Groin Strain

The most common acute injuries about the hip and pelvis from athletic competition are muscle strains. The musculature of the groin most often affected includes the adductor group (gracilis, pectineus, adductor brevis, adductor longus, and adductor magnus). The rectus abdominus, rectus femoris, and iliopsoas are also common muscles that can be affected. The mechanism of injury can be overuse causing microtears or a sudden forceful movement. A position of external rotation and eccentric forces often cause flexor / adductor strains, and the injury most typically occurs at the myotendonous junction or the tendonous insertion.

Signs and Symptoms
A strain can be felt as a sudden sensation of tearing or twinge while playing or may not be noticed until after the activity. Symptoms include pain and swelling. Focal areas of tenderness and swelling are often detected. With more severe injuries, a defect may be palpable. The history of injury, localized tenderness, and pain with resistance are the most notable measures for diagnosis.

Differential Diagnosis
Avulsions should be ruled out with an AP pelvis radiograph. Differential diagnosis also includes hernia, internal derangement of the hip (e.g. labral tears and chondral injuries), nerve entrapments, osteitis pubis, fractures and stress fractures.

Treatments
Strains should be treated with RICE and analgesics as needed for a minimum of 2 to 3 days. Range of motion exercises should be initiated early. As pain resolves, gentle isometric exercise progressing to more dynamic resisted exercise can be performed using pain as a guide. The athlete can gradually return to play when pain-free. A protective spica bandage may assist in the early phase of return to sport for flexor / adductor strains. The most common complication is recurring symptoms and in chronic cases, surgery may be indicated but is rare.

Prevention
Training programs should be specific for the level of athlete, timing during the season, and goals of the athlete. It is important to focus on general conditioning, specifically strength, endurance, and flexibility. Programs should include warm-ups and cool downs for training and matches.

Hip labral (labrum) tears

Patients with hip pain may end up getting an MRI which shows a labral (labrum) tear. Inevitably I get asked "What is that? I've never heard of it before."

Most labral tears are not associated with a traumatic onset. Running, sprinting, and frequent rotation of the hip while playing sports is thought to result in tears of the labrum. Bony structural risk factors include hip dysplasia and femoroacetabular impingement (FAI). Clinical assessment including history, physical, and radiographic analysis is 98% accurate in determining the presence of an abnormality within the hip joint. MRI with contrast injected into the hip joint(arthrography) is 65-90% sensitive for detecting labral tears. Relief of pain (lidocaine pain test) from an intraarticular anesthetic injection at the time of arthrography is very suggestive of intraarticular abnormalities and is useful in predicting improvement with arthroscopic intervention, particularly in patients with normal imaging exams.


Signs and Symptoms
In greater than 90% of patients with labral tears, pain is reported in the anterior hip or groin region. Less often pain occurs in the lateral or posterior hip region. Patients may also report clicking, catching, locking, or giving away. Range of motion restrictions in flexion, internal rotation, and/or figure four position may be noted. Provocative tests include the anterior impingement test of flexion, internal rotation, and adduction. A positive test causes pain in the groin and restricted motion. Pain in the joint with a resisted straight leg raise may be indicative of a labral tear.

Treatment
Unfortunately the labrum does not heal on its own if it is torn. The goak of non-operative treatment is to reduce the symptoms. If non-operative methods fail, surgical intervention of labral tears may be performed open or arthroscopically. The labrum can be debrided (cleaned-up) and/or repaired with suture anchors. Histologic studies have shown potential for labral healing. Conservative treatment may include limited weight bearing, NSAIDS, and avoidance of pivoting motions on the hip. Physical therapy can improve muscle recruitment to control hip motion.

Why the hype about minimally invasive surgery?

I commonly have been asked by family members and friends about minimally invasive techniques, as they are increasing advertised for a variety of different surgical procedures. The questions can best be summarized by “should I have my surgery done that way?”

The goals of minimally invasive surgery are much the same as for the traditional “open” surgeries of the past. The difference is that the incisions are smaller, and in general, there is less dissection, less bleeding, and less pain, and thereby quicker rehabilitation. But these less invasive procedures must be considered with caution, as the visualization during surgery is oftentimes decreased. Less invasive does not necessarily result in better outcomes, particularly when considered in the long term. And certain procedures, such as bunion surgery, have been shown to have worse results when performed in a less invasive manner.

One such type of minimally invasive surgery is arthroscopic surgery. Arthroscopy utilizes small portals (1 to 2 cm incisions) to pass cameras and instruments to perform the surgery. Saline water is used to fill the joint and to view the procedure. This type of surgery has become a standard of care for certain injuries such as anterior cruciate ligament (ACL) surgery, and has become more popular not only in the knee, but also in the shoulder, hip, and foot and ankle. Training programs in sports medicine traditionally have provided extensive training in arthroscopic procedures. The risk of infection is decreased because of the continuous use of water in arthroscopy.

First Post

Really excited to get this blog up and running. Can't wait to tell everyone about hip arthroscopy and their options in South Florida.

Check back for more information soon!