Tendon avulsions in children and adolescents

Abstract

During growth, the apophyses and insertion sites of tendons and muscles are weaker than the tendons and muscles themselves, and bones. At these growth areas, therefore, avulsions of tendons and muscles or avulsion fractures may occur [1], especially during physical activity, including school and competitive sports. These injuries may occur also as a result of direct contusion, fall, or twisting injury. Some of these injuries cause sudden severe symptoms with pain, swelling, disability, and loss of function [2-4]. In partial avulsions, the symptoms are minor, and the correct diagnosis is frequently delayed. In these cases, often ectopic calcification is observed at a later date, as a consequence of periosteal new bone formation in the hematoma at the site of the lesion [1,5].This heterotopic bone growth may hamper the function of the limb, limiting range of motion, or by the friction of soft tissues rubbing over the prominence. Fibrotic nonhealed avulsions cause prolonged problems, prevent maximal performance, and prompt further examination in greater depth.