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American Family Physician Jan 2021Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located... (Review)
Review
Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.
Topics: Adult; Buttocks; Diagnosis, Differential; Family Practice; Female; Hip; Hip Injuries; Hip Joint; Humans; Male; Musculoskeletal Diseases; Pain
PubMed: 33448767
DOI: No ID Found -
Chinese Medical Journal Jan 2019To review the literature regarding diagnosis and treatment of labral tear. (Review)
Review
OBJECTIVE
To review the literature regarding diagnosis and treatment of labral tear.
DATA SOURCES
A systematic search was performed in PubMed using various search terms and their combinations including hip, labrum, acetabular labral tear, arthroscopy, diagnosis, and anatomy.
STUDY SELECTION
For each included study, information regarding anatomy, function, etiology, diagnosis, and management of acetabular labral tear was extracted.
RESULTS
Five hundred and sixty abstracts about anatomy, function, etiology, diagnosis, and management of acetabular labral tear were reviewed and 66 selected for full-text review. The mechanism of labral tear has been well explained while the long-term outcomes of various treatment remains unknown.
CONCLUSIONS
Labral tear is generally secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration. Patients with labral tear complain about anterior hip or groin pain most commonly with a most consistent physical examination called positive anterior hip impingement test. Magnetic resonance arthrography is a reliable radiographic examination with arthroscopy being the gold standard. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection. When fail to respond to conservative treatment, surgical treatment including labral debridement, labral repair, and labral reconstruction is often indicated.
Topics: Acetabulum; Arthroscopy; Hip Injuries; Humans; Rotator Cuff Injuries; Rupture
PubMed: 30614856
DOI: 10.1097/CM9.0000000000000020 -
British Journal of Sports Medicine Jun 2015Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area.
BACKGROUND
Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area.
AIM
The 'Doha agreement meeting on terminology and definitions in groin pain in athletes' was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions.
METHODS
A one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting.
RESULTS
Unanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes: 1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain. 2. Hip-related groin pain. 3. Other causes of groin pain in athletes. The definitions are included in this paper.
CONCLUSIONS
The Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research.
Topics: Abdominal Pain; Athletic Injuries; Consensus; Diagnostic Imaging; Female; Femoracetabular Impingement; Forecasting; Groin; Hip Injuries; Humans; Male; Medical History Taking; Patient Outcome Assessment; Physical Examination; Risk Factors; Sports; Terminology as Topic
PubMed: 26031643
DOI: 10.1136/bjsports-2015-094869 -
Orthopaedic Surgery Dec 2019Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA... (Review)
Review
Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA approaches have been used with great anatomic success, they damage periarticular muscles, which are already quite weak in type IV DDH. The recently developed direct anterior approach (DAA) can provide an inter-nerve and inter-muscle approach for THA of type IV dysplasia hips. However, femur exposure with the DAA could be difficult during surgery and it is hard to apply femoral shortening osteotomy. THA techniques used for type IV DDH include anatomic hip center techniques (true acetabular reconstruction) and high hip center techniques, wherein an acetabulum is reconstructed above the original one. Although anatomic construction of the hip center is considered "the gold standard" treatment, it is impossible if the anatomical acetabular is too small and shallow. Procedures used to support type IV DDH reduction with anatomic hip center techniques include greater trochanter osteotomy, lesser trochanter osteotomy, and subtrochanteric osteotomy. However, these techniques have yet to be standardized, and it is unclear which is best for type IV DDH. One-state and two-state non-osteotomy reduction techniques have also been introduced to treat type IV DDH. Potential complications of THA performed in patients with type IV DDH include leg length discrepancy (LLD), peri-operative femur fracture, nonunion of the osteotomy site, and nerve injury. It is worth noting that nowadays an increasing number of Crowe type IV DDH patients are more sensitive to postoperative LLD.
Topics: Arthroplasty, Replacement, Hip; Hip Dislocation; Humans; Osteotomy; Postoperative Complications
PubMed: 31755242
DOI: 10.1111/os.12576 -
Orthopaedic Surgery Dec 2019Investigation of the treatment of femur fractures and the type of femur fracture-associated complications regarding timing of surgery and length of hospital stay.
OBJECTIVE
Investigation of the treatment of femur fractures and the type of femur fracture-associated complications regarding timing of surgery and length of hospital stay.
METHODS
In this retrospective cohort study, a total of 358 hip fractures were evaluated retrospectively from 1 January 2008 until 31 December 2010 at a level I trauma center in Germany. Inclusion criteria was age >18 years and a proximal femur fracture. Both sexes were evaluated. Mean age was 75.5 years, most patients were female (63.7%). Intervention was the operative treatment of proximal femur fracture. Outcome parameters were time until surgery, complications, reoperations, mortality, and length of hospital stay.
RESULTS
Among the proximal femur fractures (n = 358), 46.6% were pertrochanteric, 11.2% subtrochanteric, and 42.2% femoral neck fractures. Operation upon hip fractures was managed regularly within 24 hours of injury (73%; mean for femoral neck: 28.3 hrs.; mean for pertrochanteric fractures: 21.4 hrs.; mean for subtrochanteric fractures: 19.5 hrs.). Delayed treatment, as well as implantation of hip total endoprosthesis (TEP), increased the overall length of hospital stay (15.4 vs 17.6 days; 18.1 vs 15.8 days). Accordingly, surgical procedures performed within 24 hours of injury resulted in a shorter hospital residence. Longest delay of operation was measured for hip fractures (28.3 hrs.). In 351 patients, secondary injuries were detected in 94 individuals (26%), with fractures being the most common secondary injury (n = 40). We recorded postoperative complications of nonsurgical and surgical origin, and 33.6% of our patient cohort displayed complications. Complications were distributed among 118 patients. There was no significant difference in complications regarding the time of operation, with most nonsurgical and surgical complications appearing within 24 hours after operation (n = 110 vs n = 31). Nonsurgical complications, such as anemia (n = 49) and electrolyte imbalances (n = 30), were observed more frequently than surgical complications (n = 107 vs n = 34); however, these complications were reduced by delay in surgery (82.0% in 6-24 hrs. vs 74.2% in ≥24 hrs.). Anticoagulant therapy and age did not affect postoperative complications. The hospital mortality of patients was 6.2%. Follow-up was restrained to ambulatory visits in the clinic.
CONCLUSIONS
Surgical management of hip fractures performed within 24 hours of injury minimizes hospital stay. We did not detect significant differences in the spectrum or number of complications regarding delay of surgery. Surgical complications mainly occur with rapid primary care, and medical complications can be reduced by more intensive preparation of patient and operation procedures.
Topics: Aged; Arthroplasty, Replacement, Hip; Female; Fracture Fixation, Internal; Hip Fractures; Humans; Length of Stay; Male; Postoperative Complications; Retrospective Studies; Time-to-Treatment
PubMed: 31568676
DOI: 10.1111/os.12524 -
Sports Health 2017Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved... (Review)
Review
CONTEXT
Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved techniques has resulted in improved access to the hip joint and ability to treat various hip pathologies.
EVIDENCE ACQUISITION
Electronic databases, including PubMed and MEDLINE, were queried for articles relating to hip arthroscopy indications (1930-2017).
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
Initially used as a technique for loose body removal, drainage/debridement of septic arthritis, and treatment of pediatric hip disorders, hip arthroscopy is currently used to treat various hip conditions. The recognition of femoroacetabular impingement (FAI) as a source of hip pain in young adults has rapidly expanded hip arthroscopy by applying the principles of osseous correction that were previously described and demonstrated via an open surgical dislocation approach. Hip pathologies can be divided into central compartment, peripheral compartment, peritrochanteric space, and subgluteal space disorders.
CONCLUSION
Although hip arthroscopy is a minimally invasive procedure that may offer decreased morbidity, diminished risk of neurovascular injury, and shorter recovery periods compared with traditional open exposures to the hip, it is important to understand the appropriate patient selection and indications.
Topics: Arthritis, Infectious; Arthroscopy; Cartilage, Articular; Contraindications; Femoracetabular Impingement; Hip Injuries; Hip Joint; Humans; Joint Loose Bodies; Ligaments, Articular; Osteoarthritis, Hip; Patient Selection; Synovectomy; Synovial Membrane; Tendons
PubMed: 28678628
DOI: 10.1177/1941738117712675 -
BMJ (Clinical Research Ed.) Dec 2008To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football.
DESIGN
Cluster randomised controlled trial with clubs as the unit of randomisation.
SETTING
125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months).
PARTICIPANTS
1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group).
INTERVENTION
A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements.
MAIN OUTCOME MEASURE
Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip).
RESULTS
During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83).
CONCLUSION
Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players.
TRIAL REGISTRATION
ISRCTN10306290.
Topics: Adolescent; Athletic Injuries; Cluster Analysis; Exercise; Female; Hip Injuries; Humans; Leg Injuries; Muscle Strength; Physical Fitness; Risk Factors; Soccer; Treatment Outcome
PubMed: 19066253
DOI: 10.1136/bmj.a2469 -
Knee Surgery, Sports Traumatology,... Oct 2022The literature on hip injuries in ballet dancers was systematically evaluated to answer (1) whether the prevalence of morphological abnormalities and pathology of hip... (Review)
Review
PURPOSE
The literature on hip injuries in ballet dancers was systematically evaluated to answer (1) whether the prevalence of morphological abnormalities and pathology of hip injuries in dancers differs from the general population (2) if there are any specific risk factors which contribute to a higher rate of hip injury and (3) what are the outcomes of primary and secondary intervention strategies.
METHODS
A systematic literature search of Medline, EMBASE and the Cochrane Library was undertaken for all literature relating to hip injuries in ballet dancers using the PRISMA guidelines. Reference lists were also searched for relevant literature. Clinical outcome studies, prospective/retrospective case series published between 1989 and October 2021 were included. Review articles (non-original data), case reports, studies on animals as well as book chapters were excluded.
RESULTS
The search yielded 445 studies, of which 35 were included for final analyses after screening. This included 1655 participants, of which 1131 were females. The analyses revealed that damage at the chondrolabral junction and degenerative disease of the hip may develop at a higher rate in ballet dancers than in the general population (odds ratio > 1 in 15/18 cohorts). The intra-articular lesions were more frequently found in postero-superior region of the hip suggesting an alternative impingement mechanism. Furthermore, numerous risk factors specific for hip injury in ballet were highlighted amidst a wide body of literature which consistently reports risk factors for a more generic 'dancer vulnerability'.
CONCLUSION
Ballet dancers may suffer from both higher rates of chondrolabral damage and degenerative disease in their hips. In contrast to other sports, the intra-articular lesions are more frequently found in postero-superior region of the hip. Future research clarifying the prevalence of osseous abnormalities and prevention strategies in dancers may be pivotal in delaying the development of hip disease in this cohort.
LEVEL OF EVIDENCE
Level IV.
Topics: Dancing; Female; Hip; Hip Injuries; Humans; Male; Prospective Studies; Retrospective Studies
PubMed: 35305112
DOI: 10.1007/s00167-022-06928-1 -
Medicine Feb 2019The term "floating" is used in orthopedic literature to describe certain patterns of skeletal injuries that share one common character which is disruption and... (Review)
Review
BACKGROUND
The term "floating" is used in orthopedic literature to describe certain patterns of skeletal injuries that share one common character which is disruption and discontinuity of bones above and below a joint. The first time used in orthopedic literature being in late 1970 to describe a type of elbow injury. Later the word was used increasingly and applied to a variety of injuries affecting the knee, shoulder, hip, forearm, hand, and ankle. Currently, there are about 12 different skeletal injuries described as floating.
OBJECTIVES
The aim of this article was to define the term "floating" used in traumatic orthopedics and to discuss its history, mechanism of injury in each region, treatment and outcomes based on the currently available literature. As there were many separate articles describing different sites of floating injuries, this review aimed to summarize all floating injuries into 1 article.
Topics: Age Factors; Ankle Injuries; Arm Injuries; Clavicle; Compartment Syndromes; Fibula; Fracture Fixation, Internal; Fractures, Bone; Hip Injuries; Humans; Knee Injuries; Metacarpal Bones; Metatarsal Bones; Orthopedic Procedures; Terminology as Topic; Elbow Injuries
PubMed: 30762776
DOI: 10.1097/MD.0000000000014497 -
Tidsskrift For Den Norske Laegeforening... Jan 2019Knowledge about diagnostics and treatment of chronic Morel-Lavallée lesions is sparse.
BACKGROUND
Knowledge about diagnostics and treatment of chronic Morel-Lavallée lesions is sparse.
MATERIAL AND METHOD
The patient presented is a 65-year-old woman who develops a post-traumatic chronic Morel-Lavallée lesion. The paper describes the course of her treatment including dos and don’ts with reference to literature from a systematic PubMed search.
RESULTS AND INTERPRETATION
The Morel-Lavallée lesion is often missed in the trauma setting during both primary, secondary and tertiary examination, resulting in a chronic lesion. Knowledge of the lesion minimises this risk. The gold standard for diagnosis is magnetic resonance imaging, but ultrasonography may also be used in the acute setting. The chronic lesion can be successfully treated with doxycycline-induced obliteration of the cavity followed by compression treatment for a short period.
Topics: Accidental Falls; Aged; Female; Hip Injuries; Humans; Magnetic Resonance Imaging; Middle Aged; Soft Tissue Injuries
PubMed: 30644680
DOI: 10.4045/tidsskr.18.0351