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will reduce the risk of recurrence. Displacement of an avulsion fragment may
require surgical repair to restore full elbow function.

Sever Disease
Sever disease is a calcaneal apophysitis occurring at the insertion of the Achilles
tendon at the posterior aspect of the calcaneus. It afflicts predominantly runners,
jumpers, and soccer players. Sever disease is often bilateral, is more common in
males, and has its peak incidence between 10 and 12 years of age.
Onset of pain is gradual and associated with activity. Localized tenderness
occurs at the insertion of the Achilles tendon on the calcaneus. Pain is often
elicited with pressure to the medial and lateral sides of the heel known as the
squeeze test. A maneuver such as hanging the heels over the edge of a step,
climbing steps, or hopping applies tension to the Achilles tendon and exacerbates
the pain. Patients are often found to have a tight gastrocnemius–soleus muscle
complex and limited dorsiflexion of the foot. Radiographs of the site are usually
normal and are unhelpful, except to exclude bony injuries such as stress fractures.
Management includes rest, ice, and anti-inflammatory medications. Heel
padding or lifts may be helpful in relieving tension in the area. Flexibility
exercises should concentrate on both the hamstrings and the calf muscles. When
therapy is initiated early in the disease, most patients are able to return to normal
activity by 2 months. Recurrence of symptoms is common. As in most cases of
apophysitis, symptoms generally resolve with the closure of the apophysis at
skeletal maturity.

Bursitis
Bursae are membranous sacs that serve as both the shock absorbers and the ball
bearings of the musculoskeletal system. They disperse forces from blows on bony
prominences and reduce friction where tendons or ligaments are in frequent
motion.
Trauma, either in a single blow or by repetitive forces, can inflame the bursa,
which responds with increased production of synovial fluid. The bursa sac

subsequently swells and a cycle of swelling, irritation, and inflammation ensues.
Bursitis is most commonly an overuse syndrome seen in adults and adolescents,
and is less common in young children.
Injury or cellulitis of the skin overlying a bursa sac can predispose to infection.
Septic bursitis frequently presents with fever, swelling, tenderness, and warmth.
Aspiration and culture are necessary for definitive diagnosis. The organisms
found in septic bursitis are the same as those in septic arthritis, with S. aureus
accounting for more than 90% of cases and Group A Streptococcus identified as