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Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review

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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.

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References

  1. Caine DJ. Are kids having a rough time of it in sports? Br J Sports Med. 2010;44:1–3.

    PubMed  Google Scholar 

  2. Caine DJ, Provance AJ. Pediatric and adolescent injury in adventure and extreme sports. Res Sports Med. 2018;26:5–19.

    PubMed  Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

  6. Steffen K, Engebretsen L. More data needed on injury risk among elite young athletes. Br J Sports Med. 2010;44:485–9.

    PubMed  Google Scholar 

  7. Youth Olympic Games. https://www.olympic.org/youth-olympic-games. Accessed 1 Mar 2020

  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.

  9. Emery CA. Injury prevention in kids’ adventure and extreme sports: future directions. Res Sports Med. 2018;26(Supple. 1):199–211.

    PubMed  Google Scholar 

  10. DiFiori JP. Overuse injury of the physis: a “growing” problem. Clin J Sport Med. 2010;20:336–7.

    PubMed  Google Scholar 

  11. Armstrong N, McManus AM. Preface. The elite young athlete. Med Sport Sci. 2011;56:1–3.

    PubMed  Google Scholar 

  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 Central  PubMed  Google Scholar 

  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  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Google Scholar 

  17. Hochholzer Th, Schöffl V. Epiphyseal fractures of the finger middle joints in young sport climbers. Wilderness Environ Med. 2005;16:139–42.

    PubMed  Google Scholar 

  18. Ogden JA. Skeletal injury in the child. New York: Springer; 2000.

    Google Scholar 

  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.

    Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Google Scholar 

  22. Bedoya MA, Jaramillo D, Chauvin NA. Overuse injuries in children. Top Magn Reson Imaging. 2015;24:67–81.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  24. Nguyen JC, Markhardt BK, Merrow AC, Dwek JR. Imaging of pediatric growth plate disturbances. RG. 2017;17:1791–812.

    Google Scholar 

  25. Dotter WE. Little leaguer’s shoulder. Guthrie Clin Bull. 1953;23:68–72.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  27. Shih C, Chang CY, Penn IW. Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology. 1995;195:855–9.

    CAS  PubMed  Google Scholar 

  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  Google Scholar 

  29. Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Jt Surg. 1963;45A:587–622.

    Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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  Google Scholar 

  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  Google Scholar 

  33. Adams JE. Little league shoulder: osteochondrosis of the proximal humeral epiphysis in boy baseball pitchers. Calif Med. 1966;105:22–5.

    CAS  PubMed Central  PubMed  Google Scholar 

  34. Torg JS. The little league pitcher. Am Fam Phys. 1972;6:71–6.

    CAS  Google Scholar 

  35. Cahill BR. Little league shoulder: rotational stress fracture of proximal epiphysis. J Sports Med. 1974;2:150–2.

    CAS  PubMed  Google Scholar 

  36. Tullos HS, Fain RH. Little leaguer shoulder: lesions of the proximal epiphyseal plate. J Sports Med. 1974;2:152–3.

    CAS  PubMed  Google Scholar 

  37. Lipscomb AB. Baseball pitching injuries in growing athletes. J Sports Med. 1975;3:25–34.

    CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  39. Albert MJ, Drvaric DM. Little league shoulder: case report. Orthopaedics. 1990;13:779–81.

    CAS  Google Scholar 

  40. Carson WG, Gasser SI. Little leaguer’s shoulder. A report of 23 cases. Am J Sports Med. 1998;26:575–80.

    PubMed  Google Scholar 

  41. Ricci AR, Mason DE. Little league shoulder: case report and literature review. Del Med J. 2004;76:11–4.

    PubMed  Google Scholar 

  42. Flemming JL, Hollingsworth CL, Squire DL, Bisset JS. Little leaguer’s shoulder. Skelet Radiol. 2004;33:352–4.

    Google Scholar 

  43. Hatem SF, Recht MP, Profitt B. MRI of little leaguer’s shoulder. Skelet Radiol. 2006;35:103–6.

    Google Scholar 

  44. Song JC, Lazarus ML, Song AP. MRI findings in little leaguer’s shoulder. Skelet Radiol. 2006;35:107–9.

    Google Scholar 

  45. Popkin CA, Posada A, Clifford PD. Little leaguer’s shoulder. Clin Imaging. 2006;30:365–7.

    PubMed  Google Scholar 

  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  Google Scholar 

  47. Anton C, Podberesky DJ. Little league shoulder: a growth plate injury. Pediatr Radiol. 2010;40(Supple 1):S54.

    PubMed  Google Scholar 

  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.

    Google Scholar 

  49. Reeder MT, Smith B. Little league shoulder. J Am Osteopath Assoc. 2015;115:522.

    PubMed  Google Scholar 

  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.

    Google Scholar 

  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 Central  PubMed  Google Scholar 

  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  Google Scholar 

  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.

    Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Google Scholar 

  58. Ejnisman B, Andreoli V, Pochini ADC, et al. Proximal humeral epiphysiolysis in a gymnast. Acta Orthop Bras. 2007;15(5):290–1.

    Google Scholar 

  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  Google Scholar 

  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.

    Google Scholar 

  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.

  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  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

  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.

    CAS  Google Scholar 

  67. Huckaby MC, Kruse D, Gibbs LH. MRI findings of proximal radial physeal injury in a gymnast. Pediatr Radiol. 2012;42:1395–400.

    PubMed  Google Scholar 

  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  Google Scholar 

  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.

  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  Google Scholar 

  71. Inagaki H, Inoue G. Stress fracture of the scaphoid combined with the distal radial epiphysiolysis. Br J Sports Med. 1997;31:256–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Google Scholar 

  73. Gerber SP, Griffin PP, Simmons BP. Case Report: Breakdancer’s wrist. J Ped Orthop. 1986;6:98–9.

    CAS  Google Scholar 

  74. Read MT. Stress fractures of the distal radius in adolescent gymnasts. Br J Sports Med. 1981;15:272–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  75. Fliegel CP. Stress related widening of the radial growth plate in adolescents. Ann Radiol. 1986;29:374–6.

    CAS  PubMed  Google Scholar 

  76. Carter SR, Aldridge MJ. Stress injury of the distal radial growth plate. J Bone Jt Surg (GB). 1988;70:834–6.

    CAS  Google Scholar 

  77. Carter SR, Aldridge MJ, Fitzgerald R, Davies AM. Stress changes of the wrist in gymnasts. Br J Radiol. 1988;61:109–12.

    CAS  PubMed  Google Scholar 

  78. Resnick DL. Case 6: a12-year-old gymnast with intermittent pain in the wrist. Radiographics. 1988;8(2):246–8.

    Google Scholar 

  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.

    CAS  Google Scholar 

  80. Vender MI, Watson K. Acquired Madelung-like deformity in a gymnast. J Hand Surg (USA). 1988;13:19–21.

    CAS  Google Scholar 

  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.

    CAS  Google Scholar 

  82. Ruggles DL, Peterson HA, Scott SG. Radial growth plate injury in a female gymnast. Med Sci Sports Exerc. 1991;23:393–6.

    CAS  PubMed  Google Scholar 

  83. Li DK, Lloyd-Smith R. Wrist pain in an adolescent gymnast. Clin J Sports Med. 1991;1:259–61.

    Google Scholar 

  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.

    CAS  Google Scholar 

  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  Google Scholar 

  86. Nattiv A, Mandelbaum BR. Injuries and special concerns in female gymnasts. Detecting, treating, and preventing common problems. Phys Sportsmed. 1993;21:66–82.

    CAS  PubMed  Google Scholar 

  87. De Smet L, Claessens A, Fabrey G. Gymnast wrist. Acta Orthop Belg. 1993;59:377–80.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  91. Frizzell JB, Brunet G. Stress changes of the distal radial physis. Can Assoc Radiol J. 1997;48:54–5.

    CAS  PubMed  Google Scholar 

  92. Howe WB, Caine D, Bergman GD, Keeler LW. Wrist pain—gymnastics. Med Sci Sports Exerc. 1997;29:S151.

    Google Scholar 

  93. Brooks TJ. Madelung deformity in a collegiate gymnast: a case report. J Athl Train. 2001;36:170–3.

    PubMed Central  PubMed  Google Scholar 

  94. Barkdell T, Annunziata CC. Acquired Madelung-type deformity in a gymnast. Med Sci Sports Exerc. 2007;39(5):S133–4.

    Google Scholar 

  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 Central  PubMed  Google Scholar 

  96. Poletto ED, Pollock AN. Radial epiphysitis (aka Gymnast Wrist). Pediatr Emerg Care. 2012;28(5):484–5.

    PubMed  Google Scholar 

  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  Google Scholar 

  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.

    Google Scholar 

  99. Hochholzer T, Schöffl V, Krause R. Finger-epiphysen-verletzungen jugendlicher sportkletterer. Sport Orthop Traumatol. 1997;13:100–3.

    Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

  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  Google Scholar 

  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.

    Article  Google Scholar 

  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  Google Scholar 

  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.

    Google Scholar 

  107. Schoffl V, Hochholzer T, Winkerlmann H, Strecker W. Pulley injuries in rock climbers. Wildern Environ Med. 2003;41:94–100

    Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

  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  Google Scholar 

  112. Wall EJ. Knee injury: gymnastics. Med Sci Sports Exerc. 1997;29(suppl):S152.

    Google Scholar 

  113. Blatnik TR, Briskin S. Bilateral knee pain in a high-level gymnast. Clin J Sport Med. 2013;23:77–9.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  115. Borders H. Physeal stress injury. Pediatr Adolesc MSK MRI, J Herman Kan, pp. 78–83.

  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.

    CAS  PubMed  Google Scholar 

  117. Ehara S. Physeal stress injury to the knee. AJR. 2006;187:W554.

    PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  119. Cahill BR. Stress fracture of the proximal tibial epiphysis: a case report. Am J Sports Med. 1977;5:186–7.

    CAS  PubMed  Google Scholar 

  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.

    Google Scholar 

  121. Weber PC. Salter–Harris type II stress fracture in a young athlete. Orthopaedics. 1988;11:309–11.

    CAS  Google Scholar 

  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.

    CAS  Google Scholar 

  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  Google Scholar 

  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.

    Google Scholar 

  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  Google Scholar 

  126. Shah S. Premature growth plate closure in a ballet dancer en Pointe. Clin J Sport Med. 2017;27(5):e69–71.

    PubMed  Google Scholar 

  127. Wall EJ. Growth plate overuse syndrome of the ankle in athletes. Med Sci Sports Exerc. 1997;5:299.

    Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Google Scholar 

  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  Google Scholar 

  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.

    Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Google Scholar 

  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 Central  PubMed  Google Scholar 

  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.

    Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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  Google Scholar 

  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.

    Google Scholar 

  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 Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  147. Schlegel C, Buchler U, Kriemler S. Finger injuries of elite rock climbers. Schweizerische Zeitschrift fur Sportsmeizin und Sportstraumatologies. 2002;50(1):7–10.

    Google Scholar 

  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  Google Scholar 

  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  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

  153. Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med. 2006;16:501–14.

    Google Scholar 

  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  Google Scholar 

  155. Lishen Q, Jianhua O. Epiphyseal injury in gymnasts. Chin J Sports Med. 1983;2:7–12.

    Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  157. Dixon M, Fricker P. Injuries to elite gymnasts over 10 years. Med Sci Sports Exerc. 1993;25:1322–9.

    CAS  PubMed  Google Scholar 

  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  Google Scholar 

  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 Central  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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  Google Scholar 

  162. Micheli LJ, Klein JD. Sports injuries in children and adolescents. Br J Sports Med. 1991;25:6–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  163. Tipton CM, Matthes RD, Maynard JA. Influence of chronic exercise on rat bones. Med Sci Sports Exerc. 1972;4:55.

    Google Scholar 

  164. Kiiskinen A. Physical training and connective tissues in young mice: physical properties of Achilles tendons and long bones. Growth. 1977;41:123–37.

    CAS  PubMed  Google Scholar 

  165. Simon MR. The effects of dynamic loading on the growth of epiphyseal cartilage in the rat. Acta Anat. 1978;102:176–83.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  167. Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 1983;8:643–51.

    CAS  PubMed  Google Scholar 

  168. McCaw ST, Bates BT. Biomechanical implications of mild leg length inequality. Br J Sports Med. 1991;25:10–3.

    CAS  PubMed Central  PubMed  Google Scholar 

  169. Morscher E. Etiology and pathophysiology of leg length discrepancies. Prog Orthop Surg. 1977;1:9–19.

    Google Scholar 

  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.

    Google Scholar 

  171. Caine DJ, Golightly YM. Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective. Br J Sport Med. 2011;45:298–303.

    Google Scholar 

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Authors and 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

    Dennis Caine

  2. Physical Therapy Division, Duke Health Interprofessional Education, Duke University School of Medicine, 311 Trent Drive, Durham, NC, 27710, USA

    Rachel Meyers

  3. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Jie Nguyen

  4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Jie Nguyen

  5. Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany

    Volker Schöffl

  6. School of Clinical and Applied Sciences, Leeds Becket University, Leeds, England, UK

    Volker Schöffl

  7. School of Medicine, University of Colorado, Denver, CO, USA

    Volker Schöffl

  8. Department of Trauma and Orthopedic Surgery, Friederich Alexander University, Erlangen-Nuremburg, Germany

    Volker Schöffl

  9. Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, Via Salvador Allended, 43, 84081, Baronissi, SA, Italy

    Nicola Maffulli

  10. Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona, Largo Città di Ippocrate, 84131, Salerno, Italy

    Nicola Maffulli

  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

    Nicola Maffulli

  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

    Nicola Maffulli

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  1. Dennis Caine
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  2. Rachel Meyers
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Corresponding author

Correspondence to Dennis Caine.

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Conflict of interest

Dennis Caine, Rachel Meyers, Jie Nguyen, Volker Schöffl, and Nicola Maffulli declare that they have no competing interests.

Funding

No sources of funding were used to assist in the preparation of this article.

Authorship contributions

DC wrote the first draft of the manuscript. RM assisted with the systematic search and retrieval of the literature following PRISMA guidelines. She also developed the PRISMA flowchart. VS and NM provided clinical interpretation of case studies reviewed and assisted with the development of the summary tables. JN provided imaging and clinical interpretation of case studies and assisted with the development of the summary and supplementary tables. RM, JN, VS, and NM assisted with revisions of the original manuscript. All authors read and approved the final manuscript.

Data availability statement

Supplementary information in the form of six summary tables (Supplementary Information Tables S1–S6) is available to authorized users [see title page for information] or from the author on request. These summary tables correspond to results discussed in Sects. 3.2.1–3.2.6.

Supplementary Information

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Caine, D., Meyers, R., Nguyen, J. et al. Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review. Sports Med 52, 741–772 (2022). https://doi.org/10.1007/s40279-021-01511-z

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