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Apophyseal And Epiphyseal Injuries (Main)

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Other Names

  • Apophysitis
  • Epiphysiolysis


  • This page is a description of the general principles of apophyseal and epiphyseal injuries in pediatric athlets


  • Terminology
    • Apophysis: normal secondary ossification center that is located in the non-weight-bearing part of the bone and eventually fuses with it over time
      • Site of a ligament or tendon attachment
      • Often the weakest point in biomechanical chain
    • Epiphysis: component of bone above the physis
      • Typically contributes to a joint
    • Apophysitis: inflammation of the apophysis
    • Epiphysiolysis: stress injury of the epiphyseal cartilage


  • General
    • Occurs due to repetitive stress
    • Force outweighs ability of structure to withstand the stress

Risk Factors

  • Intrinsic
    • Imbalances or deficits in strength and flexibility
    • Poor technique or mechanics
    • Normal variants of anatomic alignment
  • Extrinsic
    • Rapid increase in training (FIT, Frequency, Intensity, Time)
    • Long-term, high training volume Goal: hours/week < age in years
    • Suboptimal equipment
    • Poor training surfaces or sudden change in training surface
    • Early sport specialization

Differential Diagnosis

Epiphyseal Fractures (Salter-Harris Fractures)

Apophyseal and Epiphyseal Avulsion Fractures

Apophysitis and Epiphysitis

Clinical Features

  • History
    • Chronic
    • Insidious onset
    • Intermittent
    • Worse with activities
    • Improved with rest
  • Physical Exam: (See: Physical Exam (Main))




Return to Play


See Also


Created by:
John Kiel on 30 June 2019 20:00:01
Last edited:
25 January 2022 16:29:29