Upper extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment

Given the frequency and severity of overuse injuries in pediatric athletes and the potential for long-term deleterious effects, it is important for radiologists to have a comprehensive understanding of these injuries and their imaging spectrum. This article addresses chronic overuse injuries involving the upper extremity in the pediatric athlete. Chronic upper extremity overuse injuries in competitive pediatric athletes yield imaging findings that can be subtle, obvious and characteristic, or atypical. Prompt application of the appropriate imaging modalities and their accurate interpretation expedites management, returning the pediatric athlete to the playing field while minimizing long-term adverse outcomes.Summary statementProper modality selection and interpretation in the imaging evaluation of upper extremity overuse injuries in pediatric athletes include an understanding of skeletal development, mechanism of injury, and clinical presentation to provide accurate diagnoses and mitigate long-term adverse sequelae.Learning objectivesAfter reading this article and taking the test, the reader will be able to:
• Describe the clinical presentation and imaging characteristics of a variety of pediatric overuse injuries in the upper extremity including little league shoulder, rotator cuff tendinosis, gymnast wrist, climber's finger, and myriad pathologies about the elbow.
• Explain how the physis plays a crucial role in pediatric overuse injury and how to evaluate physeal injury in a multimodal approach.
• Understand the clinical management for certain pediatric overuse injuries, especially those that have potential for long-term and/or permanent disability.