3 for the price of 1
Not unexpected to find stress reaction at the hamstring origin, but satisfaction of search nearly missed a stress reaction at the rectus femoris origin, and then again at the iliopsoas origin.
In my experience, stress at the SIAI is most common, followed by the tuber os ischii, but I do not see so often stress at the minor trochanter, but maybe I overlook them?
Q1: Is there maybe a natural development and logical order of appearance of these locations, or is it only related to the kind of stress the player experiences (incidental order of appearance)? I would love to see a case with 4 or 5 such stress reactions, but where should I suspect the next around the hip? At the SIAS? Major trochanter?
Q2: I guess this is physeal stress, although the physis/apophysis is not always easy to discern. Do you call it stress reaction, apohysiolysis, avulsion, or something else?
Q2: I guess this is physeal stress, although the physis/apophysis is not always easy to discern. Do you call it stress reaction, apohysiolysis, avulsion, or something else?
Q3: Are there any recommendations on imaging follow up of such lesions? Or just follow clinically?
Case by Dr. Roar Pedersen
Very over-achieving of you....3 in 1! I think the term "apophysitis" is used most commonly....though there is no "itis" about it. Apophysioloysis is the most correct term, but it's a mouthful. No matter what you call it, rest will heal and there should be no need for f/u imaging. Don't you agree?
ReplyDeleteI agree! The point about f/u imaging can be challenging as these performers and their parents/coaches/physicians may be eager to find out if it is safe to return to play. Sometimes it is really hard to see the apophysis, and I try to get away from it by saying "avulsion" or "stress reaction". I guess there will always be a phase where there is stress reaction before the bony fragment/apophysis let go from the rest of the bone - and in those cases I need to find the right terms to make it understandable for the referrer. I guess 3 sites increases the time of RTP?
ReplyDeleteQ1: Is there maybe a natural development and logical order of appearance of these locations...
ReplyDeleteYes it is getting worse with eager parents/coaches/physicians.
Q2: Do you call it stress reaction, apohysiolysis, avulsion, or something else?
Failing stress reaction, because stress REaction will strength the physis and tendon. The normal reaction is "growth". I agree with Hilary: Apophysioloysis, but common used apophysitis.
Q3: Are there any recommendations on imaging follow up of such lesions? Or just follow clinically?
Not following... Active instruction on resting a suitable period of time, 1-2 month. It's our responsibility to give the right advise.
Our responsibility to give the right advice, I like that
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