Sports-related muscle injuries are frequent in adults and youngsters. The presentation of muscle and tendon trauma largely depends on the patient`s age: in youngsters the skeleton is weaker than in adults, whereas their ligaments and tendons can withstand more force. Therefore, skeletal lesions, more specifically those of the physis, are common in children. The type of sports activity determines the nature of the lesion. Most commonly apophyses of the hip and pelvis are subject to avulsion fractures in youngsters, and in tennis the pelvis is the most likely site to be affected. Lesions can be either acute or chronic. Acute apophysiolysis (or apophyseal avulsion fracture) usually occurs between puberty and the age of 25, and is caused by violent muscle contraction. Sudden pain is reported, and examination may reveal loss of function, local swelling and tenderness. Different sports may cause acute strain on different apophyses, causing lesions on specific locations (table 1). The most common sites are the ischial tuberosity (most frequently seen in gymnastics), anterior inferior spine (common in soccer and tennis) and the anterior superior iliac spine. The iliac crest is the site most often affected in tennis, but other apophyses may be involved as well (Figure 1a.). Initially conventional radiography with contralateral comparison (in order to differentiate a true lesion from the unfused physis) usually suffices, showing a displaced fragment at the origin or insertion of the muscle or tendon. However, plain radiographs may be misinterpreted as negative in children, when an apophyseal avulsion fracture is not displaced or when the apophysis is not ossified. In such cases, ultrasound, CT and MRI (Figure 1b) may prove helpful.
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