Ischial apophysis injuries in athletes

The diagnosis and treatment of ischial tuberosity pain in athletes include several clinical entities. These injuries include apophysitis, adult tug lesion, painful unfused apophysis, and acute and old avulsions. In some avulsion injuries a bony fragment can be seen, but they can also be x-ray-negative, especially in children. An insertional tendon rupture is also possible. Conservative treatment of apophysitis includes modification of activities and anti-inflammatory medication. Avulsions, if diagnosed early, usually heal with conservative therapy, especially if the displacement is not marked. Urgent surgical treatment is recommended in cases with total or nearly total soft-tissue hamstring muscle insertion rupture. Surgery has to be considered also in cases with dislocation of the apophysis or bony avulsion of more than 2cm. Excision of the excessive mass or poorly united fragment provides relief of pain in some cases of old avulsions.