Musculoskeletal injuries in adolescents

The approach to evaluating a musculoskeletal injury in an adolescent consists of several key elements: An awareness of the presence of an open growth plate, Confidence in your musculoskeletal examination, No hesitation to refer for orthopedic evaluation. Evaluating a bone injury if the growth plates are open can be challenging. One must remember that the growth plate is the weak link of the muscle-tendonbone unit, that a tender growth plate is an injured growth plate, and that radiographs of the contralateral side often are helpful to compare with the injured growth plate. Many musculoskeletal injuries can be evaluated and treated by the primary care physician. Failure to refer at the proper time, however, can be catastrophic. Each physician should be aware of his or her own level of knowledge with regard to musculoskeletal injuries and always practice within his or her comfort level, which is dependent on one's own training and experience. In addition to injuries that obviously require orthopedic intervention, referral should be strongly considered if the primary care physician is unsure of the diagnosis, if recovery does not progress as expected, or if surgical intervention is a treatment option that will hasten recovery.