Apophysitis of the Pelvis and Hip

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Important pelvis and hip muscle origins on plain radiograph of the pelvis (adult for reference).

Avulsion fractures can occur at any muscular or ligamentous site. Apophyseal avulsion fractures are common in the adolescent population. Enthesopathy/apophysitis and apophyseal avulsion fractures should be excluded before considering tendinopathy.

The classic sites of enthesopathy about the hip are:

• Iliopsoas insertion to the lesser trochanter of the femur
• Rectus femoris origin from the anterior inferior iliac spine
• Sartorius origin from the anterior superior iliac spine
• Rectus abdominis insertion at the superior aspect of the pubic symphysis.

Enthesopathies cause activity related pain, often with sudden turning movements. Iliopsoas tendon insertion enthesopathy is most common in those that kick a ball frequently.

Differential Diagnosis

Depending on the age of the child one should also consider Irritable hip (early childhood), Perthes (later childhood), and SUFE (overweight teenage boys). Septic arthritis should also be considered.

Resources

Clinical Practice Guidelines : Apophysitis of the Pelvis and Hip - Emergency Department (rch.org.au)