Peds

Hip Apophysitis

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Hip Apophysitis, Iliac Crest Apophysitis, Anterior Superior Iliac Spine Apophysitis, Anterior Inferior Iliac Spine Apophysitis, Ischial Tuberosity Apophysitis, Greater Trochanter Apophysitis

  • Mechanism
  1. Chronic overuse injuries
    1. Common in Running, kicking or dance
  2. Acute avulsion Fracture or blunt Trauma
  • Images
  1. Apophysitis Sites
    1. OrthoPedsApophysitisOsteochondrosis.jpg
  • Signs
  • Distribution (Seven Hip Apophysitis sites)
  1. Ilium
    1. Iliac Crest
      1. Transverse abdominis insertion
      2. External oblique insertion
      3. Internal oblique tendon insertion
    2. Anterior Superior Iliac Spine
      1. See Anterior Superior Iliac Spine Avulsion Fracture
      2. Sartorius tendon insertion
    3. Anterior Inferior Iliac Spine
      1. See Anterior Inferior Iliac Spine Avulsion Fracture
      2. Rectus Femoris tendon insertion
  2. Ischium
    1. Ischial Tuberosity
      1. Hamstring tendon insertion
  3. Pubis
    1. Pubic Symphysis
      1. See Pubic Apophysitis
  4. Femur
    1. Greater Trochanter
      1. Gluteus medius tendon insertion
      2. Gluteus minimus tendon insertion
      3. Piriformis tendon insertion
    2. Lesser Trochanter
      1. Psoas major tendon insertion
      2. Iliacus tendon insertion
  • Imaging
  1. Point-of-care Ultrasound
    1. Widened or fragmented apophysis (compare to opposite side)
  • Management
  1. See Apophysitis
  2. Relative rest
  3. Stretching of hip flexors, quadriceps, hamstrings
  4. Gradual return to play over weeks to months