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Definition and Epidemiology

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Iliac apophysitis is an overuse related traction injury affecting the iliac crest apophysis. The iliac apophysis closes on an average round 17 years of age. It is most commonly seen in long-distance runners and skaters. It has been reported in hockey, lacrosse, and football players. The exact incidence in not known.

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Mechanism

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The mechanism of injury is the repetitive microtrauma because of overuse.

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Clinical Presentation

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The athlete presents with a history of gradual onset of pain over the iliac crest while running. In contrast, the athlete with an acute traumatic avulsion injury of the iliac crest or the anterior superior iliac spine will present with a sudden onset of severe pain. In athletes with iliac apophysitis, there is no history of direct impact trauma to the iliac crest. Pain is exaggerated by abduction of the hip against resistance. Tenderness is localized over the iliac crest.

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Diagnostic Imaging

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X-ray is not indicated and is normal, unless an avulsion is suspected.

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Treatment

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Treatment is symptomatic with local ice, pain medication if needed, and modification or rarely complete cessation of the offending activity in some athletes. Resolution of symptoms gradually occurs typically over a period of 4 to 6 weeks. Once pain-free and normal examination, the athlete can resume unrestricted sport participation.

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Definition and Epidemiology

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Osteitis pubis is characterized by symphysis pubis pain, and chronic stress related changes in the subchondral bone, reported most commonly in athletes participating in soccer, ice hockey, basketball, and running. The condition has also been reported in fencing, Australian rules football, and cricket.

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Mechanism

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Overuse related stress affecting the symphysis pubis is believed to be the cause for development of osteitis pubis. The exact mechanism is not known; however, it is believed that repetitive shearing forces accompanying side to side and up and down movement at the pubic symphysis predisposes to osteitis pubis. These types of movements can occur in sports requiring sudden change in direction, running, kicking, acceleration, or deceleration. Forceful contractions of hip adductors can also pull on the pubic symphysis.

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Clinical Presentation

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There is an insidious onset of pain over the symphysis pubis area or groin exaggerated by continued activity, and there is localized tenderness over the symphysis pubis. Athletes may also report pain in the thigh, hip, or perineum. Pain is aggravated by running, kicking, pivoting, sudden acceleration, and deceleration. Soccer players adapt to avoid certain kicks that cause the most pain. Pain can be reproduced or exacerbated on examination by having the athlete adduct the hip against manual resistance or passively abduct the hip. Osteomyelitis affecting the pubis symphysis must be considered in the differential diagnosis. Other causes of groin pain in young athletes ...

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