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Apophyseal Injury
Aka: Apophyseal Injury, Apophysitis, Apophyseal Fracture, Traction Apophysitis
- See Also
- Epiphyseal Fracture
- Osteochondrosis
- Epiphyseal Plate
- Femur Epiphyseal Plates
- Fibula Epiphyseal Plate
- Foot Epiphyseal Plates
- Humerus Epiphyseal Plates
- Sternum Epiphyseal Plate
- Tibia Epiphyseal Plate
- Definitions
- Apophysis
- Secondary ossification sites for tendon insertions
- Apophysitis
- Apophyseal inflammation prior to Growth Plate closure
- Epidemiology
- Apophysitis is seen most commonly in young athletes
- Pelvis is the most common site of Apophyseal Fracture
- Pathophysiology
- Bone grows faster than Muscle and tendon during growth spurt in adolescents
- Apophysis is 2-5 times weaker than surrounding structures
- Results in a physiologic inflexibility at the apophyses
- Predisposes to overuse injury especially if tight or inflexible Muscles and tendons
- Images
- Apophysitis Sites

- Causes: Extremities
- Elbow
- Medial Epicondyle Apophysitis (Little Leaguer's Elbow, Thrower's Elbow)
- Knee
- Inferior Pole of Patella (Larsen-Johansson Disease)
- Tibial Tubercle Apophysitis (Osgood-Schlatter Disease)
- Foot
- Calcaneal Aphophysitis (Sever's Disease)
- Fifth Metatarsal aphophysitis (Iselin's Disease)
- Causes: Pelvis
- Anterior Superior Iliac Spine
- See Anterior Superior Iliac Spine Avulsion Fracture
- Sartorius tendon insertion
- Anterior Inferior Iliac Spine
- See Anterior Inferior Iliac Spine Avulsion Fracture
- Rectus Femoris tendon insertion
- Ischial tuberosity
- Hamstring tendon insertion
- Iliac Crest
- Transverse abdominis insertion
- External oblique insertion
- Internal oblique tendon insertion
- Pubic Apophysitis
- Pubic Symphysis
- Gracilis tendon insertion
- Hip adductors insertion
- Signs
- Localized swelling and pain at given apophysis
- Provoked by contraction against resistance of the involved tendon insertion
- Imaging
- XRay
- Differentiates Apophysitis from avulsion Fracture, Stress Fracture, Bone Tumor, Osteochondrosis
- Ulrasound
- Widened and fragmented apophysis
- Differential Diagnosis
- Traumatic Injury
- Stress Fracture
- Avulsion Fracture
- Bony Lesions (e.g. Cancer)
- Osteomyelitis
- Inflammatory Arthropathy (multiple joints involved)
- Management
- See specific Apophysitis causes
- Conservative therapy is effective in most cases
- Self-limited, resolving as flexibility improves and Growth Plates close
- Stretching
- Relative rest with cross-training to other activities
- Ice Therapy
- NSAIDs (judicious use)
- Orthopedic or sports medicine Consultation indications
- Pain persists after apophysis fusion
- Symptoms refractory to conservative management
- Red Flags (severe pain, Trauma, inability to bear weight, night pain, systemic symptoms, cancer history)
- Prevention
- Avoid over-training and overuse
- Keep pre-high school sports involvement broad without specialization
- Encourage cross training
- References
- Achar (2019) Am Fam Physician 99(10): 610-8 [PubMed]