Imaging of the Pediatric Athlete: Use and Overuse

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Key points

  • The unique patterns of sports-related trauma of the upper extremity in children and adolescents are largely caused by the fact that the open physis is the weakest part of the pediatric skeleton and thus likely to be affected in acute“use” and chronic “overuse” injuries.

  • In the shoulder of the pitcher or other athlete using overhead motion, the proximal humeral physis and the tendons of the rotator cuff are particularly prone to chronic repetitive stress injury.

  • In the elbow, valgus stress insults

Use Injuries

The distribution and patterns of injuries of the shoulder region are generally predictable based on the sport activity. Acute fractures and dislocations are generally sustained in contact sports including football, rugby, and hockey. Impacts and collisions may result in adult-type insults, including fractures of the clavicle and humeral shaft, acromioclavicular (AC) separation, and glenohumeral dislocation. These injuries, which are not limited to the youth athlete, are discussed elsewhere in

Use Injuries

Elbow dislocation is usually sustained as an impact injury and presents immediately for clinical evaluation. Gymnasts and football players are at particular risk, given the high frequency of fall and impact trauma.5 Most dislocations are posterior or posterolateral in direction, and may be associated with medial epicondyle avulsion fracture in the patient with open physes. In the older athlete with closed physes, there may be small avulsion fragments at the medial collateral ligament attachment

Use Injuries

The wrist is vulnerable to acute injury in many athletic activities, but is particularly susceptible to trauma in sports where the athlete regularly falls, such as football and snowboarding. The distal radius is a common site of fracture, with the precise anatomic localization dependent on the age of the child. In the younger child, the metaphysis of the distal radius is most prone to injury, whereas in the older adolescent, the physis of the distal radius is most likely to fracture, commonly

Summary

Recent years have witnessed a steady rise in the number of sports-related upper extremity injuries involving the shoulder, elbow, and wrists in children and adolescents. Correspondingly, radiologists are increasingly likely to encounter these abnormalities during the course of their daily practice. These injuries, which can be seen in the setting of acute “use” trauma or chronic “overuse” trauma, tend to occur in predictable and recognizable patterns, primarily related to the presence of open

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      MRI has contributed substantially to improving the sensitivity of detecting physeal injury and has since become the imaging modality of choice in evaluating stress injury to the physis [28]. The normal MR appearance of the physis is trilaminar with a hyperintense cartilaginous layer, a hypointense zone of provisional calcification, and a hyperintense area of metaphyseal vascularization [29,30]. The normal physis appears undulating but is typically of uniform thickness with mildly increased T2 signal along both the epiphyseal and metaphyseal borders [31].

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