Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Iliac Apophysitis

From WikiSM
(Redirected from Iliac Crest Apophysitis)

Other Names

  • Anterior Inferior Iliac Spine Apophysitis
  • Anterior Superior Iliac Spine Apophysitis
  • ASIS Apophysitis
  • Iliac Crest Apophysitis
  • Iliac Apophysitis
  • Ilium Apophysitis

Background

Load video
YouTube
Iliac Apophysitis Review Pod

History

  • First cased published by Clancy in 1976[1]

Epidemiology

  • Very poorly described in the literature
  • Seen in athletes ages 12 to 18 (need citation)
  • Gudelis et al study among youth soccer players[2]
    • Mean age 12, +/- 2 years
    • 5.3% of patients had bilateral apophysitis, 48.1% only right, 46.6% only left
    • Most common location: AIIS (43%)
    • Least common location: lesser trochanter (4.1%)
    • 93.3% were primary injuries, 6.7% were reinjuries

Introduction

Illustration of AIIS and ASIS apophysitis[3]
Location of apophyseal injuries of the pelvis, including both apophysitis and apophyseal avulsion fractures[4]

General

  • Apophysitis is characterized by inflammation of the apophysis in skeletally immature athletes
  • It can occur at the iliac crest, anterior superior iliac spine and anterior inferior iliac spine
  • Treatment is conservative, requiring relative rest, rehabilitation and a structured return to play
  • See Also: Apophyseal And Epiphyseal Injuries Main

Etiology of Apophysitis

  • Thought to be multifactorial including[5]
    • Rapid growth
    • Genetics
    • Anatomic properties
    • Accumulation of microscopic avulsions
  • Physeal plate is 2-5x weaker than surroudning fibrous structures (ligaments, tendons, joint capsule, etc)[6]
    • This makes them vulnerable to injury

Diagnosis of Apophysitis

  • History: must characterize mechanism if present, considerations of differential diagnoses
  • Physical examination: consider tendon attachment sites associated with pain, swelling, and/or tenderness
  • Imaging modalities: includes radiographs, ultrasound, MRI

Anatomy of Apophyses

  • They are secondary growth centers which serve as attachment sites for tendons

Iliac Crest Apophysitis

  • The iliac crest apophysis appears around 13 years old
  • Starts to fuse around 14 years old in girls (15 and 16 years old, respectively, in boys)
  • Ossification begins anterolaterally, progresses posteromedially
  • More common in sports such as rugby, hockey, tennis, dance, running sports

ASIS Apophysitis

  • Appears around ages 13 to 15
  • Fuses around ages 21 to 25
  • Occurs due to sudden contraction of sartorius or tensor fasciae latea, especially during kicking or sprinting

AIIS Apophysitis

  • Appears around ages 13 to 15
  • Fuses around ages 16 to 18
  • Occurs due to sudden contraction of the rectus femoris when kicking
  • Can mimic hip flexor sprain

Risk Factors

  • Tight muscles
  • Poor flexibility

Differential Diagnosis

Differential Diagnosis Hip Pain

Differential Diagnosis Groin Pain

Clinical Features

History

  • Patients typically have an insidious onset of hip or groin pain
  • Pain is worse with activities such as running, jumping, kicking, twisting, shooting a ball
  • Initially pain only with activity may progress to pain on rest
  • Mostly present during training (43%), competition (21%), warm up (2.5%)[2]

Physical Exam

  • The area of apophysitis is tender to touch (iliac crest, ASIS, AIIS)
  • Swelling and warmth may be present
  • Iliac crest: attachment of abdominal muscles, situps and crunches should provoke pain
  • ASIS: attachment of sartorius, hip flexion and external rotation should provoke pain
  • AIIS: attachment of rectus femoris, hip flexion, possibly knee extension should provoke pain

Special Tests

  • Needs to be updated

Evaluation

Sites of apophysitis of the pelvis and proximal femur. (1) inferior pubic ramus, (2) anterior inferior iliac spine, (3) anterior superior iliac spine, (4) pubic symphysis, (5) iliac crest, (6) greater trochanter, (7) lesser trochanter[7]

Radiographs

CT

  • May miss diagnosis of apophysitis
  • ROle is not clearly defined

MRI

  • Most sensitivity test for apophysitis
  • Findings are variable, including[8]
    • Low signal intensity on T1-weighted sequences
    • Increased signal intensity in fluid-sequences
    • bone marrow edema
    • Mild enlargement of the physis

Ultrasound

  • Findings
    • Widened or fragmented apophysis
  • Can easily compare to contralateral limb
  • Evaluate for muscle/ tendon injuries

Classification

  • Not applicable

Management

Nonoperative

  • Indications
    • First line in all patients
  • Relative rest
    • Must discontinue activities/ sports
  • Ice
  • NSAIDS
  • Topical agents
  • Physical Therapy

Operative

  • Indications unknown

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Gudelis et al[2]
    • Return to training ranged from 13-17 days
    • Return to competition: 15-22 days

Prognosis and Complications

Prognosis

  • Most athletes have an exccelent prognosis and return to play
  • There is not a lot of evidence regarding outcomes

Complications

See Also

Internal

External

References

  1. ↑ Clancy JR, William G., and Alexander S. Foltz. "Iliac apophysitis and stress fractures in adolescent: runners." The American Journal of Sports Medicine 4.5 (1976): 214-218.
  2. ↑ 2.0 2.1 2.2 Gudelis, Mindaugas, et al. "Apophysitis among male youth soccer players at an elite soccer academy over 7 seasons." Orthopaedic journal of sports medicine 10.1 (2022): 23259671211065063.
  3. ↑ Image courtesy of sportsinjuryclinic.net
  4. ↑ Urban, Szymon, et al. "Avulsion fractures of the pelvis in the pediatric population. A review of the literature and case report." Chirurgia Narządów Ruchu i Ortopedia Polska 87.3 (2022): 105-108.
  5. ↑ Micheli, Lyle J., and Allan F. Fehlandt Jr. "Overuse injuries to tendons and apophyses in children and adolescents." Clinics in sports medicine 11.4 (1992): 713-726.
  6. ↑ Auringer, Sam T., and Evelyn Y. Anthony. "Common pediatric sports injuries." Seminars in Musculoskeletal Radiology. Vol. 3. No. 03. © 1999 by Thieme Medical Publishers, Inc., 1999.
  7. ↑ Khemka, Aditya, et al. "Arthroscopically assisted fixation of the lesser trochanter fracture: a case series." Journal of hip preservation surgery 1.1 (2014): 27-32.
  8. ↑ Arnaiz, Javier, et al. "Imaging findings of lower limb apophysitis." American journal of roentgenology 196.3 (2011): W316-W325.
Created by:
John Kiel on 28 September 2020 00:26:19
Authors:
Last edited:
13 July 2025 12:39:46
Retrieved from "https://wikism.org/w/index.php?title=Iliac_Apophysitis&oldid=35565"