HIP INJURY IN A COLLEGE FOOTBALL PLAYER

Abstract

HISTORY A college football defensive back was injured when his extended left leg was forced into the ground while making a tackle. He followed through over the top of the engaged player making a second contact with the ground on a bent knee. He complained of left hip pain and was unwilling to move his left lower extremity. There were no obvious gross deformities during the on-field assessment. Unable to bear weight, the player was helped to the sideline for further evaluation. PHYSICAL EXAMINATION Sideline exam revealed pain in left hip at an intensity of 10/10 without radiation to his groin or down his leg. He repeatedly described the pain as “deep in there.” There was no left knee, ankle or foot pain. No back pain or radicular symptoms. No swelling of affected area. Left hip range of motion testing was limited by pain with flexion to 50 degrees, extension to 0 degrees, internal rotation to 30 degrees, external rotation to 40 degrees, abduction to 30 degrees and adduction to 0 degrees. He was tender to palpation over his left ASIS and proximal hip flexors without a palpable defect. Manual muscle testing revealed 4 out of 5 strength throughout his left hip secondary to pain. FABER test was positive. Sensation of left lower extremity was normal. Left knee exam was normal. Player was given 60 mg Toradol IM and iced on the field for the remainder of the game. He reported decreased pain and increased stiffness over the next hour. DIFFERENTIAL DIAGNOSIS Avulsion fracture of ASIS. Proximal hip flexor tear. Hip subluxation/dislocation. Acetabular labral tear. Traumatic femoral neck fracture. TEST AND RESULTS X-ray views of the pelvis and hip that night: No evidence of fractures or subluxation MRI the following day: Joint space widening with effusion beyond the joint capsule. Labral detachment and probable posterior acetabular avulsion fracture. Contusion in the anterior femoral neck, probable osteochondral fracture of the anterosuperior femoral head. Ligamentum teres appears somewhat thickened and hyperintense with some edema. MRI of left hip (eight weeks later): Labral tear still apparent but in normal anatomic position. Bone bruise to femoral head with no fracture seen. Ligamentum teres is intact. No rupture of joint capsule noted. Digital video of play from gamefilm: Mechanism appeared to be anterior to posterior axial loading of left hip in flexion. FINAL WORKING DIAGNOSIS Left hip posterior subluxation with posterior acetabular labral tear. TREATMENT AND OUTCOMES After orthopedic consultation, strict non weight bearing with crutches for eight weeks. NSAID's PRN for pain. Electrical stimulation to left leg. After the second MRI at 8 weeks weight bearing was allowed with progression to running over a six week period. If pain or clicking occurs with progressing of activity the patient will have an arthroscopic hip evaluation.