HIP INJURIES
Labral Tears
Hip injuries account for 6% of all sports injuries and are see most often in athletes who play sports like football, basketball, soccer, hockey and ballet. These sports, which demand rapid starts and stops, cutting and pivoting, all put stress on the hips and can lead to labral tears, bursitis, and arthritis.
Description
The hip labrum is a ring of cartilage that encircles the hip socket and helps keep the ball at the top of the femur bone from slipping out of the socket. There is minimal blood flow to this area, which makes healing without surgery difficult. When significant pain and/or dysfunction is present, it’s important to get a timely diagnosis for the best possible outcome.
Cause
Direct impact injury, dislocation, and repetitive motion/impingement can cause a hip labral tear.
Symptoms
Symptoms include a lack of stability, locking, clicking or catching felt within the joint, joint pain and stiffness, limited range of motion, or pain or discomfort that worsens upon bending or rotating the hip.
Diagnosis
Diagnosing a hip labral tear requires an in-office examination and detailed patient history. X-Rays will be obtained at the first visit to assess bony structures and possible degenerative changes. If the suspicion of a tear is high an MRI with dye will be ordered.
Non-Operative Treatment
Non-operative treatments include physical therapy, home-exercise, anti-inflammatories and injections at the site.
Operative Treatment
If non-operative treatment fails to get you to your goals, we will discuss surgery. Surgery is performed arthroscopically. During surgery, we try to address all pain generators. Typically this consists of labral repair and resection of abnormal bony structures which cause impingement. In rare situations where there is not enough labrum to repair, we may discuss reconstructing the labrum with either your own or cadaver grafts.
HIP INJURIES
Bursitis
Hip bursitis, also known as trochanteric bursitis, occurs when the fluid-filled sacs (bursa) become inflamed. Bursa exist in areas of high friction, such as when tendons run over bony prominences or projections. Runners and cyclists, in particular, are prone to hip bursitis, and it is often a side-effect of increased training intensity or overuse.
Description
Inflammation and irritation of the hip bursa located on the outside of the hip. Pain can last for six months or more after diagnosis and treatment protocols are initiated. Hip bursitis occurs more commonly in active individuals however, it is also very common during a period of increased activity.
Causes
Hip bursitis has many causes. Most commonly it is seen in individuals who repetitively flex and extend the hips (especially cyclists and runners) or in periods of increased activity.
Symptoms
Pain can vary in intensity and is classically on the outside of the hip over the bony projection known as the Greater Trochanter. This is different than pain originating from the hip joint which is typically felt on the inner thigh or groin area.
Diagnosis
Physical examination is typically all that is needed for diagnosis. I will always get X-rays to get a full assessment of the hip. MRI is almost never needed unless another diagnosis is suspected.
Non-Operative Treatment
Non-operative treatment can consist of physical therapy, anti-inflammatories, corticosteroid injections at the site, antibiotic treatment, draining the bursa of excess fluids, rest and modified activity.
Operative Treatment
Surgical intervention is rare, but when necessary it consists of removing the hip bursa. This surgery is now commonly performed arthroscopically and does not typically require an overnight hospital stay.
HIP INJURIES
Gluteal Tendinopathy
Most people are familiar with the gluteus maximus as it is the most prominent muscle on our behinds. However, its smaller, middle, sibling is perhaps more important. The Gluteus Medius is a muscle performing both stabilizing and movement functions of the pelvis and the hip. With such important functions, it is often a source of chronic injury and weakness.
Description
Injury to the gluteus medius tendon is typically due to “death by a thousand cuts.” This is a structure crucial to pelvic stability and lower extremity function. The initial injury can elicit an inflammatory response and over time can become a chronic, degenerative process.
Symptoms
Symptoms typically include pain on the outside or lateral aspect of the hip (almost identical to Trochanteric Bursitis), weakness on strength testing, pelvic instability on standing, and increased pain with activity.
Diagnosis
As with most issues, a physical exam will typically be all that is needed for diagnosis. X-rays will be taken to fully assess the hip. MRI is also common to assess the severity of the injury.
Non-Operative Treatment
Non-operative treatment, as you may have noticed, is similar for most injuries with the exception of injections. Injections are avoided in most tendinopathies due to the concern of weakening the tendon further. We focus on activity modification, anti-inflammatories by mouth, physical therapy and home exercise and topical anti-inflammatories.
Operative Treatment
Operative treatment, as with most things, comes into play when non-operative management fails to achieve your goals. I typically perform tendon repair thru a mini-open approach, but still as a same-day or outpatient procedure.
HIP INJURIES
Hamstring Injuries
The hamstring muscle group helps flex the knee. They run from their insertion on the back of the pelvis to their attachment on the front and outside of the knee. Most often these are simple strains or “pulls”, but occasionally the insertion is disrupted and requires more invasive treatment.
Description
The hamstrings are a group of three muscles responsible for flexion of the knee and extension of the hip. Injuries typically occur with forceful flexion of the hip and extension of the knee. This can be due to injury during sports (running, football, water skiing) or accidents, even simple falls.
Symptoms
Pain in your buttock region or back of the thigh, bruising in the back of your thigh which may extend to the back of your knee, tingling down your leg (the sciatic nerve runs closely to these tendons), knee flexion weakness, hip extension weakness, and a stiff legged gait as most people try to avoid hip and knee flexion.
Diagnosis
Physical examination in the office diagnoses most injuries, however a detailed history is as important to help determine severity. A history of prior tear is most predictive of a recurrence or future tear. X-Rays of your pelvis and hip are always obtained to fully assess the hip and determine if the tendon pulled a piece of bone with it. MRI is especially helpful to determine grade of injury but typically will only be obtained if there is concern surgery is needed.
Non-Operative Treatment
The vast majority of tears are minor and can be managed non-surgically with anti-inflammatories, rest, ice and protected weight bearing (crutches). When symptoms resolve we can begin physical therapy and strengthening.
Operative Treatment
If the tear is more severe, involving more than one tendon, is retracted beyond an acceptable distance, has failed non-surgical treatment or has pulled its bony attachment off the pelvis, we will discuss surgical repair. Surgery is done with an open procedure as the Sciatic nerve runs unacceptably close to the tendons to allow arthroscopic procedures to be done safely in my opinion. Surgery is still done on an outpatient basis, no need to stay overnight in the hospital.