-An athlete complains of a gradual onset of pain deep within his or her anterior groin. -Forceful kicking a ball with the medial border of the foot may cause a sharp pain with a catching sensation. -A case involving a ballerina with 10 months of left hip pain originated during a high kick in the abducted position; she felt a sudden catching sensation in the anterior left groin. -A car accident with knee dashboard impact forcing femur posteriorly. -A wrestler in a quadruped position forced back onto heels (buttock to heels)
Labral lesions have a strong correlation with anterior inguinal pain painful clicking transient locking giving way of the hip Pain may be reproduced with flexion and internal rotation of the hip An audible click may also be present The patient history usually does not reveal significant trauma The onset of pain may be related to sports and may involve a mild twisting or slipping injury Radiographs in patients with labral tears are typically unremarkable. If early osteoarthritic disease is present, the pain is out of proportion to the radiographic changes.
While the pain is usually in the groin, it could also be in the trochanteric and buttock region. A significant trauma is not necessary to disrupt the labrum - twisting or falling may be causative. The injury is usually caused by the hip joint being stressed in rotation. The pain could be acute or insidious. The most common complaint is discrete episodes of sharp pain precipitated by pivoting or twisting. Clicking or catching is common but not always present. Activities that involve forced adduction of the hip joint in association with rotation in either direction tend to aggravate. The majority of labral tears (up to two-thirds) are located anteriorly.
Their hip pain is often nonspecific regarding symptoms. Radiological findings may be negative. It is important to rule out early any possibility of fractures, infections, inflammation or ischemic necrosis; laboratory tests of blood, urine and at times synovial fluid may be necessary. Acetabular dysplasia, considered pre-osteoarthritic by some, is a valid clinical entity that must be considered. Some references are calling this disorder dysplastic acetabular rim syndrome (DARS).
Early symptoms will occur due to overload of the acetabular rim caused by hip motions such as a combination of flexion, adduction and internal rotation. Getting out of a car or doing the breast stroke are examples of this type of movement stress. Snapping, locking and clicking are common in ARS, causing the clinician to think of problems related to the labrum or a painless snapping iliopsoas.
Snapping hip complaints must be discriminated from functional hip problems such as anterior femoral glide syndrome and IT Band syndrome. Symptoms due to hip instability may be related to ARS. The patient may suffer unexplained falls or the feeling that his or her hip may give way. With acetabular dysplasia, there may be excessive anteversion of the femoral neck, causing an increase in hip internal rotation on examination. The capsular pattern of the hip that indicates osteoarthritis is almost always a decrease in hip internal rotation. Therefore, as soon as osteoarthritis appears, decreased hip internal rotation will also appear.
We are going to leave things here for today…….we wanted to leave you with 3 words for the day……..INTERNAL HIP ROTATION. Keep these 3 words in your clinical hat for the day, look for its loss and start thinking about your runners, your patients. Look for this loss when the patient is supine and in the straight leg position. Test the hip rotation from spinning the hip (from an ankle contact point) into internal rotation, compare side to side.
More tomorrow ……but remember, sometimes it is not the part……but the anchor for the part….. hence why we will be talking about the lower abdominals as the week goes on. The amount of Internal hip rotation available is only as much as the abdominal wall can support or anchor (ie. a weak abdominal wall cannot support much functional internal hip rotation…….. why ? tune in tomorrow ! as we bring this full circle.)
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