US in Children with Sports Injuries

  • Jeimylo C. de Castro


The use of ultrasound in evaluating sports injuries among children has been increasing in frequency due to its portability and its relatively quick assessment in the sidelines of a sports activity. While magnetic resonance imaging (MRI) may provide a detailed description of the condition of the injured athlete, assessing children by means of ultrasound can guide the physician as to what decisions to make while in the playing field diagnostically.

One of the most susceptible populations in sports injuries are children who early on are engaged in active sports. It can affect the growing bone and soft tissues. Consequently, this can lead to lifelong damage to the growth mechanisms. Children basically start participating in sports as an enjoyment or part of school activities for health and personal development. But as the child grows and develops a certain skill, a competitive attitude intervenes. As a result, young athletes tend to participate in sports harder and longer. And this is where sports injuries inevitably follow (Shanmugam and Maffulli, Br Med Bull. 86:33–57, 2008).

Two common patterns of injuries are usually observed among pediatric patients. Acute injuries are usually physeal or avulsion fractures due to a traumatic single event, and the other one is overuse injuries which are the result of repetitive stress and usually include the common traction apophysitis (Auringer and Anthony, Semin Musculoskeletal Radiol. 3:247–256, 1999). There are factors that contribute to sports injuries among children. These include gender affiliation, participation level, type of sports, and player position (Caine et al., Clin J Sport Med. 16:500–13, 2006). More objective risk factors may include bone-cartilage interface growth area of the immature skeleton, training error, muscle-tendon imbalance, anatomic malalignment, footwear and playing surface, nutrition, cultural deconditioning, associated disease, and psychological factors (Micheli and Klein, Br J Sp Med. 25(1):6, 1991).


Pediatric injuries Sports Ultrasound Injuries Athlete Pediatric Musculoskeletal Physeal Apophysitis Children Acute injuries Overuse injuries 


  1. 1.
    Shanmugam C, Maffulli N. Sports injuries in children. Br Med Bull. 2008;86(1):33–57.CrossRefPubMedGoogle Scholar
  2. 2.
    Schmidt B, Hollwarth ME. Sports accidents in children and adolescents. Z Kinderchir. 1989;44:357–62.PubMedGoogle Scholar
  3. 3.
    Auringer ST, Anthony EY. Common pediatric sports injuries. Semin Musculoskelet Radiol. 1999;3(3):247–56.CrossRefPubMedGoogle Scholar
  4. 4.
    Bright RW, Burstein AH, Elmore SM. Epiphyseal-plate cartilage: a biomechanical and histological analysis of failure modes. J Bone Joint Surg Am. 1974;56:688–703.CrossRefPubMedGoogle Scholar
  5. 5.
    Flachsman R, Broom ND, Hardy AE, et al. Why is the adolescent joint particularly susceptible to osteochondral shear fracture? Clin Orthop Relat Res. 2000;381:212–21.CrossRefGoogle Scholar
  6. 6.
    Caine D, DiFiori J, Maffuli N. Physeal injuries in children’s and youth sports: reasons for concern. Br J Sports Med. 2006;40:749–60.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Maffulli N, Baxter-Jones AD. Common skeletal injuries in young athletes. Sports Med. 1995;19:137–49.CrossRefPubMedGoogle Scholar
  8. 8.
    Booth FW, Goiuld EW. Effects of training and disuse on connective tissue. Exerc Sport Sci Rev. 1975;3:83–112.CrossRefPubMedGoogle Scholar
  9. 9.
    O’Dell MC, Jaramillo D, Bancroft L, Varich L, Logsdon G, Servaes S. Imaging of sports-related injuries of the lower extremity in pediatric patients. Radiographics. 2016;36(6):1807.CrossRefPubMedGoogle Scholar
  10. 10.
    Jacobson JA. Ultrasound in sports medicine. Radiol Clin N Am. 2002;40(2):363–86.CrossRefPubMedGoogle Scholar
  11. 11.
    Osgood RB. Lesions of the tibial tubercle occurring during adolescence. Clin Orthop Relat Res. 1993;6:1903.Google Scholar
  12. 12.
    Czyrny Z. Osgood-Schlatter disease in ultrasound diagnostics – a pictorial essay. Med Ultrason. 2010;12(4):323–35.PubMedGoogle Scholar
  13. 13.
    Draghi F, Danesino GM, Coscia D, Precerutti M, Pagani C. Overload syndromes of the knee in adolescents: sonographic findings. J Ultrasound. 2008;11(4):151–7.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Suzue N, Matsuura T, Iwame T, Higashino K, Sakai T, Hamada D, et al. State of the art ultrasonographic findings in lower extremity sports injuries. The J of Med Investigation. 2015;62:109–13.CrossRefGoogle Scholar
  15. 15.
    Ogden JA, Southwick WO. Osgood-Schlatter’s disease and tibial tuberosity development. Clin Orthop Relat Res. 1976;(116):180–9.Google Scholar
  16. 16.
    De Flaviis L, Nessi R, Scaglione P, Balconi G, Albisetti W, Derchi LE. Ultrasonic diagnosis of Osgood-Schlatter and Sinding-Larsen-Johansson disease of the knee. Skelet Radiol. 1989;18(3):193–7.CrossRefGoogle Scholar
  17. 17.
    Crawford DC, Safran MR. Osteochondritis dissecans of the knee. J Am Acad Orthop Surg. 2006;14(2):90–100.CrossRefPubMedGoogle Scholar
  18. 18.
    Eismann EA, Pettit RJ, Wall EJ, Myer GD. Management strategies for osteochondritis dissecans of the knee in the skeletally immature athlete. J Orthop Sports Phys Ther. 2014;44(9):665–79.CrossRefPubMedGoogle Scholar
  19. 19.
    Grimm NL, Weiss JM, Kessler JI, Aoki SK. Oseochondritis dissecans of the: pathoanatomy, epidemiology, and diagnosis. Clin Sports Med. 2014;33(2):181–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Berna-Serna JD, Martinez F, Reus M, Berna-Mestre JD. Osteochondritis dessicans of the knee: sonographically guided percutaneous drilling. J Ultrasound Med. 2008;27:255–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Gregersen HE, Rasmussen OS. Ultrasonography of osteochondritis dissecans of the knee: a preliminary report. Acta Ragiologica. 1989;30(5):552–4.CrossRefGoogle Scholar
  22. 22.
    Hosgoren B, Koktener A, Dilmen G. Ultrasonography of the calcaneus in Sever’s disease. Indian Pediatr. 2005;42:801–3.PubMedGoogle Scholar
  23. 23.
    Ferlic PW, Sadoghi P, Singer G, Kraus T, Eberl R. Treatment for ischial tuberosity avulsion fractures in adolescent athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):893–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Lazovic D, Wegner U, Peters G, Gosse F. Ultrasound for diagnosis of apophyseal injuries. Knee Surg Sports Traumatol Arthrosc. 1996;3(4):234–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Pisacano RM, Miller TT. Comparing sonography with MR imaging of apophyseal injuries of the pelvis in four boys. Am J Roentgenol. 2003;181:223–30.CrossRefGoogle Scholar
  26. 26.
    Bergen CJA, van den Ende KIM, Brinke BT, Eygendaal D. Osteochondritis dissecans of the capitellum in adolescents. World J Orthop. 2016;7(2):102–8.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kida Y, Morihara T, Kotoura Y, Hojo T, Tachiiri H, Sukenari T, Iwata Y, Furukawa R, Oda R, Arai Y, et al. Prevalence and clinical characteristics of osteochondritis dissecans of the humeral capitellum among adolescent baseball players. Am J Sports Med. 2014;42:1963–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Takahara M, Ogino T, Tsuchida H, Takagi M, Kashiwa H, Nambu T. Sonographic assessment of osteochondritis dissecans of the humeral capitellum. Am J Roentgenol. 2000;174(2):411–5.CrossRefGoogle Scholar
  29. 29.
    Cil A, Kocher M. Treatment of pediatric shoulder instability. J Pediatr Orthop. 2010;30:S3–6.CrossRefGoogle Scholar
  30. 30.
    Owens BD, Campbell SE, Cameroon KL. Risk factors for anterior glenohumeral instability. Am J Sports Med. 2014;42:2591–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Leroux T, Ogilve-Harris D, Veillete C, et al. The epidemiology of primary anterior shoulder dislocation in patients aged 10 to 16 years. Am J Sports Med. 2015;43:2111–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Lawton R, Choudhury S, Mansat P, Cofield R, Stans A. Pediatric shoulder instability: presentation, findings, treatment and outcomes. J Pediatr Orthop. 2002;22(1):52–61.PubMedGoogle Scholar
  33. 33.
    Gigis I, Heikenfeld R, Kapinas A, et al. Arthroscopic versus conservative treatment of first anterior dislocation of the shoulder in adolescents. J Pediatr Orthop. 2014;34:421–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Longo UG, van der Linde JA, Loppini M, et al. Surgical versus nonoperative treatment in patients up to 18 years old with traumatic shoulder instability: a systematic review and quantitative synthesis of the literature. Arthroscopy. 2016;32:944–52.CrossRefPubMedGoogle Scholar
  35. 35.
    Arciero RA, Mazzocca AD. Traumatic posterior shoulder subluxation with labral injury: suture anchor technique. Tech Should Elbow Surg. 2004;5:13–24.CrossRefGoogle Scholar
  36. 36.
    Beck JJ, Richmond CJ, Tompkins MA, Heyer A, Shea KG, Cruz AI. What’s new in pediatric upper extremity sports injuries? J Pediatr Orthop. 2018;38(2):e73–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Good CR, MacGillivray JD. Traumatic shoulder dislocation in the adolescent athlete: advances in surgical treatment. Curr Opin Pediatr. 2005;17:25–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Hammar MV, Wintzell GB, Astrom GO, Larsson S, Elvin A. Role of US in the preoperative evaluation of patients with anterior shoulder instability. Radiology. 2001;219(1):29.CrossRefPubMedGoogle Scholar
  39. 39.
    Li Y, Donohue KS, Robbins CB, et al. Reliability of radiographic assessments of adolescent midshaft clavicle fractures by the FACTS multicenter study group. J Orthop Trauma. 2017;31:479–84.CrossRefPubMedGoogle Scholar
  40. 40.
    Eksioglu F, Altinok D, Uslu MM, Gudemez E. Ultrasonographic findings in pediatric fractures. The Turkish J of Pediatr. 2003;45:136–40.Google Scholar
  41. 41.
    Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI. Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med. 2010;17(7):687–93.CrossRefPubMedGoogle Scholar
  42. 42.
    Hoffman DF, Adams E, Bianchi S. Ultrasonography of fractures in sports medicine. Br J Sports Med. 2015;49:152–60.CrossRefPubMedGoogle Scholar
  43. 43.
    Hubner U, Schlicht W, Outzen S, Barthel M, Halsband H. Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg Br. 2000;82(8):1170–3.CrossRefPubMedGoogle Scholar
  44. 44.
    Lazar RD, Waters PM, Jaramillo D. The use of ultrasonography in the diagnosis of occult fracture of the radial neck. J Bone Joint Surg. 1998;80-A:1361–3.CrossRefGoogle Scholar
  45. 45.
    Wang CC, Linden KL, Otero HJ. Sonographic evaluation of fractures in children. J Diag Med Sonography. 2017;33(3):200–7.CrossRefGoogle Scholar
  46. 46.
    Crowther M. Elbow pain in pediatrics. Curr Rev Musculoskelet Med. 2009;2(2):83–7.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Konin GP, Nazarian LN, Walz DM. Ultrasound of the elbow: indications, technique, normal anatomy and pathologic conditions. Radiographics. 2013;33:4.CrossRefPubMedGoogle Scholar
  48. 48.
    Atanda A Jr, Averill LW, Wallace M, et al. Factors related to increased ulnar collateral ligament thickness on stress sonography of the elbow in asymptomatic youth and adolescent baseball players. Am J Sports Med. 2017;44:3179–87.CrossRefGoogle Scholar
  49. 49.
    Knapik DM, Fausett CL, Gilmore A, et al. Outcomes of non-operative pediatric medial humeral epicondyle fractures with and without associated elbow dislocation. J Pediatr Orthop. 2017;37:e224–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Hang DW, Chao CM, Hang YS. A clinical and roentgenographic study of little league elbow. Am J Sports Med. 2004;32:79–84.CrossRefPubMedGoogle Scholar
  51. 51.
    Gore RM, Rogers LF, Bowerman J, et al. Osseous manifestations of elbow stress associated with sports activities. A J Roentgen. 1980;134:971–7.CrossRefGoogle Scholar
  52. 52.
    Iyer RS, Thapa MM, Khanna PC, Chew FS. Pediatric bone imaging: imaging elbow trauma in children—a review of acute and chronic injuries. A J Roentgen. 2012;198(5):1053–68.CrossRefGoogle Scholar
  53. 53.
    Lin CW, Chen YH, Chen WS. Application of ultrasound and ultrasound-guided intervention for evaluating elbow joint pathologies. J Med Ultrasound. 2012;20(2):87–95.CrossRefGoogle Scholar
  54. 54.
    Harada M, Takahara M, Sasaki J, Mura N, Ito T, Ogino T. Using sonography for the early detection of elbow injuries among young baseball players. Am J Roentgenol. 2006;187(6):1436–41.CrossRefGoogle Scholar
  55. 55.
    Lento PH, Primack S. Advances and utility of diagnostic ultrasound in musculoskeletal medicine. Curr Rev Musculoskelet Med. 2008;1(1):24–31.CrossRefPubMedGoogle Scholar
  56. 56.
    Hryhorczuk AL, Restrepo R, Lee EY. Pediatric musculoskeletal ultrasound: practical imaging approach. Am J Roentgenol. 2016;206(5):W62–72.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Jeimylo C. de Castro
    • 1
    • 2
  1. 1.Physical Medicine and Rehabilitation DepartmentThe Medical City-South LuzonSanta RosaPhilippines
  2. 2.SMARTMD Center for Non-Surgical Pain InterventionsMakati CityPhilippines

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