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HIP PAIN

Diposting oleh Kampung Awam Label:

Hip Pain

  1. See Also
    1. Rheumatologic Conditions affecting the Hip
    2. Hip Exam
    3. Hip Anatomy
    4. Testicular Pain
  2. Epidemiology: Groin Injury in Athletes
    1. Groin injury accounts for 2-5% of sports injury
    2. Higher risk sports for groin injury
      1. Soccer (Incidence 5-7%)

·Definition

o Number of new disease cases per population at risk

§ High incidence implies high disease occurrence

§ Low incidence implies low disease occurrence

o Measured over a given time interval

· Usage

o Determine probability of developing a specific disease

o Used to detect etiologic factors

· References

o Hennekens (1987) Epidemiology Medicine, p.54-98

      1. Ice hockey
      2. Fencing
      3. Handball
      4. Cross Country Skiing

· Epidemiology

o Injury Incidence: 0.5 to 5.6 injuries per 1000 ski days

o Majority of injuries occur on downhill runs

· Benefits

o Lower impact than other aerobic sports (e.g. Running)

§ Safe after total hip replacement

· Gschwend (2000) Acta Orthop Scand 71(3):243

· van der Bogert (1999) Med Sci Sports Exerc 31:131

o Higher femoral Bone Mineral Density

§ Pettersson (2000) Calcif Tissue Int 67(3):199

o Moderate to strenuous aerobic Exercise

§ Energy cost is net VO2 to speed ratio

· Study calculated VO2 from Heart Rate

§ Energy cost equivalent to uphill treadmill walking

· Classic skiing: 162 ml/km-kg

· Skate skiing: 148 ml/km-kg

· Mognoni (2001) Eur J Appl Physiol 85(1-2):62

o Pole striding effective in Peripheral Vascular Disease

§ Improves Claudication pain and Exercise tolerance

§ Langbein (2002) J Vasc Surg 35(5):887

· Cross country skiing techniques

o Classical skiing (Diagonal Stride)

o Skate Skiing (Free style)

§ Offset (V1)

· Double pole plant to one side (e.g. left)

· Poling when weight is transferred to one ski

§ Two skate (V2A)

· Symmetrical pole plant

§ One skate (V2)

· Pole planted as weight is transferred to each ski

· Highest energy cost (VO2 to speed) and Heart Rate

o Millet (2003) J Sports Sci 21(1):3

o Pole striding

§ Often used for dry land training in off season

§ Walking with use of poles (especially on uphill)

§ Body position and leg movement similar to skiing

· Common Cross Country Skiing Injuries

o Hip and thigh

§ Hamstring Strain

o Knee

§ Medial Collateral Ligament Sprain (most common)

§ Anterior Cruciate Ligament Rupture

§ Medial or Lateral Meniscal Tear

§ Patellofemoral Syndrome

o Ankle and calf

§ Acute Lateral Ankle Sprain

§ Medial Tibial Stress Syndrome

§ Exertional Compartment Syndrome

o Foot

§ Hallux Rigidus (Skier's Toe)

§ Sesamoid inflammation of great toe

o Shoulder

§ Acromioclavicular joint separation

§ Rotator Cuff Tendinitis

o Elbow

§ Triceps tendinitis

o Hand and wrist

§ Ulnar Collateral Ligament Rupture (Skier's Thumb)

§ Wrist extensor tendinitis

o Cold related injury

§ Frostbite

§ Hypothermia

o Exercise Induced Bronchospasm (EIB)

§ X-C Skiing has highest EIB rate of all winter sports

· EIB in 50% of Olympic skiers (25% in other sports)

· Wilber (2000) Med Sci Sports Exerc 32(4):732

§ Slow warm-up prior to cold Exercise may reduce EIB

· Slowly build-up exertion level in a work-out

· Warm-up before a ski race

· Predictors of cross country skiing performance

o Best predictors on Exercise treadmill testing

§ Males: Onset of blood lactate accumulation

§ Females: Intensity when respiratory exchange ratio 1

§ Larsson (2002) Scand J Med Sci Sports 12(6):347

o Upper body conditioning is critical to performance

§ Hoff (1999) Med Sci Sports Exerc 31(6):870

§ Mahood (2001) Med Sci Sports Exerc 33(8):1379

§ Millet (2003) J Sports Sci 21(1):3

· References

o Morris (1999) Postgrad Med 105(1):89

      1. Hurdling
      2. High Jumping
  1. Causes: Common pearls by location
    1. Groin Pain
      1. Consider Intra-articular hip pain
    2. Lateral Pain
      1. Trochanteric Bursitis
    3. Buttock Pain
      1. Referred pain from lumbosacral spine
      2. Sacroiliac joint
      3. Piriformis Syndrome (deep pain worse with sitting)
  2. Causes: Anterior Hip Pain
    1. Spontaneous onset without trauma in elderly
      1. Consider inflammatory arthritis, infection
      2. Ask about systemic symptoms
      3. Start evaluation with CBC, ESR, RF
    2. Insidious onset in elderly
      1. Risks: age >65, ROM pain, cancer, trauma, Alcohol
      2. Start with Hip XRay
        1. Evaluate for Osteoarthritis
        2. Consider Avascular necrosis, tumor or Fracture
    3. Overuse or sports related anterior hip pain
      1. Clicking or Snapping Hip
        1. Tests: Thomas Test or Snapping Hip maneuver
        2. Common Diagnoses (See Snapping Hip)
          1. Iliopsoas Bursitis
          2. Labral tear
      2. Suspected Stress Fracture
        1. Obtain MRI
        2. Non-weight bearing
      3. Resisted muscle testing and local tenderness
        1. Consider hip flexor Muscle Strain
  3. Causes: Lateral Hip Pain
    1. Overuse or sports related
      1. Consider Iliotibial Band Syndrome
    2. Tender over greater trochanter
      1. Greater Trochanteric Bursitis
    3. Tender at gluteus medius, hip abductor weakness/pain
      1. Gluteus medius muscle dysfunction
    4. Anterolateral thigh neuropathic pain
      1. Meralgia Paresthetica
  4. Causes: Groin pain or hip pain in athletes
    1. Idiopathic in 30% of cases
    2. Adductor Strain or Adductor Tendinitis (Groin Pull)
    3. Pubic Instability
    4. Osteitis Pubis
    5. Myositis Ossificans
    6. Sports Hernia
    7. Groin Disruption
    8. Iliopsoas Strain or Iliopsoas Bursitis
    9. Snapping Hip syndrome
    10. Femoral Neck Stress Fracture
    11. Pubic Ramus Stress Fracture
    12. Avulsion Fracture (Adolescent Athletes)
      1. Anterior Superior Iliac Spine Avulsion Fracture
        1. Rapid sartorius contraction in jumping sport
        2. Responds to non-operative conservative therapy
      2. Anterior Inferior Iliac Spine Avulsion Fracture
        1. Strong rectus femoris contraction in kicking sport
        2. Responds to non-operative conservative therapy
      3. Ischial Tuberosity Avulsion Fracture
        1. Rapid hamstring contraction in sprinting, hurdling
        2. Fragments >1-2 cm may require ORIF
    13. Nerve entrapment
      1. Genitofemoral nerve entrapment
      2. Lateral Femoral Cutaneous Nerve Entrapment
      3. Ilioinguinal Nerve Entrapment
      4. Obturator Nerve Entrapment
  5. Causes: Hip joint disorders with groin or hip pain by age
    1. Pediatric Causes (under age 10 years)
      1. See Pediatric Limp
      2. Legg-Calve-Perthes Disease
      3. Septic Joint
      4. Toxic Synovitis
    2. Adolescent causes
      1. Slipped Capital Femoral Epiphysis
      2. Hip Avulsion Fracture
    3. Adult causes (See causes below)
      1. Osteoarthritis of femoral head
      2. Avascular necrosis of the femoral head
      3. Acetabular labral tear
  6. Causes: Musculoskeletal causes of groin or hip pain
    1. Bone Causes
      1. Hip Fracture
      2. Femoral head avascular necrosis
      3. Cancer (primary site or metastases)
    2. Joint Causes
      1. Hip Osteoarthritis
      2. Septic Arthritis
      3. Gouty Arthritis
      4. Osteoid Osteoma
      5. Osteitis Pubis
    3. Muscle or tendon Causes
      1. Iliotibial Band Syndrome
      2. Trochanteric Bursitis
      3. Iliopsoas Bursitis
      4. Pyriformis Syndrome
      5. Myositis Ossificans
    4. Neurologic Causes
      1. Lumbar Disc Disease
      2. Lumbar Spinal Stenosis
      3. Coccygodynia
      4. Meralgia Paresthetica (see nerve entrapment above)
  7. Causes: Non-musculoskeletal causes of groin or hip pain
    1. General
      1. Inguinal Hernia
      2. Inguinal Lymphadenopathy or lymphadenitis
      3. Lumbar Disc Disease with L1-2 radiculopathy
      4. Nephrolithiasis
      5. Abdominal Aortic Aneurysm
      6. Appendicitis
      7. Diverticulitis
      8. Inflammatory Bowel Disease
      9. Malignancy
    2. Women
      1. Ovarian Cyst
      2. Urinary Tract Infection
      3. Pelvic Inflammatory Disease
    3. Men
      1. Epididymitis
      2. Hydrocele
      3. Varicocele
      4. Prostatitis
      5. Testicular Cancer
  8. References
    1. Fields (1997) Lecture: AAFP Sports Medicine, Dallas
    2. Ruane (1998) Physician SportsMed 26(4):78-103
    3. Brunner (2003) Am Fam Physician 67(3):537
    4. Fricker (1997) Br J Sports Med 31:97
    5. Lynch (1999) Sports Med 28:137
    6. Morelli (2001) Am Fam Physician 64(8):1405





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