Use of a Hip Spica for Management of an Acetabular Labral Tear in a Female Collegiate Gymnast: A Case Report

in International Journal of Athletic Therapy and Training
View More View Less
  • 1 Medical College of Wisconsin
  • 2 University of Wisconsin-La Crosse
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

The patient was a 20-year-old female gymnast complaining of lateral hip pain, posterior to the greater trochanter, that increased with hip extension and external rotation. Over the course of 1 month during the season, pain progressively shifted to the groin and hip extension and external rotation became limited. A minimally painful exercise program was implemented in conjunction with a supportive hip spica, assisting extension and external rotation while limiting flexion and internal rotation during therapeutic exercise. The resulting implementation of a hip spica is a novel way to reduce pain and improve function to augment current conservative treatments.

Greenwood is with the Medical College of Wisconsin, Milwaukee, WI, USA. Giblin and Gillette are with the University of Wisconsin-La Crosse, La Crosse, WI, USA.

Greenwood (agreenwood@mcw.edu) is corresponding author.
  • 1.

    Hunt D, Clohisy J, Prather H. Acetabular labral tears of the hip in women. Phys Med Rehabil Clin N Am. 2007;18(3):497520. PubMed ID: 17678764 doi:10.1016/j.pmr.2007.05.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105117. PubMed ID: 19468871 doi:10.1007/s12178-009-9052-9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Charbonnier C, Kolo FC, Duthon VB, et al. Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study. Am J Sports Med. 2011;39(3):557566. PubMed ID: 21160017 doi:10.1177/0363546510386002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Weber AE, Bedi A, Tibor LM, Zaltz I, Larson CM. The hyperflexible hip: managing hip pain in the dancer and gymnast. Sports Health. 2015;7(4):346358. PubMed ID: 26137181 doi:10.1177/1941738114532431

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):11691176. PubMed ID: 27629403 doi:10.1136/bjsports-2016-096743

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88(7):14481457. PubMed ID: 16818969 doi:10.2106/JBJS.D.02806

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ. Acetabular labral tears of the hip: examination and diagnostic challenges. J Orthop Sports Phys Ther. 2006;36(7):503515. PubMed ID: 16881467 doi:10.2519/jospt.2006.2135

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop. 2004;426:145150. doi:10.1097/01.blo.0000136903.01368.20

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Martin R, Kelly B, Philippon M. A classification system for labral tears of the hip [abstract]. J Orthop Sports Phys Ther. 2005;21(6):e36. doi:10.1016/j.arthro.2005.04.080

    • Search Google Scholar
    • Export Citation
  • 10.

    Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop. 2003;(417):112120. doi:10.1097/01.blo.0000096804.78689.c2

    • Search Google Scholar
    • Export Citation
  • 11.

    Byrd JW. Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2014;42(3):737751. PubMed ID: 23982400 doi:10.1177/0363546513499136

  • 12.

    Crawford JR. Current concepts in the management of femoroacetabular impingement. J Bone Joint Surg Br. 2005;87-B(11):14591462. doi:10.1302/0301-620X.87B11.16821

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Siebenrock KA, Ferner F, Noble PC, Santore RF, Werlen S, Mamisch TC. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop. 2011;469(11):32293240. PubMed ID: 21761254 doi:10.1007/s11999-011-1945-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthrosc J Arthrosc Relat Surg. 2015;31(6):11991204. doi:10.1016/j.arthro.2014.11.042

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Schmitz MR, Campbell SE, Fajardo RS, Kadrmas WR. Identification of acetabular labral pathological changes in asymptomatic volunteers using optimized, noncontrast 1.5-T magnetic resonance imaging. Am J Sports Med. 2012;40(6):13371341. PubMed ID: 22422932 doi:10.1177/0363546512439991

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Silvis ML, Mosher TJ, Smetana BS, et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011;39(4):715721. PubMed ID: 21233405 doi:10.1177/0363546510388931

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Gallo RA, Silvis ML, Smetana B, et al. Asymptomatic hip/groin pathology identified on magnetic resonance imaging of professional hockey players: outcomes and playing status at 4 years’ follow-up. Arthrosc J Arthrosc Relat Surg. 2014;30(10):12221228. doi:10.1016/j.arthro.2014.04.100

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012;40(12):27202724. PubMed ID: 23104610 doi:10.1177/0363546512462124

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Wall PD, Fernandez M, Griffin DR, Foster NE. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM R. 2013;5(5):418426. doi:10.1016/j.pmrj.2013.02.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Emara K, Samir W, Motasem EH, Ghafar KA. Conservative treatment for mild femoroacetabular impingement. J Orthop Surg. 2011;19(1):4145. doi:10.1177/230949901101900109

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Yazbek PM, Ovanessian V, Martin RL, Fukuda TY. Nonsurgical treatment of acetabular labrum tears: a case series. J Orthop Sports Phys Ther. 2011;41(5):346353. PubMed ID: 21335929 doi:10.2519/jospt.2011.3225

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Narveson JR, Haberl MD, Nathan Vannatta C, Rhon DI. Conservative treatment continuum for managing femoroacetabular impingement syndrome and acetabular labral tears in surgical candidates: a case series. Int J Sports Phys Ther. 2018;13(6):10321048. PubMed ID: 30534469 doi:10.26603/ijspt20181032

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Narveson JR, Haberl MD, Grabowski PJ. Management of a patient with acute acetabular labral tear and femoral acetabular impingement with intra-articular steroid injection and a neuromotor training program. J Orthop Sports Phys Ther. 2016;46(11):965975. PubMed ID: 27686411 doi:10.2519/jospt.2016.6573

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Wright AA, Hegedus EJ, Taylor JB, Dischiavi SL, Stubbs AJ. Non-operative management of femoroacetabular impingement: a prospective, randomized controlled clinical trial pilot study. J Sci Med Sport. 2016;19(9):716721. PubMed ID: 26795448 doi:10.1016/j.jsams.2015.11.008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    MacIntyre K, Gomes B, MacKenzie S, D’Angelo K. Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report. J Can Chiropr Assoc. 2015;59(4):398409. PubMed ID: 26816416.

    • Search Google Scholar
    • Export Citation
  • 26.

    Loudon JK, Reiman MP. Conservative management of femoroacetabular impingement (FAI) in the long distance runner. Phys Ther Sport. 2014;15(2):8290. PubMed ID: 24629576 doi:10.1016/j.ptsp.2014.02.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Cashman GE, Mortenson WB, Gilbart MK. Myofascial treatment for patients with acetabular labral tears: a single-subject research design study. J Orthop Sports Phys Ther. 2014;44(8):604614. PubMed ID: 25029918 doi:10.2519/jospt.2014.5095

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Fairley J, Wang Y, Teichtahl AJ, et al. Management options for femoroacetabular impingement: a systematic review of symptom and structural outcomes. Osteoarthritis Cartilage. 2016;24(10):16821696. PubMed ID: 27107630 doi:10.1016/j.joca.2016.04.014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018;46(6):13061314. PubMed ID: 29443538 doi:10.1177/0363546517751912

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Alradwan H, Philippon MJ, Farrokhyar F, et al. Return to preinjury activity levels after surgical management of femoroacetabular impingement in athletes. Arthrosc J Arthrosc Relat Surg. 2012;28(10):15671576. doi:10.1016/j.arthro.2012.03.016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Audenaert EA, Peeters I, Vigneron L, Baelde N, Pattyn C. Hip morphological characteristics and range of internal rotation in femoroacetabular impingement. Am J Sports Med. 2012;40(6):13291336. PubMed ID: 22472271 doi:10.1177/0363546512441328

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Tijssen M, van Cingel RE, de Visser E, Hölmich P, Nijhuis-van der Sanden MW. Hip joint pathology: relationship between patient history, physical tests, and arthroscopy findings in clinical practice. Scand J Med Sci Sports. 2017;27(3):342350. PubMed ID: 26833818 doi:10.1111/sms.12651

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Kuhlman GS, Domb BG. Hip impingement: identifying and treating a common cause of hip pain. Am Fam Physician. 2009;80(12):14291434. PubMed ID: 20000305.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    LeBeau RT, Nho SJ. The use of manual therapy post–hip arthroscopy when an exercise-based therapy approach has failed: a case report. J Orthop Sports Phys Ther. 2014;44(9):712721. PubMed ID: 25098193 doi:10.2519/jospt.2014.5047

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 229 229 122
Full Text Views 144 144 11
PDF Downloads 76 76 3