Epiphyseal Injuries

Growth plates and epiphyses are areas located at the ends of long bones, in which new bone is produced. Pre-adolescent and adolescent bones are not yet mature and trauma can lead to disruption of bone growth patterns by causing the growth plate to close prematurely. The growth plate may be injured with greater frequency than injuries to ligaments and bones due to the fact that the growth plate at this stage is the weakest link in the musculoskeletal system.

Forces through muscles, tendons, ligaments, and bone most commonly affect growth plates in the wrist, ankle, knee, and elbow joints. These forces may be acute (such as falling on an outstretched hand) or overuse in nature. Susceptible areas of concern include the elbow in baseball pitchers, the front of the shoulder, and front of the hip and back of the heel in runners.

Signs and Symptoms

• Pain can become progressively worse (as a result of overuse) or can occur immediately following a traumatic event.
• The level of injury varies in severity from minor epiphyseal separations (requiring short-term immobilization followed by rehabilitation) to crushing of the plate (leading to premature closing). If the latter occurs, joint function can be dramatically and permanently effected.

On-Site Management

Refer. Referral to a sports medicine practitioner is essential. Epiphyseal injuries can eventually lead to growth problems and uneven limbs if not promptly corrected.

Control Inflammation. The SportsAider should apply the R.I.C.E. principle. Avoid excessive compression if too painful.

Promote Healing. Immediate splinting and/or casting maybe required for this type of injury. Complete rest of the injured limb is also indicated.

Return to Activity

Since this type of injury can be quite serious in a growing athlete, return to play should only occur with a physician's approval.

Prevention

• Physical Maturity. Adolescent athletes are injury prone during "growth spurts". Participation in contact sports is not recommended for young people who are rapidly growing, have poor muscle development, and/or are obese. Physically mature adolescents should not compete with less developed athletes, as this exposes the smaller individuals to a greater risk of injury.
• Strength and Conditioning. Adequate strength, flexibility, and fitness levels appropriate to the sport are important in reducing the chance of growth plate injuries.

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