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Clinical Reasoning Typical cases are discussed there. The cases are brought by practioners.

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Old 03-02-2017, 07:59 AM   #1
Mariette
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Default Best Treatment for Ischial Tuberosity Apophyseal tracton/avulsion injury

Male patient (15 years old) is an age group champion hurdler. Runs an average of 13.0s on 100m Hurdles 84cm. L Leg dominant for short hurdles but can switch to both in long hurdles . Had an epic wipe-out fall in warm-up, but apart from bruises etc he continued to run long hurdles shortly thereafter and the following day broke the record for short hurdles.
Couldn't train on that Monday as his hip hurt. Rested for 2 weeks and then began slow easy running and swimming as it was school holiday. 6 weeks later resumed speed and hurdle training and had one race but felt slow and if his hip got stuck....teenage language. Saw several therapists and he had Dry needling Trigger points, manipulation, corrective exercises for every thing that was instable or too stable. No pain with walking or climbing stairs at school. Can just not sprint and slow down, as if he doesn't have brakes. There is nothing wrong with him he said.
The GP insisted on MRI and CT scans. Diagnosis: The left ischial tuberosity apophysis demonstrates physeal widening with the physis measuring 2.5mm in diameter and is slightly irregular in its contour. This is compared to the right which is curvilinear and measures approximately 1mm in thickness. No abnormal soft tissue calcification.

Without seeing him the Orthopedic Surgeon prescribed crutches for 4-6 weeks.
He did barefoot running on grass yesterday afternoon and different agility runs with his dogs. He doesn't know the diagnosis and thinks it is because of his L leg dominance and him being a teenager that the one side of his body is a bit overdramatic in producing pain and growing bones and if that is sorted out he'll be fine and back on track. He doesn't have any fear avoidance behavior .....how do I burst his bubble and give him crutches???
Please any recommendations?
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Old 03-02-2017, 10:26 AM   #2
Jo Bowyer
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This is a difficult enough situation when teenagers do know the diagnosis and someone has been through the scans with them.

Why doesn't he know his diagnosis? I am mindful that the culture may be different in the UK. The reason I ask is that much of my discussion with teenagers involves persuading them to think that they have come to the right decision themselves, rather than me telling them outright.
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Last edited by Jo Bowyer; 03-02-2017 at 11:20 AM.
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