Signs included mild swelling and point tenderness over the ilium, with no superficial discoloration or obvious deformities.
The athlete characterized a decrease in pain during the night, reporting a 4/10 dull pain. An athletic trainer revealed pain upon palpation of the left ilium and sacroiliac joint (SI), and the athlete complained of a persistent 6/10 pain level during the day with weight-bearing activity. The athlete’s complaint at initial injury was persistent left hip and back pain. Although HO is described thoroughly in the literature, 4–22 the etiology and pathogenesis of this case provides a unique perspective for athletic health care practitioners to consider in their clinical practice.Ī 17-year-old male high school volleyball player reported he repetitively “dove for balls” during in-season practices, which caused landing on his left hip. 9,24,25 The following case highlights acquired HO following a fracture of the anterior superior iliac spine (ASIS) fracture resulting from repeated microtrauma to the pelvis. Radiographic evidence of HO may appear as early as 3 weeks or as late at 12 weeks from the initial trauma and can lead to several differential diagnoses, mostly related to soft tissue structures. 4–22 The current case depicts an acquired HO at the ilium due to repetitive trauma in a skeletally immature volleyball player.Įvaluation of acute blunt trauma injury typically includes physical examination and diagnostic imaging, such as radiograph and bone scan, 9,23 yet lower impact repetitive trauma may not yield advanced imaging during the acute stages of injury. 4–22 Bony areas, such as the cervical spine, elbow, and greater trochanter, are most commonly affected by HO. Acquired HO is more common in athletes, 9 usually due to one traumatic incident, specifically surgery or direct blunt force. However, acquired HO typically occurs due to trauma such as fracture, surgery, or direct muscular trauma. 9 Because of a neurogenic etiology, HO occurs due to spinal cord or central nervous system injury. Heterotopic ossification has two primary etiologies: acquired and neurogenic. 8–10 In addition, HO injuries have been identified concomitantly with hip arthroplasty (.06% to 90%) and distal humeral fractures (10% to 90%). 4–10 The incidence of HO, specifically in cases of repetitive microtrauma, has not been well documented however, prevalence of HO related to other injuries has been previously documented in spinal cord injuries (20% to 30%) and closed head injuries (10% to 20%). Heterotopic ossification is characterized by the abnormal growth of bone in soft tissue. 3 However, less common injuries, such as heterotopic ossification (HO), are a potential risk in traumatic sports. Most injuries to the hip in volleyball are often classified as muscle strains. However, significant hip injuries in volleyball are relatively rare. 1,2 Athletic skills, such as diving and rolling, may increase risk because of the repeated trauma to the pelvis and torso. Volleyball is one of the most popular sports played in the world, with nearly 200 million participants.
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