Iliac crest apophysitis

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Case
A 17-year-old female player presented with a 12-month history of localised left hip pain. This has become much worse over the three months leading up to her visit. This appeared to have coincided with a period where she was training more regularly. The pain was predictably made worse by running, and other physical activity, and improved by rest. The pain was very well localised to the anterior superior iliac spine (ASIS) region and anterior aspect of the iliac crest and was associated with localised tenderness in this region. There was modest discomfort with resisted hip flexion but an otherwise normal examination.

Findings
There appears to be subtle widening of the apophysis of the left iliac crest on an AP x-ray of the pelvis. The x-ray series is otherwise normal. There is bone oedema within the anterior superior aspect of the left iliac bone over a length of approximately 40 mm AP. This involves the width of the iliac blade at the crest. The growth plate appears wide with T2 increased signal consistent with an apophyseal avulsion injury. No other significant bone abnormality identified.

Discussion
There are seven apophyses located about the hip and pelvis. All of these have been reported as sites of both acute traumatic avulsion and apophysitis. Injuries to the iliac crest apophysis are relatively uncommon. These injuries are generally due to overuse, rather than caused by an acute trauma. The iliac apophysis develops anteriorly and then ossifies from anterior to posterior as a patient progresses towards skeletal maturity. This apophysis is one of the last to close in the body, with the average chronologic age of completion being 16 years in boys and 14 years in girls. As this case illustrates, ossification can be more delayed, occurring as late as 20 years in boys and 18 years in girls.

As with ‘apophysitis’ at other sites this generally resolves spontaneously. Treatments that have been reported in the literature include physical therapy, activity modification, anti -inflammatory medication and the use of compressive garments. The use of bone stimulators and pulsed ultrasound have also been described. The critical treatment however is patient education and controlled loading. It is essential the player, their parents and coaches understand that there is a clear relationship to training volume and that there is a need to make sure that this is managed appropriately. The player should also be reassured that this is generally a self-limiting problem that will resolve at skeletal maturity.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Kazeem
18 December 2020 6:50

Great.

dr marina
24 December 2020 22:42

can magnetic therapy help in this case?

Dr jo
28 December 2020 16:11

Interesting Article.

Bangoura
Bangoura
30 December 2020 14:38

ANATOMIQUEMENT LES SACROS ILLIAQUES SONT LES 02 ARTICULATIONS SITUEES ENTRE L OS DU BASSIN ET LE SACRUM. UNE ATTEINTE DE CETTE ARTICULATION PEUT PROVOQUER DES DOULEURS ATROCES SUR TOUTE LA SPHERE DU BASSIN ET DE LA CUISSE. LES LESIONS DE L APOPHYSE DE LA CRETE ILLIAQUE SONT RARES.ELLES SONT GENERALEMENT DUES A UNE SURUTILISATION PLUTOT QU A UN TRAUMATISME AIGUI. L AGE MOYEN DE LA FERMETURE DE L APOPHYSE EST DE 16ANS CHEZ LE GARCON 14 ANS CHEZ LA FILLES. CEPENDANT L OSSIFICATION EST PLUS RETARDEE 20 ANS CHEZ LE GARCON ET18 ANS CHEZ LA FILLE.. LA RADIOGRAHIE NUMERISEE EST… Read more »

Hussein Ali kahdim alzuabidi
02 January 2021 15:53

Cryotherapy could be effective

Satwika
08 January 2021 15:30

of course but not if the pain is very long standing

Seyed MohammadJavad AshrafMansouri
04 January 2021 6:47

thank so much

Earnest Paul
06 January 2021 6:30

when treating an adolescent athlete with chronic unilateral low back pain, always have in mind that there could also be apophysitis of PSIS. It’s uncommon but if pain is unresolving unilateral LBA and tenderness over PSIS check for apophysitis of PSIS. Seen 2 such cases in my practice.

Satwika
08 January 2021 15:29

thanks for sharing. please post more cases.

Seyed MohammadJavad AshrafMansouri
09 January 2021 7:08

Excllent,thanks for sharing

Juvencio
18 January 2021 4:26

Interesting case.thank you for sharing