14 years-old male soccer player presents with right hip pain after kicking. The site of referred higher pain is located on the anterior-superior iliac spine.
The dynamic ultrasound exam shows a partial strain of the sartorius tendon bone attachment, togheter with a gross irregularity of the cortical bone surface, a common finding in young patients; power-doppler evaluation defines the typical post-traumatic hypervascularity.
In these cases I always suggest to perform also the Mri exam for the correct diagnosis and clinical management.
Ultrasound imaging is not enough: what’s about the osteochondral involvment?
Axial (left) and Sagittal Pdw-Spair Mri scans (1.5 Tesla).
The partial tear of sartorius tendon with associated marrow and soft tissue edema is evident. Apophyseal injuries to the hip and pelvis are quite frequent in skeletally immature individuals playing football. Combining ultrasound and Mri imaging modalities is the gold standard, especially beacuse radiographs may be interpreted as negative also in case of non-displaced fractures.
If you are a “pure sonographer” or a physiotherapist don’t forget to talk with a radiologist about these kind of injuries.