Purpose or Case Report: Recombinant human growth hormone (rhGH) accelerates linear growth but may predispose to physeal stress and injury through accelerated chondrocyte hypertrophy and transient physeal widening. A multitude of musculoskeletal complications include slipped capital femoral epiphysis (SCFE), tibial tubercle avulsion, Osgood–Schlatter disease, Little League shoulder, osteochondritis dissecans, scoliosis, and Sever’s disease. However, sequential multi-physeal injuries in a single patient receiving rhGH are exceedingly rare and not well documented.

We present a 14-year-old male, a baseball player, receiving GH therapy for Idiopathic Short Stature who develops multiple, temporally distinct physeal injuries during two years of active therapy (April 2023 to July 2025).
April 2023: Patient starts GH therapy
July 2023: Left shoulder injury: Radiograph shows widening of the proximal humeral physis consistent with Little League shoulder (Salter–Harris I).
August 2023: Left proximal thigh pain: Radiograph of pelvis demonstrates left inferior pubic ramus fracture and right anterior inferior iliac spine (AIIS) avulsion fracture.
Nov 2023: Left elbow pain with pitching: Radiographs of the elbow consistent with healing lateral epicondyle fracture, with confirmation of capitellar osteochondral lesion on MRI.
April 2024: Right knee injury with x-ray findings consistent with Osgood-Schlatter’s disease.
July 2025: 1.5 months of left hip pain: Pelvic radiograph demonstrates healing of right ischial tuberosity avulsion fracture and right lesser trochanter avulsion fracture.
Notably, the patient has a history of medial epicondyle avulsion fracture (2020) and left AIIS avulsion fracture (March 2023), suggesting pre-existing physeal susceptibility or higher physical exhaustion prior to GH initiation.

This case underscores the importance of potential additive effects of rapid growth (with GH therapy) and repetitive stress. Radiologists should maintain high suspicion for additional or contralateral physeal injuries in GH-treated adolescents, especially those engaged in high-impact sports, and communicate these risks to referring clinicians for coordinated management.
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