Hip Injuries Lecture Notes

Introduction

• Final step in the hip lecture series, focusing on hip injuries.
• Previously covered hip anatomy, inspection, and history questions.
• Current focus: common injuries in athletic training.

Labral Tears

• Anatomy Recap: Labrum extends the acetabulum, creating suction for femoral head stability.
• Mechanisms/Causes:
  • Hip dislocations and repetitive subluxations.
  • Slipped capital epiphysis and acetabular dysplasia.
  • Repeated athletic trauma (e.g., volleyball players, running backs).
• Symptoms: Catching and locking due to labrum flaps.
• Diagnostic Tests: Positive scouring test (pain and clicking).

Snapping Hip Syndrome (Coxasaltans)

• Definition: Audible and palpable snapping during hip movement.
• Types:
  • Internal: Caused by iliopsoas or hamstring tendons.
  • External: Caused by glute max fibers, IT band, or trochanteric bursitis.
  • Intra-articular: Often related to labral tears.
• Symptoms: Positive snapping hip sign and jerk test.
• Treatment: Varies based on type, includes surgery and cortisone injections.

Athletic Pubalgia (Sports Hernia)

• Mechanism: Increased muscular loads causing pubic symphysis strain.
• Symptoms: Groin pain, unilateral adductor weakness.
• Differentials: Adductor strain, abdominal strain, traditional hernia.

Osteitis Pubis

• Cause: Inflammation of the pubic symphysis due to trauma.
• Symptoms: Pain during hip abduction, tenderness, pain with directional changes.
• Differentials: Sports hernia, adductor strain, hip flexor strain.

Adductor Strain

• Mechanism: Hypercontraction or stretch of adductor muscles.
• Symptoms: Pain with active contraction and passive stretch.

Myositis Ossificans

• Cause: Repeated direct blows to quadriceps leading to bone growth in muscle.
• Symptoms: Decreased knee flexion, palpable hard mass.
• Treatment: Avoidance of repeated trauma, possible surgical removal.

Iliac Crest Contusion

• Mechanism: Direct blow to the iliac crest.
• Symptoms: Tenderness, ecchymosis, limited hip motion.
• Differentials: Fracture, tensor fasciae latae strain.

Femoral Neck Stress Fractures

• Cause: Repetitive stress, common in runners and gymnasts.
• Symptoms: Night pain, deep seated hip pain.
• Treatment: Conservative rest or surgical fixation.

Femoral Shaft Fracture

• Mechanism: Direct contact or stress fracture breaking.
• Treatment: Requires traction splint and surgery.

Arthritis

• Less common in younger athletes but seen in older populations.

Piriformis Syndrome

• Cause: Piriformis muscle compresses sciatic nerve.
• Symptoms: Radiculopathy, positive straight leg raise test.

Bursitis

• Common Type: Trochanteric bursitis due to TFL/IT band friction.
• Symptoms: Inflammation, pain during hip movement.

Adolescent Pathologies

Slipped Capital Femoral Epiphysis

• Mechanism: Slippage of femoral neck in adolescents.
• Symptoms: Limitation in hip rotation, toe-out gait.

Legg-Calvé-Perthes Disease

• Cause: Ischemic lesions in femoral head.
• Symptoms: Medial thigh pain, limb shortening.

Conclusion

• Comprehensive overview of hip pathologies.
• Emphasis on symptoms, causes, diagnostics, and treatment options.
• Importance of early diagnosis and appropriate treatment.