Apophysitis

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Apophysitis
• Focal tenderness over the growth center with pain on stretch or resisted use of the attached muscle
• X-ray not needed given a typical presentation
• Brief period of relative rest, then a gradual return to activity as pain allows
• Ice after activity and motrin as needed
• Stretching and strengthening of the attached muscles
• Physical therapy referral
• Follow up as needed

Apophysitis is irritation of a growth center where a tendon attaches; it is common during growth spurts in active children and goes away when growth finishes. Recommended supportive care with ice and motrin after activity, with an emphasis on stretching, adjusting activity to pain, and a gradual return to full sports. Return precautions given including swelling, limping, night pain, fever, sudden severe pain with a pop, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Laterality, site (pelvis, ischium, medial epicondyle, patella, fifth metatarsal, distal radius)
Clinical diagnosis; x-ray for one-sided persistent pain; avulsion
Ice, motrin; stretching and strengthening
Training load
PT, orthopedics
Little league elbow

Return precautions in the template

swellinglimpingnight painfeversudden severe pain with a pop

Sources

Overuse Injuries, Overtraining, and Burnout in Young Athletes. Clinical Report. Pediatrics 2024;153(2):e2023065129. (replaces earlier report)
The Cribsiders #86: , #94 Overuse Injuries

Few formal guidelines cover this topic, so the template also leans on expert opinion.