Normal Hip

Your Child's Hip


The hip joint is a simple ball and socket joint. The ball is called the femoral head and the socket is called the acetabulum. The surfaces of the hip joint are covered with articular cartilage which is lubricated with synovial fluid and allow the two adjoining bones to move nearly friction-free. (The animation to the left demonstrates this.)

The ball and socket joint in the hip is much deeper than other ball and socket joints in the body such as the shoulder. This makes the hip much more stable. The hip is surrounded by a joint capsule which adds even more stability. Lastly, there is a layer of fibrous cartilage around the rim of the hip joint called the labrum that surrounds the hip joint and provides additional depth and stability.

The hip is one of the largest joints in the body and absorbs an enormous amount of stress during our daily activities including walking, running and jumping. Some of the strongest muscles in the body attach to the hip joint enabling us to do all of these activities.

Hip Conditions


A hip condition not caught early in life could lead to larger problems in adolescence and adulthood.

From initial screening to the final treatment and beyond, the Children's Hip Program offers specialized treatment for patients from birth to age 21.

 

 


 

Femoroacetabular Impingement

What is Femoroacetabular Impingement?


Femoroacetabular impingement (FAI) is a condition that results from abnormal contact between the top of the thigh bone (femoral head) and the outside part of the hip socket (acetabulum). Damage can occur to the surfaces of the hip joint over time as a result of repeated abnormal contact during activities and range of motion of the hip. (The animation to the left demonstrates this.)

What causes Femoroacetabular Impingement?


The cause of FAI is not known in most cases. Some doctors believe that heavy physical activities, such as football and weight lifting, or heavy labor before the body stops growing can contribute to FAI. Some childhood problems, such as Legg-Calve-Perthes disease or slipped capital femoral epiphysis (SCFE), can lead to FAI.

There are two types of FAI, Cam and Pincer. Most patients have a mixed pattern with both cam and pincer deformities. Cam FAI is the result of an abnormally shaped upper femur. The abnormal 'bump' on the upper femur can cause uneven contact with the hip socket, potentially damaging the cartilage. Pincer FAI is the result of a socket that is too deep or oriented in an incorrect direction. This can lead to pinching of the cartilage rim (labrum) of the socket with movement.

Learn more about Femoroacetabular Impingement.

Symptoms and Treatments


What are the symptoms of Femoroacetabular Impingement?


Patients with FAI typically complain of hip pain and a loss of motion in the hip joint. Symptoms related to FAI can include cartilage damage, labral tears, early hip arthritis, hyperlaxity (too much mobility in the hip), hip pain and low back pain. Pain can occur during physical activities such as walking or running. Some patients report pain after prolonged sitting. Pain can be located in the groin, thigh or knee.

Signs of FAI can begin in the adolescent years but it becomes much more common in young and middle-age adults. These signs may get worse with age.

How is Femoroacetabular Impingement diagnosed?


Your doctor may diagnose FAI after taking a thorough medical history, followed by a physical examination and X-ray. Magnetic resonance imaging (MRI) or a computed tomography (CT) scan can be used to better assess the shape of the upper femur and socket and to confirm the amount of damage to the cartilage in the joint.

Treatment of Femoroacetabular Impingement (FAI)


Treatment can include conservative care, such as:

  • Medications
  • Physical therapy
  • Limiting physical activities

Surgery is often needed and may be minimally invasive (arthroscopic). Some FAI surgery can require an open surgical method depending on the extent of the damage to the cartilage.

Patient Testimonials


Teen Regains MobilityRyan


It is an athlete's worst nightmare: the inability to play at peak performance. For Ryan Stuart, an athletic and intelligent teenager from Thomasville, Ga., this frustration was taken to a new level. Terrible pain, a loss of flexibility and a grinding feeling in the hips kept him from playing to his potential. It was an ordeal that would last four years and see the young man visit more doctors than he would care to remember.

Ryan had always excelled at sports. Baseball and football are his favorites, and he stood out as a catcher and offensive lineman, two positions that take a toll on the joints. During middle school, Ryan began to notice nagging pain in his legs and hips. He thought the symptoms were due to his active lifestyle. A doctor recommended Ryan rest for a year, and reluctantly he agreed. He said the decision drove him crazy.

"I loved playing sports," he said. "It was all I ever did."

In high school, Ryan continued to play, but the pain did not go away. A doctor ordered blood tests but was unable to find anything conclusive. After X-rays and more visits, Ryan's doctor still could not find the source of the pain and referred him to an orthopaedic specialist. Magnetic resonance imaging (MRI) scans, more X-rays and a full body bone scan were ordered. The results remained murky, and the best the doctor could do was to diagnose juvenile arthritis, which Ryan had previously tested negative.

At this point, both Ryan and his mother, Beth, were frustrated.

"It was hard watching my son going through this kind of pain and not be able to do anything about it," she said.

Ryan's medical odyssey then took him to Tallahassee, Fla., where more tests were ordered with the same disappointing result. Ryan's doctor then questioned whether the young man's symptoms were psychological. "He thought it was all in my head," Ryan said.

This was more than his mother could take. Ryan was ultimately referred to an Atlanta doctor who, after having Ryan endure another round of tests, told the young man he needed to stop playing football until they could find out what was wrong. Ryan took the news hard.

"I was absolutely crushed," he said.

Ryan was prescribed a powerful arthritis medicine that made him very sick but did not decrease the pain. Soon after, Ryan was referred to pediatric hip specialist Tim Schrader, M.D.

By this point, Ryan was mentally exhausted from the constant travel and the disappointment of not having any answers. During the four-hour trip from Thomasville to Atlanta, Beth tried to keep his spirits up.

At Children's, Dr. Schrader reviewed all of Ryan's MRI images and X-rays. He immediately ordered another round of X-rays, but rather than sending Ryan home to have his doctors perform the test, Dr. Schrader did them right away. After the images were taken, Ryan sat anxiously in the waiting room

"An entire year of searching and driving to different doctors, and my diagnosis came down to two 15-minute X-rays," he said.

Dr. Schrader, whom Ryan calls his "medical savior," had the answer-Ryan had femoroacetabular impingement (FAI). Dr. Schrader said surgical dislocation of the hip with acetabular rim trimming and a femoral head/neck osteoplasty-a type of hip surgery-would correct the problem. Ryan would then begin the long, slow rehabilitation process. Despite the enormity of the news, Ryan said he felt a huge sense of relief. Finally, he had an answer and a plan to regain his independence and live pain-free.

"The pain, doctor's visits and not knowing had defined my life for so long," he said. "Now, I could move forward."

Ryan actually had two surgeries, one on each hip, to fix his problem. He said that throughout his entire ordeal, his older brother and younger twin sisters supported him. But, it was his mother who rode the hundreds of miles and spent countless hours with Ryan to find the answer to his painful problem.

"She was with me every step of the way," he said. "When I got discouraged, when nobody could figure it out, she would say something to motivate me. She was my hero." Today, Ryan no longer plays football, but he does wrestle for the Thomas County Yellow Jackets. He has completed all of his high school classes early and is now taking college-level courses. Ryan has been accepted to the University of Alabama where he will study sports medicine.

When asked what advice she would give someone going through a similar situation, Beth does not hesitate to answer. "Don't ever give up. Your child is going through a tough time, and it's important to understand what he's going through. It can be a humbling experience, but keep going until you find your answer."

Learn more about:


3 related images

Combine FAI shot through lateral preop Combine FAI AP pelvis preop Combine FAI AP pelvis postop

What are X-rays?


X-rays are made by using low levels of external radiation to produce images of the body, the organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially treated plates (similar to camera film) and a negative-type picture is made. The more solid a structure is, the whiter it appears on the film. For this reason, bones appear very white on an X-ray film, but less dense tissue such as muscle, blood, skin and fat appears darker. An X-ray provides a picture of inside the body by using special radioactive rays. An X-ray can show bones, tissues or parts of organs.

 

 


 

Legg-Calve-Perthes Disease

What is Legg-Calve-Perthes Disease?


Legg-Calve-Perthes disease is a temporary condition in children in which the ball-shaped head of the thigh bone, referred to as the femoral head, loses its blood supply. As a result, the femoral head collapses. (The image to the left represents this.) The body will absorb the dead bone cells and replace them with new bone cells. The new bone cells will eventually reshape the femoral head of the thigh bone. Legg-Calve-Perthes disease causes the hip joint to become painful and stiff for a period of time.
Legg-Calve-Perthes disease goes through four phases of changes that affect the head of the femur. The phases include:

  • Phase 1--Blood supply is absent to the femoral head and the hip joint becomes inflamed, stiff and painful. Portions of the bone turn into dead tissue. The ball of the thigh bone becomes less round in appearance on X-rays. This phase can last from several months up to one year.
  • Phase 2--The body cleans up the dead bone cells and replaces them with new, healthier bone cells. The femoral head begins to remodel into a round shape again. The joint is still irritated and painful. This phase can last from one to three years.
  • Phase 3--The femoral head continues to model itself back into a round shape with new bone. This phase lasts for one to three years.
  • Phase 4--Normal bone cells replace the new bone cells. This last phase can last a few years to complete the healing process.

What causes Legg-Calve-Perthes Disease?


The cause of Legg-Calve-Perthes disease is unknown. It is four times more likely to occur in boys than girls.
Legg-Calve-Perthes disease commonly affects first-born children and is typically seen in children 4 to 8 years of age. The majority of cases affect only one hip.

Learn more about Legg-Calve-Perthes Disease.

Symptoms and Treatments


What are the symptoms of Legg-Calve-Perthes Disease?


The child typically complains of hip pain that is aggravated by activity. Sometimes, they will also experience pain in their thigh or knee area. The child usually walks with a limp and reports that rest will alleviate the pain. The symptoms of Legg-Calve-Perthes disease may resemble other conditions or medical problems of the hip. Always consult your child's doctor for a diagnosis.

How is Legg-Calve-Perthes Disease diagnosed?


In addition to a complete medical history and physical examination, diagnostic procedures for Legg-Calve-Perthes disease may include:

  • X-rays--A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
  • Bone scans--A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
  • Magnetic resonance imaging (MRI)--A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
  • Arthrograms--A diagnostic imaging test to study the non-bony structures of joints.
  • Blood tests

Treatment for Legg-Calve-Perthes Disease


Your child's physician will determine the specific treatment for Legg-Calve-Perthes disease based on:

  • Your child's age, overall health and medical history
  • The extent of the condition
  • Your child's tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

The goal of treatment is to preserve the roundness of the femoral head and to prevent deformity while the condition runs its course. Treatment options are dependent upon the amount of hip pain, stiffness and X-ray changes over time, as well as how much of the femoral head has collapsed.

Typically, the first step of treatment is to regain hip motion and eliminate pain that results from the tight muscles around the hip and the inflammation inside the joint. Treatment may include:

  • Rest
  • Activity restrictions
  • Medications
  • Bed rest and traction
  • Casting or bracing (to hold the femoral head in the hip socket, permit limited joint movement and allow the femur to remold itself into a round shape again)
  • Surgery (to hold the femoral head in the hip socket)
  • Physical therapy (to keep the hip muscles strong and to promote hip movement)
  • Crutches or wheelchair (in some cases)

2 related images

Perthes ap pelvis Perthes frog pelvis

What are X-rays?


X-rays are made by using low levels of external radiation to produce images of the body, the organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially treated plates (similar to camera film) and a negative-type picture is made. The more solid a structure is, the whiter it appears on the film. For this reason, bones appear very white on an X-ray film, but less dense tissue such as muscle, blood, skin and fat appears darker. An X-ray provides a picture of inside the body by using special radioactive rays. An X-ray can show bones, tissues or parts of organs.

Eli Clarkson

Eli Clarkson is the kind of 8-year-old that feels the need to hurdle over a sofa to go from the living room to the kitchen. An hour playing outside usually comes with a new collection of grass stains, scrapes and bruises.

So when a limp and hip pain in his right leg slowed him down in the summer of 2011, his parents, Eric and Lynn, thought it was probably just a minor injury from being such an active kid.

“He was developing a really bad limp, and he was getting ready to play his first season of football in the fall,” Eric said. “He said his groin was hurting, and I just thought he pulled his groin.”

Perthes Diagnosis

An X-ray at Children’s Healthcare of Atlanta’s Scottish Rite hospital revealed that Eli had Legg-Calvé-Perthes disease, a condition that affects the top of the thigh bone. In a child with Perthes, the top of the thigh bone, or femoral head, loses blood supply and collapses.

Eric and Lynn were initially told that recovery in some cases of Perthes could take between three and five years and result in some long-term disabilities. The family’s pediatrician recommended they take Eli, 7 at the time, to see Tim Schrader, M.D., the Medical Director of the Children’s Hip Program.

“Dr. Schrader is a rockstar,” Eric said. “He told us he was doing a different procedure (for Perthes patients).”

Treating His Condition

One treatment for Perthes is core decompression, a minimally invasive procedure in which a hole is drilled into the femoral head to promote blood flow. Dr. Schrader uses core decompression but includes an additional procedure called bone marrow aspirate concentrate (BMAC). During this procedure, a sample of bone marrow is taken out the hip bone and placed into the femoral head. This extra step can help the recovery process by increasing blood flow and helping the bone grow stronger.

Eli had the procedure Aug. 25, 2011. He had to stay in a cast and wheelchair for about six weeks. He wore a brace for another four months.

“We had a reserved optimism,” Eric said. “We didn’t really have anything to gauge it against. We listened to and believed in Dr. Schrader. We had hope.”

Recovery and Physical Therapy

Eli Clarkson in Physical TherapyEli attended physical therapy with Andrea Carmin, P.T., twice a week for six months at Children’s at Meridian Mark. He quickly developed a bond with Andrea and worked hard to build strength and flexibility in his hip.

The Clarkson family had regular follow-up appointments with Dr. Schrader, during which they would see before and after X-rays of their son’s hip. For the most part, they could never tell a difference.

But when they had their most recent appointment, six months since their previous one, they saw a big difference.

“There was this beautiful, white ball that is his femoral head,” Eric said. “My wife and I just looked at each other and said, ‘There it is. That is what has been missing.’”

Eli has returned to two of his favorite sports—swimming and baseball—and will play football in the fall.

“He had the most phenomenal attitude through the whole thing,” Eric said. “I never thought a 7-year-old boy could be my hero.”

 

 


 

Developmental Dysplasia of the Hip

What is Developmental Dysplasia of the Hip (DDH)?


Developmental dysplasia of the hip (DDH) is a term used to describe a wide range of hip abnormalities ranging from a misshapen ball or socket to a complete dislocation of the hip. DDH happens in one in every 1,000 births and can sometimes develop after birth. DDH is most common in first-born breech females who also have a close relative with the condition. With DDH, the hip socket (acetabulum) may be shallow. This can allow the ball (femoral head) of the leg bone to slip in and out of the hip socket. The ball may move partially or completely out of the socket. Treatment options vary based on your child's age.

What causes DDH?


DDH is usually caused by genetic and environmental factors. DDH is more common in females. One of the environmental factors may be the baby's response to the mother's hormones during pregnancy. A tight uterus that limits fetal movement or a breech position are also associated with DDH. DDH is more likely to occur in the left hip.

What are the risk factors for DDH?


First-born babies are at higher risk because the uterus is small and there is limited room for the baby to move, affecting the development of the hip. Other risk factors may include:

  • Family history of DDH, or very flexible ligaments
  • Position of the baby in the uterus, especially with breech presentations
  • Associations with other orthopaedic problems that include metatarsus adductus, clubfoot deformity, congenital conditions and other syndromes

Symptoms and Treatments


What are the signs or symptoms of DDH?


Signs of DDH in babies, infants and toddlers include:

  • Leg may appear shorter on the side of the affected hip.
  • The rotation of the affected hip may be different.
  • Folds in the skin of the thigh or buttocks may appear uneven.
  • Space between the legs may look wider than normal.
  • The hip may shift, click or clunk during certain movements, such as diaper changes.

Signs of DDH in adolescents, teens and young adults include:

  • Hip pain
  • Clicking sound in the hip joint
  • Catching feeling in hip joint
  • Limited or excessive movement of the hip
  • Difference in limb length

How is DDH diagnosed?


Your doctor will do a physical exam of your child at birth and during infancy to check for DDH and other hip problems. Signs may not show until later in life. Diagnostic procedures may include:

  • X-ray--uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
  • Ultrasound (sonography)--uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to assess the shape and stability of the hip.
  • Computed tomography (CT) scan--uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
  • Magnetic resonance imaging (MRI)--uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

What can be done?


The goal of treatment is to reposition the ball back into the hip socket so the hip can stabilize and then develop normally. Some hips do not continue to develop normally after they stabilize. Further treatment may become necessary.

Treatment is based your child's:

  • Age, health and medical history
  • Extent of the DDH
  • Tolerance for medicine, procedures or therapies

Treatment for babies and infants


Pavlik harness--is typically used on babies up to age 6 months to guide the hip into place, while allowing some movement of the legs. The harness is applied by your baby's doctor and is usually worn full time for at least six weeks. Your baby is seen often during this time so that the harness may be checked for proper fit and to examine the hip. During treatment, ultrasounds or X-rays may be used to check the position of the hip and assess progress. Treatment typically ends when X-ray or ultrasound evaluations are normal. DDH may be successfully treated with the Pavlik harness in infancy, but it is important to monitor the hips during growth. Sometimes the hip may fail to fully develop and further treatment may be necessary.

Treatment for toddlers


Closed reduction surgery and casting--If the other methods are not successful, or if DDH is diagnosed after the age of 6 months, a closed reduction surgery may be required to put the hip back into place manually. This surgery is often combined with other procedures, such as arthrogram and adductor tenotomy, to help assess the reduction and increase the hip stability. With an arthrogram, X-rays are taken after injecting contrast into the joint to highlight the cartilage and other soft tissues that are not seen with X-rays alone. An adductor tenotomy involves cutting tendons to increase hip flexibility. If closed reduction surgery is successful, a special cast (spica cast) is used to hold the hip in place. The spica cast is worn for three to six months. The cast is changed from time to time to accommodate your child's growth. Your child may need to wear a brace after the cast is removed. Physical therapy may be needed to help make the muscles around the hip stronger.

Treatment for adolescents, teens and young adults


Periacetabular Osteotomy (PAO)--Older children at or near skeletal maturity may benefit from a periacetabular osteotomy (PAO). With a PAO, cuts are made around the hip socket. This allows the hip socket to be moved into a more normal position. This reduces joint stress and improves hip function. A PAO may also delay or eliminate the need for total hip replacement later in life. Some patients may need physical therapy for a full recovery.

Meet Abby

After being diagnosed with hip dysplasia at age 6, Abby Ewing came to Children's for an operation on both hips.

Meet Brittany

When severe hip pain threatened to sideline 15-year-old Brittany Watson's fastpitch softball career, our pediatric hip specialists helped get her back in the game.

Meet the Murphy Sisters

Annaliese and Isla Murphy both showed early signs of developmental dysplasia of the hip (DDH). The Children's Hip Program helped both girls recover quickly.

Learn more about:

6 related images

Bilateral DDH dysplasia AP pelvis preop Bilateral DDH dysplasia Von Rosen preop Bilateral DDH dysplasia false profile Bilateral DDH dysplasia AP pelvis postop Bilateral DDH dislocation AP postop Pre-op AP with bilateral DDH

What are X-rays?


X-rays are made by using low levels of external radiation to produce images of the body, the organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially treated plates (similar to camera film) and a negative-type picture is made. The more solid a structure is, the whiter it appears on the film. For this reason, bones appear very white on an X-ray film, but less dense tissue such as muscle, blood, skin and fat appears darker. An X-ray provides a picture of inside the body by using special radioactive rays. An X-ray can show bones, tissues or parts of organs.

 

 


 

Slipped Capital Femoral Epiphysis

What is Slipped Capital Femoral Epiphysis?


Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects children. In SCFE, the head, or "ball," of the thigh bone (referred to as the femoral head) slips off the neck of the thigh bone. An analogy commonly used to describe this condition is that it can be like a scoop of ice cream slipping off the top of a cone. (The image to the left represents this.) This condition causes the hip joint to become painful and stiff.

Approximately one half of SCFE cases affect both hips, and boys are affected more often than girls. It can result from trauma, also referred to as an "acute slip," or can occur over a period of weeks to years. This is called a "chronic slip."

SCFE has three degrees of severity:

  • Mild--Approximately one-third of the femoral head slips off of the thigh bone (see A).
  • Moderate--Approximately one-third to one-half of the femoral head slips off of the thigh bone (see B).
  • Severe--More than one-half of the femoral head slips off of the thigh bone (see C).

What causes Slipped Capital Femoral Epiphysis?


The cause of SCFE is unknown. Risk factors that increase the likelihood of SCFE include:

  • Obesity
  • Medications (such as steroids)
  • Thyroid problems
  • Radiation treatment
  • Chemotherapy
  • Bone problems related to kidney disease

Who is affected by Slipped Capital Femoral Epiphysis?


SCFE is an unusual condition, which is more likely to occur in boys than girls. Children ages 11 to 15 are most at risk.

SCFE is more prevalent in the Northeast region of the United States than in the Southwestern states. It is also more prevalent among African-Americans.

Symptoms and Treatments


What are the symptoms of Slipped Capital Femoral Epiphysis?


Symptoms of SCFE typically include pain in the hip that is aggravated by activity. Sometimes the adolescent will also experience pain in the groin, thigh or knee area.

In acute slips, the adolescent will complain of immediate pain, limp or feel like the "leg is giving way."

The adolescent with a chronic slip usually walks with a limp, complains of hip pain and reports that rest alleviates the pain. The adolescent may walk with his leg turned outward and may also have a click in the hip.

The symptoms of SCFE may resemble other conditions or medical problems of the hip. Always consult your adolescent's physician for a diagnosis.

How is Slipped Capital Femoral Epiphysis diagnosed?


In addition to a complete medical history and physical examination, diagnostic procedures for SCFE may include:

  • X-ray--A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
  • Bone scans--A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
  • Magnetic resonance imaging (MRI)--A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
  • Blood tests

The ultimate goal in SCFE is to diagnose the condition early in order to prevent the head of the femur from slipping further off of the thigh bone, thus preventing hip deformity. When the diagnosis of SCFE is made, the adolescent is not allowed to bear weight on the hip. Crutches or a wheelchair may be used.

Treatment of Slipped Capital Femoral Epiphysis


Your adolescent's doctor will determine the specific treatment for SCFE based on:

  • Your adolescent's age, overall health and medical history
  • The extent of the condition
  • Your adolescent's tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

The goal of treatment is to prevent the femoral head from further slippage. Treatment usually may include:

  • Surgery (involving the use of a steel pin to hold the femoral head onto the femur to prevent further slipping)
  • Physical therapy (following surgery, to help strengthen the hip and leg muscles)

6 related images

SCFE acute repositioning pelvis preop SCFE acute repositioning preop SCFE frog postop SCFE AP postop Frog pelvis with unilateral left SCFE AP pelvis with unilateral left SCFE

What are X-rays?


X-rays are made by using low levels of external radiation to produce images of the body, the organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially treated plates (similar to camera film) and a negative-type picture is made. The more solid a structure is, the whiter it appears on the film. For this reason, bones appear very white on an X-ray film, but less dense tissue such as muscle, blood, skin and fat appears darker. An X-ray provides a picture of inside the body by using special radioactive rays. An X-ray can show bones, tissues or parts of organs.

 

 


 

Apophysitis

What is apophysitis?

Apophysitis is an inflammation at the point where the tendon (soft tissue) attaches to the bone. It can cause pain, swelling and tenderness in the hip area. It is common in teens between the ages of 12 and 18 because of growth spurts and increased activity. Apophysitis regularly affects dancers, soccer players, runners and hockey players. Children or teens with tight hips and thigh muscles are more prone to this injury.

What causes apophysitis?

Apophysitis is an overuse injury. Repeated movement and stress to the muscles attached to the bone can result in inflammation and irritation. Young athletes can be prone to the injury if training or competing for an extended amount of time. Children and teens can also suffer from apophysitis during a growth spurt, when bone growth can put added stress on the muscle’s flexibility. Other factors that can increase the likelihood of apophysitis include knock-knees and pronation.

Learn more about apophysitis.

Symptoms and Treatments


What are the signs of apophysitis?

The most common sign of apophysitis is a dull pain in the groin or front side of the hip. The pain or discomfort will typically get worse with continued activity. Apophysitis can also result in tenderness and swelling at the site of the injury. These symptoms can be mistaken for muscle strain.

How is apophysitis diagnosed?

The doctor may diagnose apophysitis after reviewing the patient’s medical history, asking about the symptoms and performing a physical examination. X-rays can help diagnose the condition by ruling out any other injuries, especially fractures. Our radiology department follows specific imaging protocols. The amount of radiation used for an X-ray is based on the size and needs of each patient.

How is apophysitis treated?

The first thing a patient suffering from apophysitis should do is rest from the activity that is causing the pain and inflammation. Other treatments include:

  • Icing the injured area for 15 to 20 minutes during a three-hour span every day.
  • Taking anti-inflammatory medication, as recommended by your doctor. This may include over-the-counter medication
  • Physical therapy to learn good strengthening and stretching exercises. Our physical therapists will work closely with a patient’s doctor on therapy protocols specific to the injury.

Parents should be cautious before letting their child return to sports-specific activities after the pain has subsided. If the child or teen can’t walk normally without a limp, he is likely not ready to return to activity. When the pain is gone, gentle stretching and strengthening of the area can begin. Returning to sport-specific activity should be done gradually.

6 related images

Bilateral iliac apophysitis Right anterior superior iliac spine (ASIS) avulsion Right anterior inferior iliac spine (ASIS) avulsion Right ishial apophyseal avulsion fracture Left anterior superior iliac spine (ASIS) avulsion Left anterior inferior iliac spine (AIIS) avulsion

What are X-rays?


X-rays are made by using low levels of external radiation to produce images of the body, the organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially treated plates (similar to camera film) and a negative-type picture is made. The more solid a structure is, the whiter it appears on the film. For this reason, bones appear very white on an X-ray film, but less dense tissue such as muscle, blood, skin and fat appears darker. An X-ray provides a picture of inside the body by using special radioactive rays. An X-ray can show bones, tissues or parts of organs.

 

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