Pediatric Overuse Injuries

The incidence of pediatric overuse injuries is increasing in proportion to rising participation and training intensity in youth sports worldwide. The growing musculoskeletal system of children and adolescents makes them susceptible to a unique type of injuries which differ from those in a mature skeleton and requires specific knowledge about normal physiology and imaging manifestations of injuries. The most common overuse injuries in children include stress fractures, traction apophysitis, and repetitive physeal injuries. Less commonly, osteochondral lesions, impingement syndromes, and tendinopathies may also occur. Additionally, several conditions, including normal developmental variants or diseases like chronic nonbacterial osteomyelitis and osteoid osteoma, can mimic overuse injuries in the pediatric skeleton and must be recognized to avoid diagnostic errors. The imaging approach to overuse injuries in children should be precise and prioritize safe imaging modalities-magnetic resonance imaging and ultrasound-to prevent unnecessary radiation exposure. In this review article, we will emphasize the imaging approach and features of relatively common overuse injuries of the growing skeleton, as well as conditions that may mimic an injury.