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Alyssa C. Adams, Kelly B. Fleming and Patricia M. Tripp

and osteoarthritis. Although uncommon among the general population (4–23% of hip pain cases), 1 hip dysplasia diagnoses (at varying severities) occur in 67–92% of competitive female athletes whose sport performance depends heavily on flexibility (e.g., gymnastics, ballet, and figure skating). 2

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Matthew D. Freke, Kay Crossley, Trevor Russell, Kevin J. Sims and Adam Semciw

Hip strength and range of movement (ROM) impairments are consistently reported in individuals with hip pain when compared with asymptomatic controls. 1 – 3 The presence of hip pain also affects lower limb reaching, gait, forward stepping, and squatting with evidence that dynamic single-leg balance

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Danielle Lovett Carter and Norelee Kennedy

Background:

Hip arthroscopy is a minimally invasive surgical procedure. Femoroacetabular impingement (FAI) is being increasingly recognized as a cause of hip pain in athletes and is a growing indication for arthroscopic surgery. Few studies have attempted to address patient views on outcome after arthroscopy, and no qualitative studies have been carried out to date.

Objectives:

To explore athletes' perceptions of rehabilitation outcome, the rehabilitative process, and return to sport and to gain insight into factors that affected this process.

Methodology:

A retrospective qualitative approach was adopted using semistructured interviews. Eight eligible participants were interviewed. Each had been treated with hip arthroscopy for FAI from September to November 2010. Data were audiotaped, transcribed verbatim, and analyzed using thematic analysis.

Results:

Three main themes emerged. (1) The ability to participate in sport; athletes were relatively satisfied with outcome despite some limitations in sporting ability. (2) Perceptions of hip problems; there was a lack of understanding and an association of hip problems with older people among the general public. (3) Athletes' perception of rehabilitation; athletes were dissatisfied with the rehabilitation and sought greater physiotherapy input.

Conclusions:

Overall, athletes were relatively satisfied with their outcome 1 y after hip arthroscopy, despite some having to adapt their sporting activities. Key areas that need to be addressed in future research include factors affecting outcomes of hip arthroscopy, longer-term outcomes, perception of FAI among the public and health practitioners, and the development of a standardized evidence-based rehabilitation protocol.

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Thomas Koesterer, Aaron Blanchard and Patrick Donnelly

Objective:

To present a unique case of meralgia paresthetica.

Background:

A 21-year-old male collegiate lacrosse player fell, twisted his right leg, and felt a “pop” in his hip. Objective fndings included: antalgic gait, mild palpable swelling, and tenderness to touch with limited range of motion due to pain. Joint stability tests were negative.

Differential Diagnosis:

Right hip abductor strain, hip sprain, trochanteric bursitis, or labral tear.

Treatment:

The physician’s findings included deep hip pain that increased with hip scouring and pain with active and passive motion. The physician’s diagnosis was hip sprain; treatment was to continue with ice and begin active progression for return to play. The athlete was treated over the next several days with warm whirlpools, stretching, and a hip fexor wrap. Ten days postinjury, the athlete played in a game, but in the fourth quarter came off the field stating he couldn’t feel his thigh. The orthopedic physician evaluated the athlete and provided a differential diagnosis of right hip fexor strain and hip capsule sprain with numbness, possibly due to meralgia paresthetica. The physician ordered treatment to continue and began a regimen of 600 mg of ibuprofen three times per day and noted the athlete could continue to play.

Uniqueness:

The athlete did not show any symptoms of meralgia paresthetica for 10 days post initial injury. The meralgia paresthetica was most likely caused by swelling resulting from the hip sprain, in which the swelling compressed the lateral femoral cutaneous nerve (LFCN) against the inguinal ligament.

Conclusions:

Meralgia paresthetica may occur as a result of trauma and subsequent swelling of the inguinal region. A thorough evaluation of the hip must be conducted to ensure no motor neuron involvement is associated with the paresthesia symptoms.

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Austin Greenwood, Naoko A. Giblin and Cordial Gillette

imaging to differentiate clinically-relevant pathology from incidental findings. Classic findings include anterior hip pain or “c” sign, painful hip flexion and internal rotation, positive anterior impingement test, and positive FABER test. 2 , 6 , 11 , 31 , 32 These exam findings, in combination with

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John H. Hollman, Tyler A. Berling, Ellen O. Crum, Kelsie M. Miller, Brent T. Simmons and James W. Youdas

Conditions contributing to hip pain are experienced across the lifespan. In young, active adults, anterior hip pain can be particularly problematic. Differential diagnoses for anterior hip pain in young adults range from extra-articular muscle injuries to intra-articular labral tears. 1 Hip pain

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Heather VanOpdorp, Bonnie Van Lunen and James Swanson

Context:

Hip and pelvic injuries are often associated with direct trauma, but spe-cific fractures to the acetabulum are rare. The signs and symptoms of an acetabular fracture can mimic those of conditions that are more common at the hip area, and therefore the specificity of the diagnostic testing is crucial.

Objective:

To present the case of a female Division I college field-hockey player who developed a superomedial acetabular fracture.

Background:

The athlete’s initial complaint of intolerable hip pain decreased after a 3-week rest period but persisted with passive internal and external hip rotation. Additional diagnostic testing was needed to differentiate the various pathologies that were associated with her symptoms.

Conclusions:

Clinicians should be aware of the potential differential diagnoses of the hip and should investigate all potential possibilities even though they might not coincide with the initial injury.

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Chen Deng, Jason C. Gillette and Timothy R. Derrick

A detailed understanding of the hip loading environment is needed to help prevent hip fractures, minimize hip pain, rehabilitate hip injuries, and design osteogenic exercises for the hip. The purpose of this study was to compare femoral neck stress during stair ascent and descent and to identify the contribution of muscles and reaction forces to the stress environment in mature adult subjects (n = 17; age: 50–65 y). Motion analysis and inverse dynamics were combined with musculoskeletal modeling and optimization, then used as input to an elliptical femoral neck cross-sectional model to estimate femoral neck stress. Peak stress values at the 2 peaks of the bimodal stress curves (stress vs time plot) were compared between stair ascent and descent. Stair ascent had greater compressive stress than descent during the first peak at the anterior (ascent: −18.0 [7.9] MPa, descent: −12.9 [5.4] MPa, P < .001) and posterior (ascent: −34.4 [10.9] MPa, descent: −27.8 [10.1] MPa, P < .001) aspects of the femoral neck cross section. Stair descent had greater tensile stress during both peaks at the superior aspect (ascent: 1.3 [7.0] MPa, descent: 24.8 [9.7] MPa, peak 1: P < .001; ascent: 15.7 [6.1] MPa, descent: 18.0 [8.4] MPa, peak 2: P = .03) and greater compressive stress during the second peak at the inferior aspect (ascent: −43.8 [9.7] MPa, descent: −51.1 [14.3] MPa, P = .004). Understanding this information can provide a more comprehensive view of bone loading at the femoral neck for older population.

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Scott W. Cheatham, Keelan R. Enseki and Morey J. Kolber

Context:

Hip arthroscopy has become an increasingly popular option for active individuals with recalcitrant hip pain. Conditions that may be addressed through hip arthroscopy include labral pathology, femoral acetabular impingement, capsular hyperlaxity, ligamentum teres tears, and the presence of intra-articular bodies. Although the body of literature examining operative procedures has grown, there is a paucity of evidence specifically on the efficacy of postoperative rehabilitation programs. To date, there are no systematic reviews that have evaluated the available evidence on postoperative rehabilitation.

Objective:

To evaluate the available evidence on postoperative rehabilitation programs after arthroscopy of the hip joint.

Evidence Acquisition:

A search of the PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar databases was conducted in January 2014 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews.

Evidence Synthesis:

Six studies met the inclusion criteria and were either case series or case reports (level 4 evidence) that described a 4- or 5-phase postoperative rehabilitation program. The available evidence supports a postoperative period of restricted weight bearing and mobility; however, the specific interventions in the postoperative phases are variable with no comparison trials.

Conclusion:

This review identified a paucity of evidence on postoperative rehabilitation after hip arthroscopy. Existing reports are descriptive in nature, so the superiority of a particular approach cannot be determined. One can surmise from existing studies that a 4- to 5-stage program with an initial period of weight-bearing and mobility precautions is efficacious in regard to function, patient satisfaction, and return to competitive-level athletics. Clinicians may consider such a program as a general guideline but should individualize treatment according to the surgical procedure and surgeon guidelines. Future research should focus on comparative trials to determine the effect of specific postoperative rehabilitation designs.