Ischial tuberosity pain in athletes may be caused by several clinical entities, which
include acute and old bony or periosteal avulsions and apophysitis. We studied the
natural course of these injuries based on our clinical case series of fourteen patients
with apophysitis and twenty-one with avulsion of the ischial tuberosity. Only patients
with the diagnosis confirmed by X-ray finding were included. The clinical diagnostic
criteria of ischial apophysitis consisted of gradually increasing functional and papatory
pain at the ischial tuberosity without any major trauma at the beginning of the symptoms.
Typically there was asymmetry on plain radiographs of the ischial tuberosities in
apophysitis; the involved apophyseal area became sclerotic, wider than the non-symptomatic
apophysis, osteoporotic patches developed and the lower margin of the ischial tuberosity
became irregular. The patients with avulsion reported an acute trauma at the beginning
of the symptoms and an avulsion fragment was immediately after injury or later seen
in plain radiographs. The mean age of the patients with apophysitis (14.1 yrs) was
lower than that of the subjects with avulsions (18.9 yrs). Apophysitis of the ischial
tuberosity usually healed well without complications. Avulsions often caused more
prolonged pain with referral pain to the posterior parts of the thigh which often
required operative interventions. A small bony or periosteal avulsion sometimes grew
to a pseudotumor calcification. We recommend conservative treatment as the primary
treatment modality for both ischial tuberosity apophysitis and avulsion fractures.
Key words
Apophysis - growth - injury - sports
