Overuse Injuries of the Hip and Pelvis: Apophysitis, Stress Fractures, and Tendinopathies

Abstract 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.