Patient presents with left groin discomfort.
18 yo/M – the left-handed baseball player with left hip discomfort of 2 weeks duration. Worsening of signs & symptoms. No prior corticosteroid/opioid regimen or carcinoma is reported.
Left hip pain_ AP PELVIS VIEWS
Close up-left hip- showing minimal displacement with cortical disruption of inferior pubic ramus.
The coned view above optimally shows two transversely oriented radiolucencies in addition to the radiographic findings described above.
TEACHING POINTS:
DISCUSSION:
Between 13 – 15 years of age, the ossification center of the ischial tuberosity begins. This structure is 2-5 x weaker than the surrounding tendons & ligaments. A sudden exertion can cause avulsion of the epiphysis from the parent inferior ramus. The biceps semimembranosus tendon has a lateral origin on the ischial tuberosity.
IMAGING:
Plain film examination if the initial imaging modality. Occult fractures can be detected with MRI scanning because it demonstrates the presence/extent of edema on fluid-sensitive images.
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Case compliments of Dr. A. Calderone DC Stuart, Florida
REFERENCES:
At ProImaging we provide expert chiropractic radiology interpretation.