1. Snap, Crackle, Apophysitis ArAFP 66th Annual Scientific Assembly June 15, 2013
Elton R. Cleveland, DVM, MD.
University of Arkansas for Medical Sciences
Arkansas Children’s Hospital

2. Apophysitis
Inflamation of the apophysis that is usually caused by overuse or repetitive traction to the physis
Usually no bruising or ecchymosis
Insidious

4. Little League Elbow Epiphysitis of medial epicondyle
caused by repetitive strain of throwing
damage to radiocapitellum
osteochondrosis of capitellum
increase valgus stress
rest, modified activity, limit throws, mechanics

9. Osgood- Schlatter Boys (12 1/2-13), girls (11 1/2 years)
Tensile stresses acting across the junction of the immature patellar tendon and the tibia tubercule
Pain, tenderness, swelling - Bilat 56%
Rest, ice, activity modification, pain mgmt, hamstring stretches, padding

10. Osgood-Schlatters Disease

11. Sinding-Larsen-Johannson
Osgood - Schlatter of the inferior pole of the patella

12. Achilles Tendonitis Frequently recurrent problem
tight achilles with recurrent traction
rare rupture in young athlete
rest, ice, heel cord stretching, strengthening

14. Sever’s Disease Osgood-Schlatter’s of the heel - Bilat 61%
Girls y/o, Boys 10-12y/o
activity related heel pain
X-rays may not be helpful because fragmentation and sclerosis of the calcaneal apophysis is normal
calf stretches, heel lifts, strengthen dorsiflexors, activity modification

17. Pelvic Apophysitis Iliac ASIS AIIS Symphysis Ishial tuberosity
Greater Trochanter
Lesser Trochanter

18. Apophysitis vs Apophyseal Avulsion Fractures

19. Apophysitis
Inflamation of the apophysis that is usually caused by overuse or repetitive traction to the physis
Usually no bruising or ecchymosis
Insidious

20. Avulsion Fracture Sudden pain with activity
Can recall specific activity
Most severe with activity
Improves with rest
+/- Swelling – tenderness with palpation
Passive stretch may reproduce pain

21. Avulsion Fracture
Soccer cases
Gymnastics 55 cases
Rossi, Dragoni

22. Avulsion Fx – Hip/Pelvis
Ishial Tuberosity 54%
AIIS 22%
ASIS 19%
Pubic symphysis 3%
Iliac Crest 1 %
Rossi, Dragoni

23. Pelvic Apophysitis – D/D
Pelvic Avulsion Fractures
Snapping Hip Syndrome
Spondylolysis
Femoral Neck Stress Fracture
Sports Hernia

24. Imaging
Xray CT
MRI
U/S

26. Avulsion Fx – Hip/Pelvis
ASIS – Sartorius
Ishial Tuberosity – Hamstring
AIIS- Rectus Femoris –
Lesser Trochanter –
Iliac Crest – obliques
Metzmaker, Pappus

28. Avulsion Fx – Hip/Pelvis
ASIS – Sartorius
Ishial Tuberosity – Hamstring
AIIS- Rectus Femoris –
Lesser Trochanter –
Iliac Crest – obliques
Metzmaker, Pappus

30. Avulsion Fx – Hip/Pelvis
ASIS – Sartorius
Ishial Tuberosity – Hamstring
AIIS- Rectus Femoris –
Lesser Trochanter –
Iliac Crest – obliques
Metzmaker, Pappus

34. Avulsion Fx – Hip/Pelvis
ASIS – Sartorius
Ishial Tuberosity – Hamstring
AIIS- Rectus Femoris –
Lesser Trochanter –
Iliac Crest – obliques
Metzmaker, Pappus

36. Avulsion Fx – Hip/Pelvis
ASIS – Sartorius
Ishial Tuberosity – Hamstring
AIIS- Rectus Femoris –
Lesser Trochanter –
Iliac Crest – obliques
Metzmaker, Pappus

38. Surgery ?
Consider if >2cm displacement