Pediatric upper extremity stress injuries

To provide primary care physicians with strategies to evaluate and manage pediatric upper extremity stress injuries related to overuse with a focus on anatomic location, patient history, physical examination, and imaging.

Children are susceptible to stress injuries due to their open physes. The physeal cartilage of epiphyses and apophyses is the weakest structure in the developing skeleton. The differential diagnosis for pediatric stress injuries includes injury to the bone, physis, epiphysis, and apophysis. Most stress injuries in children improve with rest. Missed or misdiagnosed stress injuries can lead to growth abnormalities and potential malalignment.

Awareness of stress injuries is important for timely diagnosis and prevention of sequelae. A thorough history, focused physical examination, and proper imaging studies are crucial steps to identify upper extremity stress injuries in the pediatric population.