Diagnosing sports injuries of the hip

With athletes pushing their bodies to the limit, hip injuries are increasingly common, says Mr Arvind Mohan.

In diagnosing any hip pathology a full history including the sport, mechanism of injury and technique of the sport along with a detailed examination is paramount.

Stress fractures of the hip
Stress fractures of the hip are usually seen as undisplaced fractures of the neck of the femur or pubic rami in athletes with amenorrhoea or eating disorders.

Patients complain of pain on movement and pain relieved by resting.

Fractures can involve the superior or inferior aspect of the neck and should be referred to an orthopaedic surgeon urgently.

These fractures are usually diagnosed by X-ray of the hip or they might even need an MRI.

Fractures of the neck of the femur need fixation, whereas pubic rami fractures are usually managed conservatively.

Bone contusions
Bone contusions are seen in athletes involved in running and kicking sports and present as severe pain in the hip, aggravated by weight bearing.

They are usually diagnosed on an MRI scan of the hip as bone oedema and managed conservatively with rest and analgesics.

Avulsion fractures
Avulsion fractures are usually seen at the attachment of various muscles around the hip joint, for example the sartorius, rectus femoris, iliopsoas and adductors. If the fracture is small, say 2cm, it can be managed conservatively with rest and analgesics. Larger fractures may need fixation.

Acetabular labral lesions
There are three types of acetabular labral lesions depending on the location - anterior, posterior and inferior. Most commonly they are seen anteriorly and associated with sudden twisting and rotating movements.

Common in people with developmental dysplasia of the hip. Hip arthroscopy is a good tool in management of these injuries as evidence shows that if not treated patients are at greater risk of developing early arthritis of the hip.

Psoas or adductor sprain
Adductor sprain is the most commonly seen sprain around the hip in athletes.

In acute settings it can be managed conservatively. However, chronic sprains might need a surgical intervention. The iliopsoas bursa is the largest bursa in the body and can get inflamed in various sports such as ballet and soccer. These sprains can be diagnosed with MRI or ultrasound.

Snapping hip
Snapping hip can be attributed to both iliopsoas and iliotibial band.

They are easily distinguished on localisation of pain. It is usually managed conservatively, with surgery only indicated for recalcitrant cases.

Ostetitis pubis
Ostetitis pubis is a painful, inflammatory and non-infectious condition affecting the pubic symphysis.

It is common in athletes involved in forceful kicking sports. Muscle imbalance around the hip and abdominal wall is considered the major aetiological factor and it is managed conservatively with rest, analgesics and physiotherapy.

Sports hernias
Sports hernias present as unexplained groin pain in many professional athletes and involve a spectrum of injuries principally involving the conjoined tendon, inguinal ligament, transversalis fascia, internal oblique and external oblique muscles. Investigations such as MRI are used for diagnosis.

Hamstring injuries
Hamstring injuries are usually seen in active sports such as football and rugby, and can be a sprain, partial or complete rupture. MRI can be used for imaging but still has a high incidence of false negative results.

Roughly, one third of these patients need operative fixation if there is an underlying tear.

Piriformis syndrome
Piriformis syndrome usually presents with buttock pain.

Various aetiologies have been suggested, including compression of the sciatic nerve or hypertrophy of the piriformis muscle. Most cases respond conservatively. Surgical intervention in the form of release of the piriformis and decompression of the sciatic nerve is needed only in recalcitrant cases.

Mr Mohan is an orthopaedic surgeon at Southampton General Hospital, Southampton

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