When Bones Don't Get Better

     Kids bones are different from adult bones. They have growth plates - areas where new bone is made allowing the bone to grow. These areas are softer than bone and can be easily injured. They can be fractured either with direct trauma or with overuse – the muscle attachments can repeatedly pull on the same area enough to separate it from the bone causing a growth-plate injury which can cause permanent damage.

     Young athletes often put their bones under stresses that adult athletes would never do. . A pitcher on a traveling team might play 4 games in a weekend. A professional pitcher gets 3 to 5 rest days between games. In a push to “get better” young athletes may play a sport all year long while pros get seasonal breaks. “Over-use” injuries are common in adolescent athletes and the cure – resting from the offending activity – is something neither the adolescent, the parents or the coaches are willing to accept.

     Parents need to know what to watch for when an injury or pain in an extremity doesn’t get better.

     Any injury to the elbow in children is worrisome. After a fall or after repetitive overuse (like pitching) the elbow can be sore and swollen. An initial X-Ray may not show a fracture but elbow fractures are notoriously hard to see and may take a few days to show up. If your child has elbow pain and the initial X-ray is negative but the pain persists, be sure to go back to the doctor and get another X-ray.

     Hip pain can also be very serious. In younger children, the hip joint can deteriorate and cause chronic pain. In older children, especially in obese children, the growth plate on the top of the femur (the upper leg bone) that can slip off the top of the bone and cause hip pain. If this injury is not caught, the growth plate can lose it’s blood supply and the child may have permanent damage. Any child with either acute or chronic hip pain needs to have hip X-rays done in a special position. Problems with the hip can cause “referred” pain in the knee, so a child who complains of chronic knee pain and has been told that his knee “is normal” should have his hip checked.

     Knee pain is very common. If the child has additional symptoms of catching, locking or limitation of motion, the knee needs evaluation. However, many knee problems don’t have these symptoms and just present with chronic, recurring pain. The most common problem is just under the front of the knee on the top of the tibia (lower leg bone) where there is a small lump on which the upper leg tendons attach. This is Osgood-Schlatter disease and usually only needs rest from activity when the area is swollen and tender. Pain within the knee itself can also be a stress fracture, damage to the cartilage or damage to the growth plate in the knee. If the pain is persistent, simple X-rays of the knee may not show the problem and a full “knee series” of X-rays should be done.

     Any pain in the areas of the extremities along the shaft and between joints needs to be investigated. Bone tumors – both benign and malignant – are common in childhood and adolescence. Often, trauma can fracture an area of bone that has already been weakened by a tumor. If a child gets a fracture from trauma but it doesn’t seem to be healing right with treatment, a tumor should be suspected. Again, the first X-rays may not show the problem, so never hesitate to get repeat X-rays when any extremity lesion isn’t getting better.