Ischial apophyseal stress injury
A runner with gradual-onset pain in the left hip for six months, aggravated by running. No history of trauma. X-ray reported as normal (not available for assessment).
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The physis of the left ischial tuberosity is widened and the ischial apophysis appears somewhat enlarged. Adjacent bone marrow edema and a rim of soft-tissue edema are also seen. The MR findings are consistent with an ischial apophyseal stress injury.
No ischial tuberosity displacement. The hamstring origin is intact.
The MR findings and clinical history in this case are typical for ischial apophyseal stress injury.
In pediatric patients, the physis is structurally the weakest point of the musculoskeletal unit and therefore is most susceptible to injuries (acute avulsions and chronic stress injuries). Its counterpart in adults is the musculotendinous junction, with injuries resulting in hamstring tears and tendinosis, respectively.