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...can helpful. If femoral neck stress fractures are not treated, a complete fracture can occur. Slipped capital femoral epiphysis results from posterior displacement of the proximal femoral physis. In osteitis pubis, patients describe a gradual progression of discomfort and pain in the midline directly over the pubic symphysis. In snapping hip syndrome, athletes experience a "snapping" sensation when the hip is flexed and extended. Athletes may be more at risk for hip osteoarthritis than the general population.
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Hip injuries are fairly common, accounting for roughly 5% to 6% of musculoskeletal complaints in adults and 10% to 24% of complaints in children. (1) These injuries are particularly common in certain athletes, such as dancers, runners, and soccer players, because their sports activities involve a high degree of increased force and extremes of movement across the hip.
A wide variety of disorders can result in hip pain in athletes. Evaluation of hip injuries varies significantly with the patient's age and activity, the type of injury, and its severity.
In this 2-part article, we discuss the causes, diagnosis, and initial treatment of hip and pelvis injuries in young adult and mature athletes. This first part focuses on the history, physical examination, and several diagnoses commonly seen in these athletes. In the second part, to appear in a later issue of this journal, we will take a closer look at some additional soft tissue injuries that may be seen in athletes who present with hip complaints.
PATIENT EVALUATION
Anatomy
The hip joint has a ball-and-socket configuration that allows for significant stability and mobility (Figure 1). The spherical area of articulation between the head of the femur and the acetabulum allows for significant pressure distribution in a weight-bearing joint that still can move extensively in 3 separate planes: frontal, sagittal, and transverse. Force across the joint ranges from 1.6 to 3.3 times body weight when a person walks and increases by up to 5 times body weight when a person runs.
[FIGURE 1 OMITTED]
The bony hip is composed of the head of the femur and the acetabular surface of the innominate bones. The acetabulum includes contributions from all 3 pelvic bones: the ilium, ischium, and pubis. The innominate bones articulate anteriorly at the symphysis pubis; the posterior portion of the pelvic girdle is completed by the sacrum (superiorly) and the coccyx (inferiorly).
The articular surface of the acetabulum is covered by a layer of cartilage that has a thickened circumferential rim, or labrum, that serves to deepen the acetabulum and bolster support of the femoral head. Additional stability is provided by 3 ligaments (iliofemoral, ischiofemoral, and pubofemoral) that surround the joint capsule and the small, less functional ligamentum teres, which is attached to the head directly. (2) The femoral head is roughly two thirds of a sphere that is covered in hyaline cartilage and connected to the femoral shaft by the neck. Typically, the junction of the femoral neck with the femoral shaft has an angle of 125[degrees] to 135[degrees]. (3)
Muscles in the joint area include those within the gluteal and lower lumbar regions and those that extend distally into the lower extremity. These muscles can be grouped by function around the hip joint: the iliopsoas and the quadriceps muscles control hip flexion; the gluteal muscles and the 3 muscles that make up the hamstrings perform extension; separate groups of muscles aid in the other hip motions (abduction, adduction, and internal and external rotation); and the gluteals, piriformis, and other smaller complementary muscles also aid in stability and movement of...
NOTE: All illustrations and photos
have been removed from this article.
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