Pelvic apophyseal injuries in young athletes

Injuries at the pelvic area in young athletes due to training can be Apophyseal or Apophysitis. Apophyseal injuries occur in skeletally immature athletes, as an acute injury, primarily between the ages of 13 and 25. Apophysitis is a chronic injury due to traction at the tendon insertion area. As a result we have a gradual onset of pain with no clear history of injury. Examination reveals tenderness to palpation at the musculotendinous insertion into the bone.

Apophyseal avulsion fractures are usually acute, and the displaced fragment may be bony or cartilaginous. The mechanism of injury is from a violent muscle contraction that occurs across an open apophysis. Sudden onset of pain, swelling, and weakness are usual the symptoms of an apophyseal avulsion fracture. Generally, there is no history of direct trauma. Radiographs is always necessary to confirm the diagnosis. Treatment of all of the apophyseal is usually non operative.

Ice should be used at the beginning and rest. Then stretching, strengthening, and proprioception. Most of these injuries are managed conservatively, and indications for surgical fixation are exceedingly rare only in significant displaced avulsions. Premature return to sport may result in re-injury.

Anterior superior iliac spine avulsion (ASIS) occurs during sudden contraction of the sartorius when the hip is extended with the knee flexed. On clinical examination, localized tenderness and/or swelling is present and flexion and abduction of the thigh provokes the symptoms. On x-rays displacement of the ASIS is noted. Marked displacement is rare.

Anterior inferior iliac spine avulsion (AIIS) can result after contraction of the rectus femoris with kicking. Examination reveals local tenderness and swelling in the region of the AIIS and exacerbation with active flexion. On x-rays demonstrate displacement of the AIIS.

Ischial tuberosity apophyseal injuries. The ischial apophysis is the site of the hamstring and adductor magnus origin, and it is the last apophysis to unite (at approximately age 25). The mechanism of injury is a vigorous hamstring contraction with the hip flexed and the knee extended. In runners, this injury occurs most often in hurdlers. The athlete complains of pain at the ischial tuberosity and difficulty sitting. Gait may be antalgic. On examination, hip flexion with the knee extended will cause symptoms; thus, the presentation and examination are similar to a hamstring injury in an adult.

Radiographs may demonstrate a displaced fragment of the ischial tuberosity. When the displasement of the avulsed fragment is greater than 2cm may require surgical fixation. Complications are more frequent than other apophyseal injuries (ASIS and AIIS). In addition, time to full rehabilitation is often longer than that of other apophyseal avulsion injuries.

Iliac crest apophysis avulsion occurs with the sudden contraction of the abdominal muscles that is opposed by simultaneous contraction of the gluteus medius and tensor fascia latae. This may result from excessive arm swing and trunk rotation while running and may occur also with a sudden change in direction. On examination, resisted abduction produces pain of the ipsilateral side and palpation of the iliac crest is painfull. Oblique x-rays will reveal an avulsion of the iliac crest.

Lesser trochanter apophysis avulsion occurs with a sudden contraction of the iliopsoas muscle. The athlete experiences a sudden pain of anteromedial hip while running. On examination, passive internal and external rotation and active hip flexion reproduces the symptoms. Gait is antalgic. Radiographs demonstrate an avulsion of the lesser trochanter.

Recent Announcements

Monday, 20 Feb 2017

5th Congress of ECOSEP & 2nd UAE FA Football Medicine Update 25th-27th November 2017 Dubai

read more

Monday, 05 Sep 2016

5th ANNUAL PODIATRIC SPORTS MEDICINE CONFERENCE In association with EUROPEAN COLLEGE OF SPORTS & EXERCISE PHYSICIANS INSPIRING CLINICAL EXCELLENCE – THINKING BEYOND BIOMECHANICS

read more

Recent Articles

Platelet Rich Plasma (PRP)

An innovative treatment, for  Musculoskeletal Pathologies , PRP uses your own blood for healing muscle, tendon and ligament injuries. 

A common form of healing is scarring which affects function . Most of the Current therapies  treating sports Injuries  do not change the intrinsically poor healing properties. Given this situation, biologically based strategies involving the stimulation of cell activities through the delivery of Growth Factors have attracted considerable interest. 

Platelet Rich Plasma is derived by placing a small amount of your blood in a filtration system which separates red blood cells from platelets. The high concentration of platelets (containing a high level of Growth Factor) is then injected into the injured tissue which initiates the body’s natural healing response.

read more

Extra Shockwave Therapy & Treatment

At European SportsCare, Extracorporeal Shockwave Therapy (ECSWT) is available for the treatment of musculoskeletal softtissue pathology such as Tendon, Ligament, Muscle and bone. Shockwave Therapy is a non-invasive treatment provided by fully trained Consultants providing this treatment for more than 15 years. It is available as an out-patient treatment in one of our comfortable consultation rooms at 68 Harley Street.

read more

Acute Lateral Ankle Sprains In Track & Field Athletes: A Proposal Of An Expanded Classification

We present a longitudinal observational study on classification of acute lateral ankle ligament injuries in track & field athletes, based on objective criteria. These very common and sometimes troublesome sports injuries are treated functionally but there is a lack in international literature in predicting the time needed for full recovery.

read more

Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes

Objective: To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively.

Design: We reviewed high level athletes with an anterior cruciate ligament rupture on either MRI or arthroscopic evaluation more than 10 years previously, who were treated conservatively. They were pair-matched with patients who had had an anterior cruciate ligament reconstruction with bone-patella-tendon-bone, with respect to age, gender and Tegner activity score before injury.Participants: In total 50 patients were pair-matched.

Results: We found no statistical difference between the patients treated conservatively or operatively with respect to osteoarthritis or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.

Conclusion: We conclude that the instability repair using

a bone-patella-tendon-bone anterior cruciate ligament reconstruction is a good knee stabilising operation. Both treatment options however show similar patient outcome at 10 year follow up.

read more

ACL injuries. Diagnosis, treatment and rehabilitation

The ability to recognize the ACL deficient knee is lacking, even among orthopaedic surgeons. The history of an acute ACL tear is remarkably constant, because the injury is often non contact, and patients usually report a twist on the flexed knee, turning to the same side as the injured knee, although hyperextension or direct injury is the cause in some sports. Patients often remember a loud pop, but, because there are no nociceptors in the ACL, pain is not an immediate feature in the isolated lesion. Players may attempt to continue to play, but they usually stop because the knee feels insecure. Pain ensues in association with a hemarthrosis: 70% of acute hemarthroses of the knee are associated with a tear of the ACL. The diagnosis must be confirmed before treatment is offered.

read more