14 year old with left hip pain caused by soccer injury. Now has illiac crest apophyseal avulsion.
There is positive avulsion of the left iliac crest with associated injury and tear of the abdominal muscles. This includes injury of the left gluteus medius, left gluteus minimus, and left gluteus maximus muscle. The avulsion injury is also associated with left external oblique muscle and associated injury to the left transversus abdominus muscle tear. There is mild left-sided Iliopsoas bursitis and muscle sprain. There is stress fracture of the left iliac crest. There is muscle strain and sprain of the left iliacus muscle.
Apophyseal injuries in the pelvis have increased over the past few years in highly competitive athletic activities. In skeletally immature individuals who play soccer and baseball apophyseal injuries are most common. The iliac crest is the site of origin and insertion for the external and internal oblique muscles, transversus abdominis muscle, gluteus medius muscle, and the tensor fascia latte. In this patient there is avulsion of the left iliac crest and edema within the left external oblique, transverse abdominus muscle, gluteus maximus, gluteus medius, and gluteus minimus muscle. This injury was caused by an acute soccer injury. In addition there is a widening of the physis. These findings are consistent with apophysitis.
The recommended management is usually non steroidal anti-inflammatory drugs, limiting athletic activity, and strengthening abdominal muscles.
American Journal of Roentgenology 2008 190:6, 1487-1491