal joint repetitive stress epiphyseal fracture nonunion in elite sport climbers. J Hand Surg Am. 2018;43(6):572.e1-572.e5. https://doi.org/10.1016/j.jhsa.2017.10.009 . - PubMed
  105. Halsey T, Johnson M, Jones G. Epiphyseal stress fractures of the fingers in an adolescent climber: a potential “Maslow’s Hammer” in terms of clinical reasoning. Curr Sports Med Rep. 2019;18:431–3. - PubMed
  106. Attkiss KJ, Bunckle HJ. Physeal growth arrest of the distal phalanx of the thumb in an adolescent pianist: a case report. J Hand Surg. 1998;23A:532–5. - PubMed
  107. Schoffl V, Hochholzer T, Winkerlmann H, Strecker W. Pulley injuries in rock climbers. Wildern Environ Med. 2003;41:94–100 - PubMed
  108. Quaine F, Vigouroux L, Martin L. Effect of simulated rock climbing finger postures on force sharing among the fingers. Clin Biomech. 2003;18:365–8. - PubMed
  109. Lutter C, Tischer T, Hotfiel T, Frank L, Enz A, Simon N, et al. Current trends in sport climbing injuries after the inclusion into the Olympic program. Analysis of 633 injuries within the years 2017/2018. MLTJ. 2020;2:201–10. - PubMed
  110. Sato T, Shinozaki T, Fukudo T, Watanabe H, Aoki J, Yanagawa T, et al. Atypical growth plate closure: a possible chronic Salter and Harris type V injury. J Pediatr Orthop. 2002;11:155–8. - PubMed
  111. Domzalski M, Mackenzie W. Growth arrest of the proximal tibial physis with recurvatum and valgus deformity of the knee. Knee. 2009;16:412–6. - PubMed
  112. Wall EJ. Knee injury: gymnastics. Med Sci Sports Exerc. 1997;29(suppl):S152. - PubMed
  113. Blatnik TR, Briskin S. Bilateral knee pain in a high-level gymnast. Clin J Sport Med. 2013;23:77–9. - PubMed
  114. Godshall RW, Hansen CA, Rising DC. Stress fractures through the distal femoral epiphysis in athletes. A previously unreported entity. Am J Sports Med. 1981;9:114–6. - PubMed
  115. Borders H. Physeal stress injury. Pediatr Adolesc MSK MRI, J Herman Kan, pp. 78–83. - PubMed
  116. Tony G, Charron A, Tins B, Lalam R, Tyrrell PNM, Singh J, et al. Intra-epiphyseal stress injury of the proximal tibial epiphysis: preliminary experience of magnetic resonance imaging findings. Eur J Radiol. 2014;83:2051–7. - PubMed
  117. Ehara S. Physeal stress injury to the knee. AJR. 2006;187:W554. - PubMed
  118. Nanni M, Butt S, Mansour R. Stress-induced Salter–Harris I growth plate injury of the proximal tibia: first report. Skelet Radiol. 2005;34:405–10. - PubMed
  119. Cahill BR. Stress fracture of the proximal tibial epiphysis: a case report. Am J Sports Med. 1977;5:186–7. - PubMed
  120. Dempewolf M, Kwan K, Sherman B, Schlechter J. Youth kicker’s knee: lateral distal femoral hemi-physeal arrest secondary to chronic repetitive microtrauma. J Am Acad Orthop Surg. 2019;3:1–6. - PubMed
  121. Weber PC. Salter–Harris type II stress fracture in a young athlete. Orthopaedics. 1988;11:309–11. - PubMed
  122. Kadel NJ, Goldstein J, Hewberg AH, Trempman E. Salter–Harris stress fracture of the proximal first metatarsal: a case report. Foot Ankle Intern. 2001;22:252–5. - PubMed
  123. Shybut TB, Rose DJ, Strongwater AM. Second metatarsal physeal arrest in an adolescent Flamenco dancer: a case report. Foot Ankle Int. 2008;29:859–62. - PubMed
  124. Bernholdt DL, Garzon-Muvdi J, Chhabra A, McFarland EG. Stress fracture of the distal tibial physis in an adolescent recreational dancer. Am J Sports Med. 2013;41:1649–52. - PubMed
  125. Csonka A, Sikarinkul E, Gargyan I, Boa K, Varga E. Operative management of bilateral Salter–Harris type III fractures of the proximal phalanges of the great toes of a 10-year-old female ballet dancer: a case report. J Pediatr Orthop B. 2016;25:393–6. - PubMed
  126. Shah S. Premature growth plate closure in a ballet dancer en Pointe. Clin J Sport Med. 2017;27(5):e69–71. - PubMed
  127. Wall EJ. Growth plate overuse syndrome of the ankle in athletes. Med Sci Sports Exerc. 1997;5:299. - PubMed
  128. Percy EC, Gamble FO. An epiphyseal stress fracture of the foot and shin splints in an anomalous calf muscle in a runner. Br J Sports Med. 1980;14:110–3. - PubMed
  129. Schapiro A, Laor T. ‘Soccer toe:’ Chronic physeal injury of the great toe metatarsal in a skeletally immature child—a case report. SA J Radiol. 2020;24(1):1834. https://doi.org/10.4102/sajr.v24i1.1834 . - PubMed
  130. Caine D, Knutzen K, Howe W, Keeler L, Sheppard L, Heinrichs D, et al. A three-year epidemiological study of injuries affecting young female gymnasts. Phys Ther Sport. 2003;4:10–23. - PubMed
  131. DiFiori JP, Caine DJ, Malina RM. Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast. Am J Sports Med. 2006;34:840–9. - PubMed
  132. Bejjami FJ, Halpern N, Pio A, Dominguez R, Voloshin A, Frankel VH. Musculoskeletal demands on Flamenco dancers: a clinical and biomechanical study. Foot Ankle. 1988;8:254–6. - PubMed
  133. Torg JS, Pollack H, Sweterlitsch P. The effect of competitive pitching on the shoulders and elbows of baseball players. Pediatrics. 1972;49:267–72. - PubMed
  134. Kanematsu Y, Matsuura T, Kashiwaguchi S, Iwase T, Suzue N, Iwame T, et al. Epidemiology of shoulder injuries in young baseball players and grading of radiologic findings of Little Leaguer’s shoulder. J Med Investig. 2015;62:123–5. - PubMed
  135. Pennock AT, Dwek J, Levy E, Stearns P, Manning J, Dennis MM, et al. Shoulder MRI abnormalities in asymptomatic little league baseball players. Orthop J Sports Med. 2018;6(2):2325967118756825. - PubMed
  136. Zhang C, Shen S, Zhang W, Qiu L, Qingying W, Wang F, et al. Effect of long-term diving on the morphology and growth of the distal radial epiphyseal plate of young divers: a magnetic resonance imaging study. Clin J Sports Med. 2019;29(4):312–7. - PubMed
  137. Auberge T, Zenny JC, Duvallet A, Godefroy D, Horreard P, Chevrot A. Study of bone maturation and osteo-articular lesions in top level sportsmen: a review of 105 cases. J Radiol (Paris). 1984;65:555–61. - PubMed
  138. Szot Z, Boron Z, Galaj Z. Overloading changes in the motor system occurring in elite gymnasts. Int J Sports Med. 1985;6:36–40. - PubMed
  139. Caine D, Roy S, Singer KM, Broekhoff J. Stress changes of the distal radial growth plate. A radiographic survey of 60 young competitive gymnasts and an epidemiologic review of the related literature. Am J Sports Med. 1992;20:290–8. - PubMed
  140. DeSmet L, Claessons A, Lefevre J, Beunen J. Gymnast wrist: an epidemiological survey of the ulnar variance in elite female gymnasts. Am J Sports Med. 1994;22:846–50. - PubMed
  141. Chang CY, Shih C, Penn IW, Tiu CM, Chang T, Wu JJ. Wrist injuries in adolescent gymnasts of a Chinese opera school: radiographic survey. Radiology. 1995;195:861–4. - PubMed
  142. DiFiori JP, Puffer JC, Mandelbaum BR, Dorey F. Distal radial growth plate injury and positive ulnar variance in non-elite gymnasts. Am J Sports Med. 1997;25:763–8. - PubMed
  143. DiFiori JP, Puffer JP, Aish B, Dorey F. Wrist pain, distal radial physeal injury, and ulnar variance in young gymnasts: does a relationship exist? Am J Sports Med. 2002;30:879–85. - PubMed
  144. Guerra MRV, Estelles JRD, Abdouni YA, Falcochio DF, Rosa JRP, Catani LH. Frequency of wrist growth plate injury in young gymnasts at a training center. Acta Orthop Bras. 2016;24:204–7. - PubMed
  145. Kraan RBJ, Kox LS, Mens MA, Kuijer PPFM, Maas M. Damage of the distal radial physis in young gymnasts: can three-dimensional assessment of physeal volume on MRI serve as a biomarker? Eur Radiol. 2019;29:6364–71. - PubMed
  146. Kraan RBJ, Kox LS, Oostra RJ, Kuijer PPFM, Maas M. The distal radial physis: exploring normal anatomy on MRI enables interpretation of stress related changes in young gymnasts. Eur J Sport Sci. 2020;20:1197–205. - PubMed
  147. Schlegel C, Buchler U, Kriemler S. Finger injuries of elite rock climbers. Schweizerische Zeitschrift fur Sportsmeizin und Sportstraumatologies. 2002;50(1):7–10. - PubMed
  148. Schöffl V, Hochholzer T, Imhoff A. Radiographic changes in the hands and fingers of young, high-level climbers. Am J Sports Med. 2004;32(7):1688–94. - PubMed
  149. Garcia K, Jarmillo D, Rubesova E. Ultrasound evaluation of stress injuries and physiological adaptations in the fingers of adolescent competitive rock climbers. Pediatr Radiol. 2018;48:366–73. - PubMed
  150. Bartschi N, Scheibler A, Schweizer A. Symptomatic epiphyseal sprains and stress fractures of the finger phalanges in adolescent sport climbers. Hand Surg Rehab. 2019;38:251–6. - PubMed
  151. Meyers RN, Howell DR, Provance AJ. The association of finger growth plate injury history and speed climbing in youth competition climbers. Wilderness Environ Med. 2020;17:812. - PubMed
  152. Sabato T, Caine D. Epidemiology of injury in community club and youth sports organizations. In: Caine D, Purcell L, editors. Injury in pediatric and adolescent sport: epidemiology, treatment and prevention. Switzerland: Springer Publishers; 2006. - PubMed
  153. Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med. 2006;16:501–14. - PubMed
  154. Holt JB, Stearns PH, Bastrom TP, Dennis MM, Dwek JR, Pennock AT. The curse of the all-star team: a single-season prospective shoulder MRI study of Little League baseball players. J Pediatr Orthop. 2020;40(1):e19-24. - PubMed
  155. Lishen Q, Jianhua O. Epiphyseal injury in gymnasts. Chin J Sports Med. 1983;2:7–12. - PubMed
  156. Caine D, Cochrane B, Caine C, Zemper E. An epidemiological investigation of injuries affecting young competitive female gymnasts. Am J Sports Med. 1989;17:811–20. - PubMed
  157. Dixon M, Fricker P. Injuries to elite gymnasts over 10 years. Med Sci Sports Exerc. 1993;25:1322–9. - PubMed
  158. Schöffl V, Hochholzer T, Imhoff A, Schöffl L. Radiographic adaptations to the stress of high-level rock climbing in junior athletes: a 5-year longitudinal study of the German junior national team and a group of rectreational climbers. Am J Sports Med. 2007;35(1):86–92. - PubMed
  159. Knowles SB, Marshall SW, Guskiewicz KM. Issues in estimating risks and rates in sports injury research. J Athl Train. 2006;41:207–15. - PubMed
  160. Materne O, Chamari K, Farooq A, Weir A, Hölmich P, Bahr R, et al. Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years. Br J Sports Med. 2020. https://doi.org/10.1136/bjsports-2020-102859 . - PubMed
  161. Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, et al. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). Br J Sports Med. 2020;54:372–89. - PubMed
  162. Micheli LJ, Klein JD. Sports injuries in children and adolescents. Br J Sports Med. 1991;25:6–9. - PubMed
  163. Tipton CM, Matthes RD, Maynard JA. Influence of chronic exercise on rat bones. Med Sci Sports Exerc. 1972;4:55. - PubMed
  164. Kiiskinen A. Physical training and connective tissues in young mice: physical properties of Achilles tendons and long bones. Growth. 1977;41:123–37. - PubMed
  165. Simon MR. The effects of dynamic loading on the growth of epiphyseal cartilage in the rat. Acta Anat. 1978;102:176–83. - PubMed
  166. Matsuda JJ, Zernicke RF, Vailas AC, Barnard RJ. Structural and mechanical adaptation of immature bone to strenuous exercise. J Appl Physiol. 1986;60:2028–34. - PubMed
  167. Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 1983;8:643–51. - PubMed
  168. McCaw ST, Bates BT. Biomechanical implications of mild leg length inequality. Br J Sports Med. 1991;25:10–3. - PubMed
  169. Morscher E. Etiology and pathophysiology of leg length discrepancies. Prog Orthop Surg. 1977;1:9–19. - PubMed
  170. Golightly YM, Allen KD, Helmick CG, Schwartz TA, Renner JB, Jordan JM. Hazard of incident and progressive knee and hip radiographic osteoarthritis and chronic joint symptoms in individuals with and without limb length inequality. J Rheumatol. 2010;3(7):2133–40. - PubMed
  171. Caine DJ, Golightly YM. Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective. Br J Sport Med. 2011;45:298–303. - PubMed

Publication Types