Clinical History
14 year old wrestler with hip pain.
Coronal inversion recovery, axial and sagittal t2 fat saturated images show increased bone marrow signal compatible with edema and stress fracture within the right ischium. There is increased widening and avulsion of the common hamstring tendon arising from the ischial tuberosity. This demonstrates a gap of approximately 8 mm.
Diagnosis
Ischial Apophysitis with Avulsion of the common Hamstring Tendon
The ishial apophyses starts to ossify between the ages of 14 and 16 years and fully fuses by age 18. Ischial apophysitis is caused by repetitive microtrauma to the ischial tuberosity and by contraction of the hamstring tendons. It is commonly seen in runners and dancers. Patient usually present with pain and swelling.
Management
Nondisplaced apophyseal avulsions of the pelvis are treated conservatively with nonsteroidal anti-inflammatory agents and by limiting activities for 4 to 6 weeks. Surgery is considered for patients with avulsion of the hamstring tendon from the initial tuberosity.
Reference
RadioGraphics 1999 19:3, 655-672
