Hip Related Sports Injuries
Athletes tend to have fairly specific types of injuries to the hip itself, these can be wide ranging, and they can be frustrating for the athlete, who simply wants to get better and get back into competition. It is important to diagnose a hip injury accurately, to maximize outcomes, and to decrease time of recovery. Many issues can be resolved without surgery, however if these become persistent or refractory to non-operative management, occasionally surgeries are necessary.
Tendon Injuries (Avulsion Fractures):
Sometimes, with very ballistic motions in and around the hip, occasionally the tendon can pull off of the bone, taking a small piece of bone with it. These are called a avulsion fractures. When this occurs, many times this will heal with a period of rest, rehabilitation, and observation. If the tendon has pulled far enough away from its origin on the bone, occasionally we will have to repair this. Younger athletes, those who are still growing, are more at risk for this particular type of injury, because of the relatively softer bone that they have compared to the tendon. This is very common in ballistic athletes, those who are splinters or perform a very quick and short motion.
The labrum is a structure within the hip joint itself, this is a soft tissue structure which helps to deepen the socket, making it more stable. At times, in the setting of trauma or wear and tear, this can become damaged or torn. This can become painful scenario, which can lead to the inability to perform certain activities, or require treatment beyond simply conservative means.
While we are still learning about the labrum and the effects of a labral tear, this can be a very painful scenario, and it can require surgical fixation. To fix the labrum can require either an arthroscopic or a small open incision to repair the labrum, this can be performed on an outpatient basis, and although the recovery phase will require several weeks of limited weightbearing and therapy, it has been shown to be consistently helpful in terms of returning someone to their previous level of pain-free activity.
Bursitis (Peritrochanteric Pain Syndrome):
Many people have already heard about bursitis. This is an inflammation of a small sac of fluid, which normally is meant to decrease pain and discomfort around the hip area. Occasionally, this can become inflamed and painful. What we have learned, is that bursitis is actually less likely than injury to the gluteus muscles, the muscles on the lateral aspect of the hip. These muscles are not necessarily torn, however they can be injured, strained, causing pain within the hip area. Oftentimes this is pain on the lateral aspect of the hip, it becomes painful when you are going from a sitting to a standing position. It is also painful to sit or lie on that side. There are also other structures that can become irritated in this setting, including the iliotibial band. It is important to differentiate which structure is either injured, tight, or otherwise having issues. Happily, this particular syndrome, is very amenable to physical therapy as well as injections of a steroid (cortisone) to decrease inflammation, and return you to your previous level of function.
Iliopsoas Tendon Injuries:
One of the major tendons that runs across the front of the hip is the iliopsoas tendon. This is a large muscle which is classified as a hip flexor. This can be injured in the setting of athletics. Less commonly, this can be injured in the setting of a total hip arthroplasty, and may require treatment. This can cause even a loud snapping sound, if injured. Many times, we can treat this nonoperatively, and the use of physical therapy and anti-inflammatories as essential in the treatment of this. There are advanced surgical options should this become a persistent issue, will make that determination based on the origin of your injury.
Injury or irritation of the sacroiliac joint (the joint that joins the pelvis to the sacrum) can be called sacroiliitis. There can be an injury that initiates this, or there can be arthritis of that joint itself. This is amenable to many forms of nonoperative management, including injections very specifically into that joint and other modalities. If this becomes severe or unmanageable by nonoperative means, there are surgeries which can be performed that we will decrease motion to that area (fusion) to decrease pain.
One of the small muscles in the back of the hip, the piriformis, has been known to cause issues within the hip area, and can secondarily cause issues with the sciatic nerve. It is important to differentiate this, versus a low back issue which can also injure the sciatic nerve. The symptoms of this are buttock pain, pain with sitting or certain activities. This can cause symptoms which radiate down the leg. It will be important to perform a physical exam to differentiate this versus other forms of muscular or nerve injury.