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Physeal stress injury
Case Detail
| Anatomy: Musculoskeletal |
 Heather Borders, MD |
| Diagnostic Category: Trauma |
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| Created: over 7 years ago |
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| Updated: over 7 years ago |
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| Tags:
PEDS
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| Modality/Study Types:
MRI
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Activities:  PDF  ImageJA |
History
13 year old male very active in sports with knee pain who had been referred for physical therapy.
Case Images
Diagnosis
Physeal stress injury
Findings
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.
Discussion
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.
Reference
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.