American family physician | 16 May 2019
S Achar and J Yamanaka
Apophysitis and osteochondrosis are common causes of pain in growing bones but have differing etiologies and required management. Apophysitis results from a traction injury to the cartilage and bony attachment of tendons in children and adolescents. Most often it is an overuse injury in children who are growing and have tight or inflexible muscle tendon units. Although apophysitis occurs in upper and lower extremities, it occurs more often in the lower extremities, with common locations including the patellar tendon attachment at the patella or tibia (i.e., Larsen-Johansson and Osgood-Schlatter diseases), the calcaneus (i.e., Sever disease), and multiple locations around the hip, including the anterior inferior iliac spine. Other locations include the medial epicondyle, which is common in patients who throw or participate in racket sports, and more rarely at the base of the fifth metatarsal (i.e., Iselin disease). Radiography can be helpful in evaluating for other pathologies but is usually not necessary. Treatment includes stretching the affected muscle groups, relative rest, offloading the affected tendon, icing after activity, and limited use of nonsteroidal anti-inflammatory drugs. Osteochondrosis presents less commonly and refers to degenerative changes in the epiphyseal ossification centers of growing bones. Unlike apophysitis, the etiology of osteochondrosis is unknown. Multiple possible etiologies have been explored, including genetic causes, hormonal imbalances, mechanical factors, repetitive trauma, and vascular abnormalities. Other locations of osteochondrosis include the second metatarsal head (i.e., Freiberg disease), the navicular bone (i.e., Köhler bone disease), the femoral head (i.e., Legg-Calvé-Perthes disease), and the capitellum (i.e., Panner disease). Radiography results may be normal initially; magnetic resonance imaging is more sensitive to early changes. Osteochondrosis generally resolves with relative rest, but close monitoring is needed to ensure resolution. Surgery is rarely needed for either apophysitis or osteochondrosis.
* Data courtesy of Altmetric.com