Cumulative Trauma

"Little league elbow" is an example of an injury to the epiphysis of children’s bones. It may be encountered by children who repeatedly throw a baseball during their childhood years. As a normal part of a child’s growth, stress is applied to the epiphysis by the strong pull of enlarging and growing muscles. Coupled with these normal stresses, the repetitive trauma of throwing a baseball can exert a great amount of force on, and can injure the epiphyses. Bone growth depends on its blood supply, and if the epiphysis is injured, blood supply will be interfered with and ultimately, growth could be hampered. Injuries to the epiphyses can result in angulation deformities, especially around the elbow, and this can give rise to either cosmetic deformities or modifications in the normal functioning of the limb. Therefore, any trauma to the child resulting in swelling, pain, or an inability to play his or her sport should be x-rayed.

The second type of growth center injury occurs to the "apophysis.” The apophyses are found at the attachments of muscles and adjust for longitudinal growth of the bone. They also allow tendon and muscle attachments to keep up with growth. Like the epiphyses, the apophyses can be affected by "osteochondrosis,” a disease of the growth centers of bones in children. This disease leads to compaction, destruction, and altered architecture of bones. Some type of trauma is needed to begin this dilapidation of the bones, such as that caused by repetitious activity. In adolescents, osteochondrosis is referred to as apophysitis, where the trauma is mainly occurring at the tendon or ligament insertion into a bone.

A very common example of this syndrome occurs in children who continuouslyrun on hard surfaces (long distance runners for example.) or who "slam" the feet down during certain activities (such as basketball). Here, swelling of the ligaments and tendons surrounding the tibial tuberosity occurs, causing inflammation and extreme pain. The tibial tuberosity is located on the anterior or front of the lower leg. Its job is to provide an anchoring point for the tendons of the quadriceps and secure the patella tendon. Continued exertion can cause a swelling of this area which can be extremely painful. This condition is known as Osgood-Schlatter’s disease. Osteochondrosis is a serious disorder that is affecting more and more children who push themselves and who are pushed to play elite, competitive sport.