Snapping Hip Syndrome

Caused by excessive repetitive movement:(1) iliotiial band moving over the greater trochanter causing trochanteric bursitis and (2) the iliopsoas tendon moving over the iliopectineal eminence

MOI: narrow pelvis, abnormal increases in abduction, and lack of ROM in to external rotation or tight interal rotators.

S/S: unstable hip, snapping sensation accompanied by severe pain and disability

Management: decrease pain and inflammation with ice, antiinflammatory medication, and modalities such as ultrasound 

Femoral Retroversion

A positional deformity caused by the contracture of the external rotator muscles of the hip. The angle of the head and neck of the femur is rotated posteriorly. This causes a "turned out" appearance. 

MOI: tightness of the external rotators of the hip or a developmental deformity

S/S: late walker, associated with flat feet, poor balance, "turned out" appearance, excessive external rotation at the hip

Management: stretching of the tight musculature, physical therapy to strengthen the adductors and internal rotators of the hip, orthotics for the feet

Femoral Anteversion

The angle of the head and neck of the femur is rotated anteriorly, beyond that of the normal torsion with respect to the shaft. The result is a range of medial hip rotation that appears to be excessive, whereas the lateral rotation spears to be limited.

MOI: developmental deformity

S/S: clumsy gait, “pigeon-toed”, “kissing patellae”, sitting with hips flexed and internally rotated, and rarely any pain.

Management: use of shoe modification, day or night splints, passive stretching exercises, and physical therapy

Hip Sprain

Hip joint is the strongest and best-protected joint in the human body. Unusual movement may cause tearing of the supporting ligamentous and muscular tissues.

MOI: violent twist, impact force, forceful contact, planted foot and trunk is twisted

S/S: significant pain in the hip, pain increases with hip flexion

Management: x-rays or MRI to rule out fracture, RICE, NSAID's, and analgesics as needed. Depending on grade of sprian, weight bearing should be restricted (crutches for grade 2-3)

Hip Pointer

Iliac crest contusion and contusion of the abdominal musculature occurs most often during contact sports. It is difficult to manage.

MOI: a direct blow to the iliac crest

S/S: immediate pain, spasms, temporary paralysis of the soft structures, unable to rotate the trunk or flex thigh without pain

Management: RICE up to 48 hours afterward, bed rest for 2 days if severe, x-ray examination, ice massage, ultrasound, injectable steroid, oral inflammatory

Dislocated Hip

Rarely occurs in sports; but as a result of traumatic force directed along the long axis of the femur. Most common dislocation is one posteior to the acetabulum

MOI: direct force to the long axis of the femur when the knee is bent

S/S: flexed, adducted, and IR thigh, palpation reveals movement of the head of the femur, capsular and ligamentous tearing, possible damage of sciatic nerve, severe pain

Management: immediate medical attention, immobilization for at least 2 weeks and the use of crutches for at least a month

Proximal Hamstring Strain

Most common injury to the thigh. Varies between pulling apart of a few muscle fibers to complete rupture.

Possible causes: muscle fatigue, faulty posture, leg-length discrepancy, tight hamstrings, improper form, adverse neural tension, and imbalance in strength between hamstrings muscle groups

MOI: sudden changes in direction or starting movement too slowly

S/S:  capillary hemorrhage, pain, and immediate loss of function varying according to the degree of trauma

Management: RICE, NSAIDs, and analgesics as needed, activity reduction, isometric exercise, ultrasound, cryotherapy, and a compression wrap

Proximal Sartorius Strain

Commonly known as the "Tailor's muscle" due to the motions it produces. The sartorius motions are: flexion, abduction, and external rotation (FABER). During sudden or harsh movements, the fibers of the sartorius can become partially or completely torn. 

MOI:  blunt trauma, sudden upward forces, excessive external rotation or adduction

Management: Rest, ice, NSAIDs, a compression wrap over the point of pain, activity reduction, stretching and strengthening as the injury progresses

Hip Flexor/Adductor Strain

Musculature includes: ilipsoas, rectus femoris, and the adductor group. Any of these muscle groups can be injured during activity; adductor longus is most often strained. 

MOI:  running, jumping, twisting with external rotation 

S/S:  sudden twinge or feeling of tearing during active movement, pain, weakness, and internal hemorrhage

Management: RICE, NSAIDs, and analgesics for 48 to 72 hours, whirlpool or cryotherapy, ultrasound, and exervise rehabilitation with the use of a compression wrap or bandage if needed

Gluteal Strain

Occurs when there is a tear in the muscle of your buttocks. 

MOI: running or jumping; common in hurdlers and dancers

S/S: pain in the buttocks, difficulty with walking up and down stairs, sitting, and with leg extension

Management: decrease in activity that increases pain, rest and ice the area, use pain medication if needed, stretching protocols, and physical therapy

Contused Genitalia

A soft-tissue injury or bruise to the genitalia.

MOI: Blood vessels near the surface are damaged due to a bump or blow

S/S: pain or tenderness, local swelling, and changes in skin color from redness and bruising

Management: ice, x-ray to rule out severity, most heal without treatment, NSAID's for pain if needed

Spermatic Cord Torsion

Occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. Usually requires emergency surgery. If treated early enough, the testicle can be saved.

MOI: no true mechanism, inherited trait that allows testicles to freely rotate in the scrotum

S/S: Sudden or severe pain in the scrotum, swelling, abdominal pain, nausea and vomiting, a testicle positioned higher

Management: Surgery is required to correct the torsion, manual detorsion can untwist the testicle, however surgery is needed to prevent further complications.

Traumatic Hydrocele

A sac that fills with fluid surrounding a testicle. Most common in babies, but are harmless. Types: noncommunicating-sac closes but body does not absorb the fluid & communicating-sac does not close and allows fluid to move in and out

Cause: a fluid-filled sac that does not close off during development or later in life when a channel to the testicles has not closed or reopens

S/S: swelling of the scrotum, a feeling of heaviness, does not cause pain

Management: infants: should go away after about a year, if it does not surgery will be required to remove it

Adults: surgery will be necessary, pain medications after surgery

Femur Fracture

The femur is the longest and strongest bone in the body. Any break along the length of the bone is a femur fracture. Types: transverse-straight horizontal break, oblique-angled line break, spiral-encircles the shaft, comminuted-broken into three or more pieces, and open-bone fragments stick out through the skin.

MOI: strong blunt force, car crash, high energy collision, falls from high heights

S/S: immediate severe pain, no weight bearing, shorter appearance, gross deformity

Management: surgical fixation, immobilization, pain medication, physical therapy

Pelvic Fracture

Pelvis is made of three bones: ilium, ischium, and pubis. Large vessels and nerves run through the pelvis, thus a pelvic fracture can be a medical emergency.

Cause: sudden muscle contractions high velocity impacts: car crash, height fall; elderly people with osteoporosis: falls 

S/S: painful, swollen, bruised, can be considerable bleeding, individual may try to bend the knee to alleviate pain

Management: non-surgical treatment-crutches or walker to prevent full weight bearing and pain medications; surgical-external fixation, pain medications, crutches or wheelchair, and physical therapy

Trochanteric Bursitis

Bursitis is inflammation of a bursa. Bursa are fluid-filled sacs in the body that are located between bones and tissues to provide a cushion. In this case, the bursa along the greater trochanter is inflamed.

MOI: running, jumping, or a direct hit to the area

S/S: pain at the point of the hip, worse at night, when lying on the affected hip, or getting up from a chair, pain increases when doing activity

Management: non-surgical-decrease in painful activity, assisted devices (cane or crutches), NSAID's, physical therapy, and steroid injections; surgical-is rare and only occurs if the non-surgical practice does not work. Surgery will take place to remove the bursa

Iliopsoas Bursitis

Inflammation of the bursa which sits underneath the iliopsoas muscle in the hip. 

MOI: overuse injury that occurs from repetitive rubbing of the iliopsoas tendon over the bursa. Common in runners and swimmers and those with tight hip flexors

S/S: pain at the front of the hip, pain that radiates down to the knee, tenderness at front of hip and quads, snapping sensation at the front of the hip, stiffness in the morning, increase in pain during activity

Management: RICE, stretching of the hip flexors, NSAIDs for the pain, refrain from painful activity, and implement physical therapy

SI Dysfunction

Pain and inflammation at the sacroiliac joint. The SI joint is located between the sacrum and the ilium. It is known to cause low back and leg pain. 

MOI: generally is a chronic issue occuring from the damage of the cartilage that lines the bones causing bones to rub on each other, any condition that alters the normal walking pattern places you at higher risk: leg-length discrepancy

S/S: pain in the lower back, worsens when standing and walking, improves when lying down

Management: steroid injections, rest and ice, NSAIDs, physical therapy, use of a sacrioiliac belt or other types of manual therapy, or surgery if too severe

Legg Perthes Disease

A childhood condition that affects the hip when blood supply is temporarily interrupted to the ball part of the joint. That part of the bone then breaks more easily and heels poorly.

MOI: the cause of the condition is unknown

S/S: limping, pain or stiffness of the hip, groin, thighs, or knees, and limited range of motion in the hip joint

Management: Rest and ice. Goal of treatment is to keep the femoral head as round as possible. Therapy: exercises, crutches, traction, casts, etc. Surgeries may be needed in children older than 7. These include: contracture release, loose body removal, hardware implants, and joint realignment.

Apophysitis

An apophysis is a growth plate that provides a region for a muscle to attach. They are made up of cartilage cells, when a muscle is too tight or begins placing stress on these cells, it can cause irritation and inflammation resulting in apophysitis. The apophysis most commonly affected: ASIS, AIIS, and iliac crest

MOI: overuse injury due to repetetive stress on the muscles attached to the apophysis  

S/S: dull pain in the groin or hip region that increases with activity, tenderness and swelling

Management: rest from activity that irriates the area, ice, gentle stretching and strengthening

Slipped Femoral Epiphysis

An unusual disorder of the adolsecent hip. The head of the femur slips off in a backward direction due to weakness in the growth plate. 

MOI:  Somewhat unknown, occurs durnig periods of accelerate growth, shortly after puberty

S/S: several weeks of hip or knee pain causing a limp, inability to walk on affected leg, leg may have a turned out appearance, may also appear to be shorter

Management: treatment should begin immediately, it requires surgery to place fixating screws to keep the head in place so that it can no longer slip during the growth period; if the fixation does not take place, future hip motion could be decreased along with the development of premature osteoarthritis

Hip Dislocation or Subluxation

A traumatic injury that occurs when the head of the femur is forced out of its socket (acetabulum). It can occur in an anterior or posterior direction depending upon the force.  This injury is generated by a large force. A dislocation remains out of socket until reduced, while a subluxation pops out and slides back into position. A dislocation is a medical emergency.

MOI: a traumatic force such as a motor vehicle collisions, a fall from a significant height, or along with a fracture to the leg

S/S: severe pain in the hip, leg appearing shorter, leg appearing turned inward or outward depending on the direction of the dislocation

Management: medical emergency, do not move patient, doctor will administrate an anesthetic and manually reduce the limp; in rare cases small bony fragments block the bone from going back into the socket, when this occurs surgery is required

Osteitis Pubis

Occurs when the pubic symphysis and surrounding muscle insertions are inflamed. Conditions associated are: pregnancy, childbirth, gynecologic surgery, urologic surgery, and athletic activities

MOI: abnormal shearing force across the pubic symphysis, muscle imbalance, poor flexibility, and SI joint dysfunction

S/S: pain at the symphysis and moving outward in to the groin, pain increasing with activity, a sensation of clicking or popping when standing up from sitting, weakness and difficulty with ambulation

Management: rest to allow for healing, physical therapy to alleviate pain and correct mechanical issues than may have been created, modalities for pain relief, stretching and strengthening

Athletic Pubalgia

Also known as a "sports hernia." It is a soft tissue injury that occurs in the groin area due to sport activity with changes of direction and twisting motions. It is a strain or tear of any soft tissue in the lower abdomen or groin area. The soft tissues most affected are: oblique muscles in the lower abdomen and the adductors.

MOI: sport activities that involve planting and suddent twisting with maximal exertion such as: football, ice hockey, soccer, and wrestling

S/S: severe pain in the groin area, increases with twisting motions, will not cause a visible bulge in the groin region, over time it can result in an inguinal hernia

Management: without treatment it can cause disabling pain in the groin region; Rest: 7-10 days with the use of ice and a compression wrap, physical therapy, and the use of NSAIDs; if severe, surgery can take place to repair the torn tissues

Ischial Bursitis

A condition that causes pain in the buttocks resulting from tissue damage and inflammation to the ischial bursa. The bursa is a fluid-filled sac lining the ischial tuberosity to reduce friction between soft tissue layers. The hamstrings originate along the ischial tuberosity and cause also cause inflammation if tight or from repetitive motions.

MOI: repetitive and prolonged activites that place stress on the ischial bursa, prolonged sitting, repetitive running, jumping, or kicking (using the hamstrings), or a direct blow or hit to the ischial tuberosity

S/S: pain in the lower buttock, acheness or stiffness in the lower buttock that increase with rest after an activity

Management: stretching protocols, rest from activity that inreases pain, icing, NSAIDs, and regrain from sitting for prolonged periods

Piriformis Syndrome

An uncommon neuromuscular disorder that occurs when the piriformis muscles compresses the sciatic nerve. The piriformis muscle is a band-like muscle that spans from the top of the hip joint across the buttock. It stabilizes the hip joint and lifts and rotates the leg away from the body. It enables us to balance and shift weight. The sciatic nerve passes through the piriformis and runs down the leg.

MOI: spasm of the piriformis muscle, piriformis tightness or inflammation, repetitive activity such as long-distance running or prolonged sitting

S/S: pain, tingling, and numbess in the buttocks, pain can radiate down the leg, pain can be triggered while sitting for long periods or walking upstairs

Management: Avoid positions that trigger pain, rest, ice, and heat can alleviate pain, a protocol of stretching and strengthening should be utilized, modalities for pain, as well as NSAIDs or corticosteroids

IT Band Syndrome

One of the most common overuse injuries in the running world. The illiotibial band runs along the lateral portion of the thigh from the hip to the lateral aspect of the knee. When this becomes inflamed, it can disable an athlete from participating.

MOI: activity that causes the leg to rotate medially repeatedly, worn-out shoes, running downhill, or excessive running

S/S: swelling and pain along the outside of the knee, pain at 45 degrees of knee flexion

Management: Rest, ice, NSAIDs, (if you do not rest, it can become a chronic issue), stretching, do activites such as swimming, pool running, or cycyling instead of running, and modalities to decrease pain and inflammation; if severe, surgery can be used to release the IT band

Arthritis of the Hip

There are three types of inflammatory arthritis that can affect the hip: rheumatoid arthritis (chemical substances attack and destroy articular cartilage), ankylosing spondylitis (chronic inflammation of the spine that causes low back pain), and systemic lupus erythematosus (can cause inflammation in any part of the body). Inflammatory arthritis occurs when the body's immune system becomes overactive and attacks healthy tissues.

MOI: direct cause is unknown, however there is evidence that genetics play a role

S/S: pain and stiffness in the hip, dull aching pain in the groin, pain worse with sitting or resting, pain causing a limp

Management: there is no cure but you can treat the symptoms: NSAIDs, corticosteroids, disease-modifying antirheumatic drugs, physical therapy, and assistive devices; surgery options: total hip replacement

Avascular Necrosis Femoral Head

Results from interruption of blood supply to the bone.  Results in the death of marrow and osteocytes and results in the collapse of the necrotic segment.

MOI: Can be caused by trauma and damage to the blood vessels that supply bone its oxygen. Other causes block the blood flow through the blood vessels, abnormally thick blood, and inflammation of the blood vessel walls. Alcoholism, steroid usage, Cushing’s syndrome, radiation exposure, and sickle cell disease also can cause this.

S/S: : Hip pain, particularly with weight bearing and rotation and limitation of weight bearing and motion.

Management: Treatment almost always includes surgery to stop any further slippage of the femoral epiphysis. This includes resurfacing arthroplasty. Surgery includes screw placement, wedge osteotomy, and remodeling of the femur head. A  rehab program will be needed after surgery.