Stress injuries of bone in children and adolescents

Abstract

Stress injuries of bone in childhood and adolescence are the result of an imbalance between physical stress on the growing musculoskeletal system and its intrinsic resilience. Children who are very active in sports are particularly affected. The classical stress injuries mainly occur in the area of the lower leg, the metatarsus and the lower lumbar spine due to the disproportionate load on healthy bone; however, overuse syndromes can also occur in the area of the growth plates and possibly lead to growth plate disorders. The anamnesis usually shows stress-related pain that has existed for along time without trauma. As part of the differential diagnosis, a stress injury must first be included in the considerations due to it being a rare entity. An X‑ray examination can show the first signs of astress reaction. In the event of aconspicuous periosteal reaction, amalignant event must also be considered. As arule, the MRI examination is then groundbreaking and in some rare cases biopsies have to be considered. The treatment of stress injuries is usually conservative. Recurrences should be counteracted by exercise control.