Orthopaedics 11-18 Years: Adolescence
Scoliosis, Scheuermann kyphosis, Osgood-Schlatter and SCFE: what to watch during adolescent growth and which signs require urgent assessment.
Growth Changes the Clinical Picture
During puberty, growth can change symptoms and the behaviour of some musculoskeletal conditions. Age alone is not enough: growth remaining, pain pattern, function and examination determine whether observation, imaging or treatment is appropriate.
Conditions Worth Recognising
Adolescent Idiopathic Scoliosis
A three-dimensional spinal deformity that often becomes apparent during the pubertal growth spurt. Most mild curves do not need surgery, but remaining growth is important when deciding follow-up and treatment.
Signs to watch:
- Uneven shoulders or waist
- Rib or lumbar prominence when bending forward
- Trunk shift or clothes hanging asymmetrically
What to do:
A visible or persistent asymmetry deserves clinical assessment. Home observation can raise suspicion but does not diagnose or measure scoliosis.
Scheuermann Kyphosis
A structural kyphosis associated with vertebral wedging during growth. It is different from simply sitting or standing with a rounded posture.
Signs to watch:
- A relatively rigid rounded upper back
- Back pain in some adolescents
- Prominence that does not fully correct with active extension
What to do:
Persistent or rigid deformity, pain or progression during growth deserves assessment; imaging is decided after the clinical examination.
Osgood-Schlatter Disease
Traction apophysitis at the tibial tubercle, common during growth in active adolescents. Symptoms are usually load-related and treatment is guided by pain and function rather than by the prominence itself.
Signs to watch:
- Pain and tenderness at the tibial tubercle
- Symptoms with running, jumping, stairs or kneeling
- A prominence may remain even after symptoms settle
What to do:
Adjust painful load rather than automatically stopping all activity. Assessment is useful if pain is atypical, severe, persistent or substantially limits sport.
Slipped Capital Femoral Epiphysis (SCFE)
URGENTA disorder of the proximal femoral growth plate that requires urgent orthopaedic treatment. Hip disease can present mainly as thigh or knee pain, so the painful site may be misleading.
Signs to watch:
- Hip, groin, thigh or knee pain with a limp
- Outward foot progression or reduced hip internal rotation
- Sudden inability to bear weight can occur in an unstable slip
What to do:
If SCFE is suspected, stop weight-bearing and arrange urgent orthopaedic/emergency assessment. Do not repeatedly test walking or force hip motion.
Sport During Adolescence
Sport remains strongly beneficial during adolescence. Overuse problems arise from the interaction between training load, recovery, previous injury, technique and the athlete's current capacity; a growth spurt is one factor, not a reason to stop sport. Persistent focal pain, limping or progressive loss of performance deserves assessment.
Read about sports injuries