Growth Plate Pain - Causes, Types, Symptoms, Diagnosis, and Treatment

What Is a Growth Plate?

A cartilage structure found at the end of long bones, which is responsible for bone growth, is referred to as a growth plate or epiphyseal plate. They are the most delicate and vulnerable parts of the skeletal structure, and in certain cases, they may even be weaker than neighboring ligaments and tendons.

What Is the Function of Growth Plates?

The growth plate is responsible for two main functions:

• Lengthening the bone: The growth plate determines the length of the bone by adding new layers of cartilage to the end of the bone. The cartilage gradually hardens and turns into bone, increasing the length of the bone.

• Shaping the bone: The growth plate also helps shape the bone as it grows. The cartilage in the growth plate is organized in a specific pattern that guides the growth and shaping of the bone.

What Is Growth Plate Pain?

Growth plate pain is a type of pain that occurs in the growth plate (a region of developing tissue located near the ends of long bones). The growth plate is responsible for the bone's lengthening during growth and development. Growth plate pain is most common in children and adolescents who are still growing and developing. It is often caused by repetitive stress or overuse, such as during sports or other physical activities that strain the bones and joints. Growth plate pain can also be caused by injury or trauma to the affected area.

What Are the Causes of Growth Plate Pain?

The causes of growth plate pain can vary, but the most common cause is overuse or repetitive stress on the growth plate. Other possible causes include the following:

• Activities such as running, jumping, and participating in sports that have a lot of impact on the legs can put stress on the growth plates.

• Trauma or injury to the bone, such as a fracture or an infection.

• Certain medical conditions, such as juvenile idiopathic arthritis, affect the growth plates and cause pain and inflammation.

What Are the Types of Growth Plate Injuries?

Long bones consist of four main regions - epiphysis, physis, metaphysis, and diaphysis.

The epiphysis is found at the end of the bone adjacent to the joint, and the physis (growth plate), is responsible for bone growth. The metaphysis is located between the growth plate and the shaft, and the diaphysis refers to the long bone's shaft.

Salter-Harris classification of growth plate injury

• Type I: It occurs when the fracture affects the physis but does not involve the area of bone around the growth plate.

• Type II: This most common type of growth plate fracture occurs when the fracture runs through the physis and the metaphysis.

• Type III: This occurs when fractures affect the epiphysis. This causes the separation of metaphysis from the epiphysis and physis.

• Type IV: This happens when fractures run through the physis, metaphysis, and epiphysis.

• Type V: It is a rare type of compression fracture through the physis that occurs when the bone's end is crushed and compresses the physis.

What Are the Symptoms of Growth Plate Injury?

Depending on the extent and site of the injury, the signs and symptoms of growth plate discomfort can differ. Common symptoms include:

• Persistent Pain in the Affected Area: The pain may be mild to moderate and can be felt as a sharp pain or dull ache.

• Swelling and Tenderness Around the Growth Plate: The area around the growth plate may feel swollen and tender to the touch.

• Stiffness and Limited Range of Motion: The affected joint may feel stiff or have limited mobility.

• Warmth and Redness: The skin around the growth plate may feel warm to the touch and appear reddened.

• Difficulty Bearing Weight on the Affected Limb: If the growth plate pain is in a weight-bearing joint, such as the knee or ankle, it may be difficult to walk or bear weight on the affected limb.

How Can Growth Plate Pain Be Diagnosed?

The diagnosis of growth plate pain involves a combination of a detailed patient's medical history, physical examination, and imaging tests.

• Medical History: The doctor will inquire about any previous injuries or medical conditions that could be contributing to the pain. They may also ask about the patient's physical activity level, as overuse or repetitive stress injuries commonly cause growth plate pain.

• Physical Examination: The doctor will perform a physical examination of the affected area to assess the location and severity of the pain. They may also check for swelling, tenderness, and range of motion. During the physical examination, the doctor may ask the patient about their symptoms and the circumstances that led to the pain.

• Imaging Tests: Imaging tests, such as X-rays or an MRI (magnetic resonance imaging), can help evaluate the extent of the injury and determine the underlying cause of the pain.

  1. X-rays can show the bone's structure and any visible fractures or deformities.

  2. An MRI can provide more detailed images of the soft tissues surrounding the bone, such as tendons, ligaments, and cartilage.

Sometimes, a doctor may also recommend blood tests to check for underlying medical conditions, such as infection or autoimmune disorders, that could contribute to the growth plate pain.

What Is the Treatment for Growth Plate Pain?

The purpose of treatment is to reduce pain and prevent further injury to the growth plate. Some common treatment methods for growth plate pain include:

• Rest: Rest is an important part of treatment for growth plate pain. Based on the location of the growth plate pain, a cast or brace may be necessary. The affected limb should be immobilized to allow the growth plate to heal properly.

• Application of Ice: Ice application to the affected area can help reduce swelling and pain. Ice should be applied for around 30 minutes several times a day.

• Medications: Pain relievers, such as Acetaminophen or Ibuprofen, can help relieve pain and reduce inflammation.

• Physical Therapy: Physical therapy can help restore the affected joint's range of motion, strength, and flexibility. It includes exercises, stretching, and massage.

• Surgery: Surgery may be necessary to treat growth plate pain in severe fractures or deformities. The surgical options include:

  1. Fracture Repair: If a fracture causes growth plate pain and discomfort, surgery may be necessary to realign and stabilize the broken bone. Screws, plates, or rods hold the bone in place while it heals.

  2. Epiphysiodesis: This surgical procedure involves stopping the growth of a bone by removing part of the growth plate. This may be necessary in cases where one limb is growing longer than the other or where there is an abnormality in the shape of the bone.

Conclusion:

The growth plate plays a vital role in determining the ultimate size and length of the bone in the future. Follow the doctor's treatment instructions if a growth plate injury occurs. Allow sufficient time for the growth plate to heal before returning to physical activity. In some cases, returning to physical activity too soon can cause the injury to worsen or lead to long-term complications. With proper care and treatment, most cases of growth plate pain can be effectively cured.