Nonarticular osteochondroses.

Nonarticular osteochondroses represent disordered enchondral ossification of epiphysis or apophysis at specific sites of muscle/tendon insertions or ligament attachments. Traditionally, osteochondroses have been identified by eponymic proper names. A generic classification is based upon the relationship of excessive or repetitive traction in occasional combination with direct pressure at discrete anatomical sites. The following are models of the several varieties: Osgood-Schlatter syndrome, typifying muscle/tendon stress on the tibial tuberosity; medial epicondylosis (Adams), resulting from forearm and elbow stress generated by muscles and creating traction through the ulnar collateral ligament attachment; and Sever's syndrome (calcaneal apophysis), associated with tension at either end of the calcaneal apophysis in combination with direct impact pressure. The general characteristics of this group include symptoms of pain or tenderness, timed appearance coincident with the developmental sequence of the apophysis, and generally symptomatic management.