Pelvic Apophyseal Injuries

Case 14: A 15-year-old hurdler injured his right hip when jumping over a hurdle during a track event. He felt a pop and had immediate pain and could not bear weight. He has tenderness over his anterior superior iliac spine and limited range of motion of his hip.

Common pelvic apophyseal injuries occurring during adolescence are listed in Table 2. These injuries are unique to growing adolescents because the growth plate is weaker than the surrounding muscle tendon unit making it more prone to injury. Acute apophyseal avulsion injuries commonly occur during sprinting, hurdling, or jumping after a sudden forceful muscular contraction. Radiographs (AP pelvis) reveal an apophyseal avulsion (Fig. 12). Pain at the apophysis occurs with activity and at rest with restricted range of motion and muscle weakness. Chronic apophyseal injuries can occur with running, skating, soccer, or other endurance sports yet radiographs do not always reveal abnormalities. Chronic traction apophy-seal injuries may present with tenderness at the apophysis along with some limitation of motion or weakness. Most apophyseal injuries heal with conservative treatment although large displaced avulsion fragments, especially of the ischial tuberosity, may require surgical fixation. Conservative treatment, over 4 to 16 weeks, consists of rest and protection of the area to limit muscle spasm with acute injuries, ice, and NSAIDs. Progressive resistance exercises begin once full range of motion is achieved. Daily therapy focuses on hip, back and lower extremity flexibility along with a structured core body strengthening program. Noncontact proprioceptive and pliometric drills specific to the athlete's sport complement the strengthening program. Practice and competition may begin when the athlete is pain free and has full motion and strength of the affected area.

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