Hip Injuries in the Athlete

Abstract

There has been a recent explosion of interest in the evaluation and management of the athlete with non-arthritic hip pain as a result of enhanced technology to diagnose and treat non-arthritic sources of hip pain. This has resulted in increasing awareness of various pathologies involving the hip in the athlete. Evaluation of the athlete with hip pain must include differentiating between intra-articular and extra-articular causes, as well ruling out referred pain from other sources. Furthermore, bony and soft-tissue sources of pain must be evaluated. This chapter reviews the clinical presentation, physical examination, associated imaging, and treatments of many sources of hip pain and injury in athletes. These pathologies include bony injuries of the hip and pelvis, such as pelvic avulsion fractures (ischial tuberosity, anterior superior iliac spine, anterior inferior iliac spine, iliac crest and lesser trochanter), osteitis pubis, stress fractures (pelvis, sacrum, acetabulum and proximal femur), and hip dislocations. The soft-tissue injuries about the hip and pelvis reviewed herein include pelvic contusions and hip pointers, muscle strains and contusions, bursitis (trochanteric and iliopsoas), the different sources of snapping hip syndrome, gluteus medius syndrome, piriformis syndrome, and athletic pubalgia. Finally, intra-articular sources of hip pain are discussed, including labral tears, chondral lesions, femoroacetabular impingement, and hip instability. This chapter, while not meant to be comprehensive, provides an overview of these increasingly commonly diagnosed sources of hip pain in athletes.