Download PDF
Semin Musculoskelet Radiol 2017; 21(03): 167-174
DOI: 10.1055/s-0037-1602416
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Upper Limbs Trauma in Pediatrics

Claudia Lucia Piccolo
2   Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
,
Michele Galluzzo
3   Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
,
Margherita Trinci
3   Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
,
Stefania Ianniello
3   Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
,
Michele Tonerini
4   Department of Emergency Radiology, Cisanello Hospital, Pisa, Italy
,
Giuseppe Guglielmi
5   Department of Radiology, University of Foggia, Foggia, Italy
,
Vittorio Miele
1   Department of Emergency Radiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
01 June 2017 (online)

Also available at
    Permissions and Reprints

Abstract

A correct interpretation of musculoskeletal imaging studies of children requires an in-depth knowledge of normal skeletal growth and physiologic changes in growing bones. During childhood the growing bones are more prone to acute and chronic injuries because of the imbalance between osseous structures and tendons and ligaments, so physeal injuries are the most commonly encountered types of lesions. This review addresses acute and chronic injuries involving the upper extremities in the pediatric population. These injuries may be subtle to recognize or atypical. The radiologist has to choose the most appropriate technique that can best recognize the problem and establish the correct diagnosis, thus avoiding diagnostic errors and potential delayed complications.

Keywords

children - musculoskeletal - physeal fractures - apophyseal fractures - chronic injuries
 

  • References

  • 1 Paz DA, Chang GH, Yetto Jr JM, Dwek JR, Chung CB. Upper extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment. Clin Imaging 2015; 39 (06) 954-964
    CrossrefPubMedGoogle Scholar
  • 2 Basilicata A, Rossi E, Castello L. , et al. Radiologia Pediatrica e Health Technology Assessment (HTA). Proposta di un razionale impiego di protocolli e creazione di una rete oncologica. Radiol Pediatr 2015; 2: 686-692
    PubMedGoogle Scholar
  • 3 Miele V, Piccolo CL, Trinci M, Galluzzo M, Ianniello S, Brunese L. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med (Torino) 2016; 121 (05) 409-430
    CrossrefPubMedGoogle Scholar
  • 4 Ecklund K, Jaramillo D. Imaging of growth disturbance in children. Radiol Clin North Am 2001; 39 (04) 823-841
    CrossrefPubMedGoogle Scholar
  • 5 Ytrehus B, Carlson CS, Ekman S. Etiology and pathogenesis of osteochondrosis. Vet Pathol 2007; 44 (04) 429-448
    CrossrefPubMedGoogle Scholar
  • 6 Rivas R, Shapiro F. Structural stages in the development of the long bones and epiphyses: a study in the New Zealand white rabbit. J Bone Joint Surg Am 2002; 84-A (01) 85-100
    PubMedGoogle Scholar
  • 7 Miele V, Di Giampietro I, Ianniello S, Pinto F, Trinci M. Diagnostic imaging in pediatric polytrauma management. Radiol Med (Torino) 2015; 120 (01) 33-49
    CrossrefPubMedGoogle Scholar
  • 8 Goldberg AS, Moroz L, Smith A, Ganley T. Injury surveillance in young athletes: a clinician's guide to sports injury literature. Sports Med 2007; 37 (03) 265-278
    CrossrefPubMedGoogle Scholar
  • 9 Washington RL, Bernhardt DT, Gomez J. , et al; Committee on Sports Medicine and Fitness and Committee on School Health. Organized sports for children and preadolescents. Pediatrics 2001; 107 (06) 1459-1462
    CrossrefPubMedGoogle Scholar
  • 10 Miele V, Di Giampietro I. Diagnostic imaging in emergency. Salute e Società 2014; 2EN: 127-138
    PubMedGoogle Scholar
  • 11 Kumar R, Madewell JE, Swischuk LE, Lindell MM, David R. The clavicle: normal and abnormal. Radiographics 1989; 9 (04) 677-706
    CrossrefPubMedGoogle Scholar
  • 12 Kocher MS, Waters PM, Micheli LJ. Upper extremity injuries in the paediatric athlete. Sports Med 2000; 30 (02) 117-135
    CrossrefPubMedGoogle Scholar
  • 13 Lomasney LM, Lim-Dunham JE, Cappello T, Annes J. Imaging of the pediatric athlete: use and overuse. Radiol Clin North Am 2013; 51 (02) 215-226
    CrossrefPubMedGoogle Scholar
  • 14 Sarwark JF, King EC, Luhmann SJ. Proximal humerus, scapula, and clavicle. In: Beaty JA, Kasser JR. , eds. Lockwood and Wilkin's Fractures in Children. 6th ed. Philadelphia, PA: Lippincott-Raven; 2006: 704-771
    Google Scholar
  • 15 Mariscalco MW, Saluan P. Upper extremity injuries in the adolescent athlete. Sports Med Arthrosc Rev 2011; 19 (01) 17-26
    CrossrefPubMedGoogle Scholar
  • 16 Davis KW. Imaging pediatric sports injuries: upper extremity. Radiol Clin North Am 2010; 48 (06) 1199-1211
    CrossrefPubMedGoogle Scholar
  • 17 Chauvin NA, Jaimes C, Laor T, Jaramillo D. Magnetic resonance imaging of the pediatric shoulder. Magn Reson Imaging Clin N Am 2012; 20 (02) 327-347 , xi xi
    CrossrefPubMedGoogle Scholar
  • 18 Pahlavan S, Baldwin KD, Pandya NK, Namdari S, Hosalkar H. Proximal humerus fractures in the pediatric population: a systematic review. J Child Orthop 2011; 5 (03) 187-194
    CrossrefPubMedGoogle Scholar
  • 19 DiPaola M, Marchetto P. Coracoid process fracture with acromioclavicular joint separation in an American football player: a case report and literature review. Am J Orthop 2009; 38 (01) 37-39 ; discussion 40
    PubMedGoogle Scholar
  • 20 Delgado J, Jaramillo D, Chauvin NA. Imaging the injured pediatric athlete: upper extremity. Radiographics 2016; 36 (06) 1672-1687
    CrossrefPubMedGoogle Scholar
  • 21 Carson Jr WG, Gasser SI. Little Leaguer's shoulder. A report of 23 cases. Am J Sports Med 1998; 26 (04) 575-580
    CrossrefPubMedGoogle Scholar
  • 22 Song JC, Lazarus ML, Song AP. MRI findings in Little Leaguer's shoulder. Skeletal Radiol 2006; 35 (02) 107-109
    CrossrefPubMedGoogle Scholar
  • 23 Iyer RS, Thapa MM, Khanna PC, Chew FS. Pediatric bone imaging: imaging elbow trauma in children—a review of acute and chronic injuries. AJR Am J Roentgenol 2012; 198 (05) 1053-1068
    CrossrefPubMedGoogle Scholar
  • 24 May MM, Bishop JY. Shoulder injuries in young athletes. Pediatr Radiol 2013; 43 (Suppl. 01) S135-S140
    PubMedGoogle Scholar
  • 25 Zember JS, Rosenberg ZS, Kwong S, Kothary SP, Bedoya MA. Normal skeletal maturation and imaging pitfalls in the pediatric shoulder. Radiographics 2015; 35 (04) 1108-1122
    CrossrefPubMedGoogle Scholar
  • 26 Roedl JB, Morrison WB, Ciccotti MG, Zoga AC. Acromial apophysiolysis: superior shoulder pain and acromial nonfusion in the young throwing athlete. Radiology 2015; 274 (01) 201-209
    CrossrefPubMedGoogle Scholar
  • 27 Park JG, Lee JK, Phelps CT. Os acromiale associated with rotator cuff impingement: MR imaging of the shoulder. Radiology 1994; 193 (01) 255-257
    CrossrefPubMedGoogle Scholar
  • 28 Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Joint Surg Am 1982; 64 (07) 1053-1058
    CrossrefPubMedGoogle Scholar
  • 29 Braithwaite KA, Marshall KW. The skeletally immature and newly mature throwing athlete. Radiol Clin North Am 2016; 54 (05) 841-855
    CrossrefPubMedGoogle Scholar
  • 30 Dwek JR, Chung CB. A systematic method for evaluation of pediatric sports injuries of the elbow. Pediatr Radiol 2013; 43 (Suppl. 01) S120-S128
    PubMedGoogle Scholar
  • 31 Major NM, Crawford ST. Elbow effusions in trauma in adults and children: is there an occult fracture?. AJR Am J Roentgenol 2002; 178 (02) 413-418
    CrossrefPubMedGoogle Scholar
  • 32 Kijowski R, Tuite MJ. Pediatric throwing injuries of the elbow. Semin Musculoskelet Radiol 2010; 14 (04) 419-429
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Greiwe RM, Saifi C, Ahmad CS. Pediatric sports elbow injuries. Clin Sports Med 2010; 29 (04) 677-703
    CrossrefPubMedGoogle Scholar
  • 34 Rudzki JR, Paletta Jr GA. Juvenile and adolescent elbow injuries in sports. Clin Sports Med 2004; 23 (04) 581-608 , ix
    CrossrefPubMedGoogle Scholar
  • 35 Gottschalk HP, Eisner E, Hosalkar HS. Medial epicondyle fractures in the pediatric population. J Am Acad Orthop Surg 2012; 20 (04) 223-232
    CrossrefPubMedGoogle Scholar
  • 36 Chen FS, Diaz VA, Loebenberg M, Rosen JE. Shoulder and elbow injuries in the skeletally immature athlete. J Am Acad Orthop Surg 2005; 13 (03) 172-185
    CrossrefPubMedGoogle Scholar
  • 37 Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br 1975; 57 (04) 430-436
    CrossrefPubMedGoogle Scholar
  • 38 Shanmugam C, Maffulli N. Sports injuries in children. Br Med Bull 2008; 86: 33-57
    CrossrefPubMedGoogle Scholar
  • 39 Rasool MN. Dislocations of the elbow in children. J Bone Joint Surg Br 2004; 86 (07) 1050-1058
    CrossrefPubMedGoogle Scholar
  • 40 Micheli LJ, Fehlandt Jr AF. Overuse injuries to tendons and apophyses in children and adolescents. Clin Sports Med 1992; 11 (04) 713-726
    PubMedGoogle Scholar
  • 41 Emery KH. Imaging of sports injuries of the upper extremity in children. Clin Sports Med 2006; 25 (03) 543-568 , viii
    CrossrefPubMedGoogle Scholar
  • 42 Crowther M. Elbow pain in pediatrics. Curr Rev Musculoskelet Med 2009; 2 (02) 83-87
    CrossrefPubMedGoogle Scholar
  • 43 Nazarian LN, McShane JM, Ciccotti MG, O'Kane PL, Harwood MI. Dynamic US of the anterior band of the ulnar collateral ligament of the elbow in asymptomatic major league baseball pitchers. Radiology 2003; 227 (01) 149-154
    CrossrefPubMedGoogle Scholar
  • 44 Bedoya MA, Jaramillo D, Chauvin NA. Overuse injuries in children. Top Magn Reson Imaging 2015; 24 (02) 67-81
    CrossrefPubMedGoogle Scholar
  • 45 Sugimoto H, Ohsawa T. Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries. Radiology 1994; 192 (02) 417-422
    CrossrefPubMedGoogle Scholar
  • 46 Kijowski R, De Smet AA. Radiography of the elbow for evaluation of patients with osteochondritis dissecans of the capitellum. Skeletal Radiol 2005; 34 (05) 266-271
    CrossrefPubMedGoogle Scholar
  • 47 Kramer J, Stiglbauer R, Engel A, Prayer L, Imhof H. MR contrast arthrography (MRA) in osteochondrosis dissecans. J Comput Assist Tomogr 1992; 16 (02) 254-260
    CrossrefPubMedGoogle Scholar
  • 48 Cain Jr EL, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med 2003; 31 (04) 621-635
    CrossrefPubMedGoogle Scholar
  • 49 Kobayashi K, Burton KJ, Rodner C, Smith B, Caputo AE. Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg 2004; 12 (04) 246-254
    CrossrefPubMedGoogle Scholar
  • 50 Maffulli N, Chan D, Aldridge MJ. Overuse injuries of the olecranon in young gymnasts. J Bone Joint Surg Br 1992; 74 (02) 305-308
    PubMedGoogle Scholar
  • 51 DiFiori JP, Caine DJ, Malina RM. Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast. Am J Sports Med 2006; 34 (05) 840-849
    CrossrefPubMedGoogle Scholar
  • 52 Pannu GS, Herman M. Distal radius-ulna fractures in children. Orthop Clin North Am 2015; 46 (02) 235-248
    CrossrefPubMedGoogle Scholar
  • 53 Gholson JJ, Bae DS, Zurakowski D, Waters PM. Scaphoid fractures in children and adolescents: contemporary injury patterns and factors influencing time to union. J Bone Joint Surg Am 2011; 93 (13) 1210-1219
    CrossrefPubMedGoogle Scholar
  • 54 De Smet L, Claessens A, Lefevre J, Beunen G. Gymnast wrist: an epidemiologic survey of ulnar variance and stress changes of the radial physis in elite female gymnasts. Am J Sports Med 1994; 22 (06) 846-850
    CrossrefPubMedGoogle Scholar
  • 55 Mandelbaum BR, Bartolozzi AR, Davis CA, Teurlings L, Bragonier B. Wrist pain syndrome in the gymnast. Pathogenetic, diagnostic, and therapeutic considerations. Am J Sports Med 1989; 17 (03) 305-317
    CrossrefPubMedGoogle Scholar
  • 56 Shih C, Chang CY, Penn IW. , et al. Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology 1995; 195: 855-859
    CrossrefPubMedGoogle Scholar
  • 57 Zetaruk MN. The young gymnast. Clin Sports Med 2000; 19 (04) 757-780
    CrossrefPubMedGoogle Scholar
  • 58 Liebling MS, Berdon WE, Ruzal-Shapiro C, Levin TL, Roye Jr D, Wilkinson R. Gymnast's wrist (pseudorickets growth plate abnormality) in adolescent athletes: findings on plain films and MR imaging. AJR Am J Roentgenol 1995; 164 (01) 157-159
    CrossrefPubMedGoogle Scholar
  • 59 Miele V, Piccolo CL, Galluzzo M, Ianniello S, Sessa B, Trinci M. Contrast-enhanced ultrasound (CEUS) in blunt abdominal trauma. Br J Radiol 2016; 89 (1061): 20150823
    CrossrefPubMedGoogle Scholar
  • 60 van der Eerden BC, Karperien M, Wit JM. Systemic and local regulation of the growth plate. Endocr Rev 2003; 24 (06) 782-801
    CrossrefPubMedGoogle Scholar
  • 61 Piccolo CL, Galluzzo M, Ianniello S. , et al. Pediatric musculoskeletal injuries: role of ultrasound and magnetic resonance imaging. Musculoskelet Surg 2017; 101 (Suppl. 01) 85-102
    CrossrefPubMedGoogle Scholar
  • 62 Kerssemakers SP, Fotiadou AN, de Jonge MC, Karantanas AH, Maas M. Sport injuries in the paediatric and adolescent patient: a growing problem. Pediatr Radiol 2009; 39 (05) 471-484
    PubMedGoogle Scholar
  • 63 Ianniello S, Merola MG, Trinci M, Galluzzo M, Miele V. Priorità diagnostiche nel management del Trauma Maggiore: ruolo dell'E-FAST e della TCMD. G Ital Radiol Med 2015; 2: 715-720
    PubMedGoogle Scholar
  • 64 Ouellette H, Kassarjian A, Tétreault P, Palmer W. Imaging of the overhead thowing athlete. Semin Musculoskelet Radiol 2005; 9 (04) 316-333
    Article in Thieme ConnectPubMedGoogle Scholar
  • 65 Miele V, Piccolo CL, Sessa B, Trinci M, Galluzzo M. Comparison between MRI and CEUS in the follow-up of patients with blunt abdominal trauma managed conservatively. Radiol Med (Torino) 2016; 121 (01) 27-37
    CrossrefPubMedGoogle Scholar