Hosting 728 files, 2951 images, and 4 contributors.

Random Case

Serous Borderline Ovarian Tumor
Joseph Junewick, MD FACR
over 11 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Physeal stress injury

Case Detail

Anatomy: Musculoskeletal
Heather Borders, MD
Diagnostic Category: Trauma
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: MRI
Adobe32 PDF Imagej32 ImageJA


13 year old male very active in sports with knee pain who had been referred for physical therapy.

Case Images


Physeal stress injury


Abnormal physeal widening involving the distal femur and proximal tibia with a normal fibular physis. There was a cartilaginous rest in the proximal tibial metaphysis.


The differential for physeal widening includes metabolic disorders such as rickets, metaphyseal dysplasia, chronic trauma, leukemia. The diagnosis of a stress injury should be considered in a patient who is athletic without a metabolic disorder or deformity.

Newly formed bone immediately adjacent to the metaphysis is sensitive to trauma. There is disruption of microvasculature and disruption of endochondral bone formation with the resultant physeal widening as cartilage is not properly mineralized.

Imaging findings include physeal widening, metaphyseal cartilage rests and metaphyseal signal change. This is important to recognize as patients with these physeal changes should not undergo physical rehab (what was prescribed for this patient). Treatment is rest.


AJR 2006; 186:1260-1264 Physeal Widening in the Knee Due to Stress Injury in Child Athletes Tal Laor

Pediatric and Adolescent MSK MRI, J Herman Kan, pp. 78-83.

Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare