{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:51:27Z","timestamp":1791366687753,"version":"4.3.1"},"reference-count":60,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Musculoskelet Radiol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hip and pelvic overuse injuries are a frequent source of pain and lost playing time in athletes and may be challenging to diagnose because of overlapping symptoms and complex regional anatomy. Injury patterns vary according to skeletal maturity: in adolescents, open apophyses are particularly susceptible to traction-related apophysitis and avulsion injuries, whereas in skeletally mature individuals repetitive loading more often results in stress fractures and chronic tendinopathies. Clinical findings are often nonspecific, and misinterpretation may delay appropriate management or safe return to sport. Imaging plays a central role in evaluation. Conventional radiography remains the initial modality in many cases, but magnetic resonance imaging is most sensitive for detecting early marrow stress changes, physeal injury, and tendon or enthesis abnormalities, while also excluding infection or neoplasm. Familiarity with characteristic imaging patterns of apophyseal injuries, femoral and pelvic stress fractures, and common tendon and peritendinous overuse disorders enables accurate diagnosis and guides appropriate treatment planning in athletic populations.<\/jats:p>","DOI":"10.1055\/a-2932-1299","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:52:42Z","timestamp":1788994362000},"page":"563-576","source":"Crossref","is-referenced-by-count":0,"title":["Overuse Injuries of the Hip and Pelvis: Apophysitis, Stress Fractures, and Tendinopathies"],"prefix":"10.1055","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6262-1799","authenticated-orcid":false,"given":"Asli I.","family":"Akdogan","sequence":"additional","affiliation":[{"name":"Izmir Katip Celebi University, Ataturk Training and Research Hospital, T\u00fcrkiye","place":["Izmir"],"department":["Department of Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2812-1528","authenticated-orcid":false,"given":"Nil","family":"Tokg\u00f6z","sequence":"additional","affiliation":[{"name":"Gazi University Faculty of Medicine, T\u00fcrkiye","place":["Ankara"],"department":["Department of Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6755-2131","authenticated-orcid":false,"given":"Ozgur","family":"Tosun","sequence":"additional","affiliation":[{"name":"Izmir Katip Celebi University, Ataturk Training and Research Hospital, T\u00fcrkiye","place":["Izmir"],"department":["Department of Radiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"3813","DOI":"10.1016\/j.ejrad.2011.04.003","article-title":"Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures","volume":"81","author":"O Nachtrab","year":"2012","journal-title":"Eur J Radiol"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1148\/rg.2016160012","article-title":"Sports injuries about the hip: what the radiologist should know","volume":"36","author":"T M Hegazi","year":"2016","journal-title":"Radiographics"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.2214\/AJR.07.3399","article-title":"MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes","volume":"190","author":"K J H\u00e9bert","year":"2008","journal-title":"AJR Am J Roentgenol"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s002560000319","article-title":"Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected","volume":"30","author":"F Rossi","year":"2001","journal-title":"Skeletal Radiol"},{"issue":"11","key":"ref5","doi-asserted-by":"crossref","first-page":"991","DOI":"10.2165\/00007256-200535110-00005","article-title":"An overview of hip injuries in running","volume":"35","author":"S A Paluska","year":"2005","journal-title":"Sports Med"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1007\/s00256-023-04552-9","article-title":"Value of MR arthrography for evaluation of children and adolescents with clinically suspected intraarticular cause of hip pain","volume":"53","author":"L Schmitt","year":"2024","journal-title":"Skeletal Radiol"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s00256-023-04542-x","article-title":"Apophyseal injuries in soccer players","volume":"54","author":"V N Sato","year":"2025","journal-title":"Skeletal Radiol"},{"issue":"09","key":"ref8","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.rehab.2010.08.030","article-title":"Anterior superior iliac spine avulsion in a young soccer player","volume":"53","author":"I Bendeddouche","year":"2010","journal-title":"Ann Phys Rehabil Med"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1148\/radiographics.19.3.g99ma05655","article-title":"Imaging features of avulsion injuries","volume":"19","author":"M A Stevens","year":"1999","journal-title":"Radiographics"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"W316-25","DOI":"10.2214\/AJR.10.5308","article-title":"Imaging findings of lower limb apophysitis","volume":"196","author":"J Arnaiz","year":"2011","journal-title":"AJR Am J Roentgenol"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1148\/rg.285075217","article-title":"Athletic pubalgia and \u201csports hernia\u201d: optimal MR imaging technique and findings","volume":"28","author":"I M Omar","year":"2008","journal-title":"Radiographics"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/BF00349098","article-title":"Bilateral avulsion fractures of the anterior superior iliac spines in sprinters","volume":"13","author":"M B Khoury","year":"1985","journal-title":"Skeletal Radiol"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2214\/ajr.181.1.1810223","article-title":"Comparing sonography with MR imaging of apophyseal injuries of the pelvis in four boys","volume":"181","author":"R M Pisacano","year":"2003","journal-title":"AJR Am J Roentgenol"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"220","DOI":"10.5001\/omj.2014.54","article-title":"Avulsion fracture of the anterior inferior iliac spine mimicking a bone tumor: a case report","volume":"29","author":"M Incedayi","year":"2014","journal-title":"Oman Med J"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1007\/s002640000184","article-title":"Avulsion fractures of the anterior inferior iliac spine: the case for surgical intervention","volume":"24","author":"C Rajasekhar","year":"2001","journal-title":"Int Orthop"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"213","DOI":"10.3944\/AOTT.2015.2996","article-title":"Apophyseal avulsion fracture of the anterior inferior iliac spine due to a simple bone cyst","volume":"49","author":"M Elmada\u011f","year":"2015","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"13","key":"ref17","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1007\/s00247-018-4233-6","article-title":"Maturation of pelvic ossification centers on computed tomography in normal children","volume":"48","author":"L E Grissom","year":"2018","journal-title":"Pediatr Radiol"},{"issue":"01","key":"ref18","first-page":"82","article-title":"Apophysitis of the ischial tuberosity: a case report","volume":"10","author":"S Papastergiou","year":"2019","journal-title":"J Orthop Case Rep"},{"key":"ref19","doi-asserted-by":"crossref","DOI":"10.1007\/b97655","volume-title":"Skeletal Injury in the Child","author":"J A Ogden","year":"2000","edition":"3rd ed."},{"issue":"11","key":"ref20","first-page":"111","article-title":"The Iliac apophysis; an invaluable sign in the management of scoliosis","volume":"11","author":"J C Risser","year":"1958","journal-title":"Clin Orthop"},{"issue":"07","key":"ref21","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1080\/00913847.1994.11947666","article-title":"Hip and pelvis avulsion fractures in adolescents: proper diagnosis improves compliance","volume":"22","author":"J A Combs","year":"1994","journal-title":"Phys Sportsmed"},{"issue":"12","key":"ref22","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1136\/bjsports-2014-094436","article-title":"Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes","volume":"49","author":"M Sailly","year":"2015","journal-title":"Br J Sports Med"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/j.clinimag.2013.04.002","article-title":"Lower extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment","volume":"37","author":"G H Chang","year":"2013","journal-title":"Clin Imaging"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"53","DOI":"10.12671\/jmt.2025.00010","article-title":"Avulsion fractures around the hip joint and pelvis","volume":"38","author":"W S Choy","year":"2025","journal-title":"J Musculoskelet Trauma"},{"issue":"09","key":"ref25","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.2106\/00004623-199909000-00011","article-title":"Avulsion fracture of the lesser trochanter as a result of a preliminary malignant tumor of bone. A report of four cases","volume":"81","author":"R Afra","year":"1999","journal-title":"J Bone Joint Surg Am"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"3519","DOI":"10.21873\/invivo.12193","article-title":"Isolated avulsion fracture of the lesser trochanter in adults","volume":"34","author":"H S Cho","year":"2020","journal-title":"In Vivo"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1007\/s00256-024-04629-z","article-title":"Imaging of soccer injuries in adolescent female athletes","volume":"54","author":"F Babler","year":"2025","journal-title":"Skeletal Radiol"},{"issue":"08","key":"ref28","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1001\/archpediatrics.2011.34","article-title":"Prospective study of physical activity and risk of developing a stress fracture among preadolescent and adolescent girls","volume":"165","author":"A E Field","year":"2011","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1055\/s-2008-1025659","article-title":"Stress fractures in athletes","volume":"8","author":"A Hulkko","year":"1987","journal-title":"Int J Sports Med"},{"issue":"17","key":"ref30","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.2106\/JBJS.17.01593","article-title":"Femoral neck stress fractures: MRI risk factors for progression","volume":"100","author":"C E Steele","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"07","key":"ref31","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1148\/rg.2018180073","article-title":"Imaging features and management of stress, atypical, and pathologic fractures","volume":"38","author":"R A Marshall","year":"2018","journal-title":"Radiographics"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1080\/000164702320155392","article-title":"Bone stress injuries of the lower extremity: a review","volume":"73","author":"J Lassus","year":"2002","journal-title":"Acta Orthop Scand"},{"issue":"03","key":"ref33","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/BF00228923","article-title":"The \u201cgray cortex \u201d: an early sign of stress fracture","volume":"24","author":"M E Mulligan","year":"1995","journal-title":"Skeletal Radiol"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1177\/036354659502300418","article-title":"Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system","volume":"23","author":"M Fredericson","year":"1995","journal-title":"Am J Sports Med"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/jbmr.1998","article-title":"Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research","volume":"29","author":"E Shane","year":"2014","journal-title":"J Bone Miner Res"},{"issue":"02","key":"ref36","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.bone.2010.05.019","article-title":"Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case\/case series studies","volume":"47","author":"A Giusti","year":"2010","journal-title":"Bone"},{"issue":"04","key":"ref37","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3928\/01477447-20080401-14","article-title":"Evaluation and management of stress fractures of the pelvis and sacrum","volume":"31","author":"R G Hosey","year":"2008","journal-title":"Orthopedics"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3348\/kjr.2005.6.1.47","article-title":"Fatigue stress fractures of the pubic ramus in the army: imaging features with radiographic, scintigraphic and MR imaging findings","volume":"6","author":"S W Lee","year":"2005","journal-title":"Korean J Radiol"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"581","DOI":"10.2214\/ajr.142.3.581","article-title":"Parasymphyseal insufficiency fractures of the os pubis","volume":"142","author":"D Casey","year":"1984","journal-title":"AJR Am J Roentgenol"},{"issue":"09","key":"ref40","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s002560050279","article-title":"MR appearance of parasymphseal insufficiency fractures of the os pubis","volume":"26","author":"M Hosono","year":"1997","journal-title":"Skeletal Radiol"},{"issue":"03","key":"ref41","doi-asserted-by":"crossref","first-page":"727","DOI":"10.2214\/ajr.174.3.1740727","article-title":"Sacral stress fractures in long-distance runners","volume":"174","author":"N M Major","year":"2000","journal-title":"AJR Am J Roentgenol"},{"issue":"07","key":"ref42","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1089\/15246090152563588","article-title":"Sacral insufficiency fractures: a report of two cases and a review of the literature","volume":"10","author":"J Lin","year":"2001","journal-title":"J Womens Health Gend Based Med"},{"issue":"05","key":"ref43","doi-asserted-by":"crossref","first-page":"316","DOI":"10.2165\/00007256-198502050-00002","article-title":"Overuse injuries in sports. A review","volume":"2","author":"P Renstr\u00f6m","year":"1985","journal-title":"Sports Med"},{"issue":"06","key":"ref44","first-page":"785","article-title":"Rehabilitation of soft tissue injuries of the hip and pelvis","volume":"9","author":"T F Tyler","year":"2014","journal-title":"Int J Sports Phys Ther"},{"issue":"03","key":"ref45","doi-asserted-by":"crossref","first-page":"2325967113500638","DOI":"10.1177\/2325967113500638","article-title":"Iliopsoas syndrome in dancers","volume":"1","author":"C Laible","year":"2013","journal-title":"Orthop J Sports Med"},{"issue":"01","key":"ref46","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.diii.2012.10.009","article-title":"Acute inguinal pain associated with iliopectineal bursitis in four professional soccer players","volume":"94","author":"S Brunot","year":"2013","journal-title":"Diagn Interv Imaging"},{"issue":"03","key":"ref47","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1055\/s-0037-1602411","article-title":"Hip and pelvis: MRI of musculotendinous trauma and mimickers","volume":"21","author":"I Tsifountoudis","year":"2017","journal-title":"Semin Musculoskelet Radiol"},{"issue":"02","key":"ref48","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1055\/s-0030-1253157","article-title":"Hamstring injuries: anatomy, imaging, and intervention","volume":"14","author":"J M Linklater","year":"2010","journal-title":"Semin Musculoskelet Radiol"},{"issue":"11","key":"ref49","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.2106\/JBJS.G.00685","article-title":"Avulsion of the proximal hamstring origin","volume":"90","author":"D G Wood","year":"2008","journal-title":"J Bone Joint Surg Am"},{"issue":"05","key":"ref50","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1148\/rg.220055","article-title":"US and MRI of pelvic tendon anatomy and pathologic conditions","volume":"42","author":"D V Flores","year":"2022","journal-title":"Radiographics"},{"issue":"03","key":"ref51","doi-asserted-by":"crossref","first-page":"605","DOI":"10.2214\/AJR.10.4682","article-title":"Imaging of the tendons about the pelvis","volume":"195","author":"L W Bancroft","year":"2010","journal-title":"AJR Am J Roentgenol"},{"issue":"04","key":"ref52","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1177\/03635465010290042501","article-title":"Hip and groin injuries in athletes","volume":"29","author":"K Anderson","year":"2001","journal-title":"Am J Sports Med"},{"key":"ref53","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.clinimag.2016.09.010","article-title":"Beyond the greater trochanter: a pictorial review of the pelvic bursae","volume":"41","author":"M V Friedman","year":"2017","journal-title":"Clin Imaging"},{"issue":"05","key":"ref54","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1213\/ane.0b013e31819d6562","article-title":"Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment","volume":"108","author":"B S Williams","year":"2009","journal-title":"Anesth Analg"},{"issue":"02","key":"ref55","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s12306-025-00924-7","article-title":"A narrative review on greater trochanteric pain syndrome: diagnostic imaging and nonsurgical treatments","volume":"110","author":"D Donati","year":"2026","journal-title":"Musculoskelet Surg"},{"issue":"04","key":"ref56","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.mric.2009.06.005","article-title":"MR imaging of overuse injuries of the hip","volume":"17","author":"P A Hodnett","year":"2009","journal-title":"Magn Reson Imaging Clin N Am"},{"issue":"02","key":"ref57","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2214\/ajr.173.2.10430134","article-title":"Gluteus medius tendon tears and avulsive injuries in elderly women: imaging findings in six patients","volume":"173","author":"C B Chung","year":"1999","journal-title":"AJR Am J Roentgenol"},{"issue":"10","key":"ref58","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1007\/s00256-008-0514-8","article-title":"Correlation of MRI findings with clinical findings of trochanteric pain syndrome","volume":"37","author":"D G Blankenbaker","year":"2008","journal-title":"Skeletal Radiol"},{"issue":"08","key":"ref59","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s00590-021-03123-9","article-title":"External snapping hip syndrome is associated with an increased femoral offset","volume":"32","author":"O Andronic","year":"2022","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"01","key":"ref60","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1055\/s-2008-1067934","article-title":"Iliopsoas musculotendinous unit","volume":"12","author":"D G Blankenbaker","year":"2008","journal-title":"Semin Musculoskelet Radiol"}],"container-title":["Seminars in Musculoskeletal Radiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2932-1299.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:05:35Z","timestamp":1791363935000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2932-1299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":60,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,10,6]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2932-1299","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1089-7860","1098-898X"],"issn-type":[{"value":"1089-7860","type":"print"},{"value":"1098-898X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}