Top

HSS Journal ®

Published in:

01-10-2012 | Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip

An Algorithmic Approach to Mechanical Hip Pain

Authors: Lazaros A. Poultsides, MD, MSc, PhD, Asheesh Bedi, MD, Bryan T. Kelly, MD

Published in: HSS Journal ® | Issue 3/2012

Abstract

Background

As our understanding of hip pathology evolves, the focus is shifting toward earlier identification of hip pathology. Therefore, it is vitally important to elucidate intra-articular versus extra-articular pathology of hip pain in every step of the patient encounter: history, physical examination, and imaging.

Questions/Purposes

The objective was to address the following research questions: (1) Can an algorithmic approach to physical examination of a painful non-arthritic hip provide a more accurate diagnosis and improved treatment plan? (2) Does an anatomical layered concept of clinical diagnosis improve diagnostic accuracy? (3) What are the diagnostic tools necessary for the accurate application of a four-layer (osteochondral, inert, contractile, and neuromechanical) diagnosis?

Methods

An unrestricted computerized search of MEDLINE was conducted. Different terms were used in various combinations.

Results

An algorithmic approach to physical examination of a painful nonarthritic hip, including history, physical examination (specific tests), and advanced imaging allow for better interpretation of debilitating intra- and extra-articular disorders and their effect on core performance. Additionally, it improves our understanding as to how underlying abnormal joint mechanics may predispose the hip joint and the associated hemipelvis to asymmetric loads. These abnormal joint kinematics (layer I) can lead to cartilage and labral injury (layer II), as well as resultant injury to the musculotendinous (layer III) and neural structures (layer IV) about the hip joint and the hemipelvis. The layer concept is a systematic means of determining which structures about the hip are the source of hip pathology and how to best implement treatment.

Conclusions

A clear understanding of the differential diagnosis of hip pain through a detailed and systematic physical examination, diagnostic imaging assessment, and the interpretation of how mechanical factors can result in such a wide range of compensatory injury patterns about the hip can facilitate the diagnosis and treatment recommendations.

Allen WC, Cope R. Coxa saltans: The snapping hip revisited. J Am Acad Orthop Surg. 1995;5:303–308.

Antolak SJ,Jr, Hough DM, Pawlina W, Spinner RJ. Anatomical basis of chronic pelvic pain syndrome: The ischial spine and pudendal nerve entrapment. Med Hypotheses. 2002;3:349–353.

Babst D, Steppacher SD, Ganz R, Siebenrock KA, Tannast M. The iliocapsularis muscle: An important stabilizer in the dysplastic hip. Clin Orthop Relat Res. 2011;6:1728–1734.

Baker CL,Jr, Massie RV, Hurt WG, Savory CG. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. 2007;8:827–832.

Bano A, Karantanas A, Pasku D, Datseris G, Tzanakakis G, Katonis P. Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: A case report. J Med Case Reports. 2010;4:236.

Bedi A, Dolan M, Leunig M, Kelly BT. Static and dynamic mechanical causes of hip pain. Arthroscopy. 2011;2:235–251.

Bellabarba C, Sheinkop MB, Kuo KN. Idiopathic hip instability. an unrecognized cause of coxa saltans in the adult. Clin Orthop Relat Res. 1998;355:261–271.PubMed

Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;9:2138–2145.

Bittersohl B, Hosalkar HS, Apprich S, Werlen SA, Siebenrock KA, Mamisch TC. Comparison of pre-operative dGEMRIC imaging with intra-operative findings in femoroacetabular impingement: Preliminary findings. Skeletal Radiol. 2011;5:553–561.

10.

Braly BA, Beall DP, Martin HD. Clinical examination of the athletic hip. Clin Sports Med. 2006;2:199–210

11.

Brown RA, Mascia A, Kinnear DG, Lacroix V, Feldman L, Mulder DS. An 18-year review of sports groin injuries in the elite hockey player: Clinical presentation, new diagnostic imaging, treatment, and results. Clin J Sport Med. 2008;3:221–226.

12.

Brunner A, Horisberger M, Herzog R. Evaluation of a computed tomography-based navigation system prototype for hip arthroscopy in the treatment of femoroacetabular cam impingement. Arthroscopy. 2009;4:382–91.

13.

Bunker TD, Esler CN, Leach WJ. Rotator-cuff tear of the hip. J Bone Joint Surg Br. 1997;4:618–620.

14.

Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;7:1448–1457.

15.

Busconi BD OB. Differential diagnosis of the painful hip. In: McCarthy JC, ed. Early hip disorders. New York: Springer; 2003:7–16.

16.

Byrd JW. Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect. 2006;55:347–355.

17.

Byrd JW. Hip arthroscopy: Surgical indications. Arthroscopy. 2006;12:1260–1262.

18.

Byrd JW, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;7:1668–1674.

19.

Byrd JW, Jones KS. Traumatic rupture of the ligamentum teres as a source of hip pain. Arthroscopy. 2004;4:385–391.

20.

Byrd JW, Jones KS. Adhesive capsulitis of the hip. Arthroscopy. 2006;1:89–94.

21.

Casartelli NC, Maffiuletti NA, Item-Glatthorn JF, Staehli S, Bizzini M, Impellizzeri FM, Leunig M. Hip muscle weakness in patients with symptomatic femoroacetabular impingement. Osteoarthritis Cartilage. 2011;7:816–821.

22.

Cho KH, Lee SM, Lee YH, Suh KJ, Kim SM, Shin MJ, Jang HW. Non-infectious ischiogluteal bursitis: MRI findings. Korean J Radiol. 2004;4:280–286.

23.

Crawford K, Philippon MJ, Sekiya JK, Rodkey WG, Steadman JR. Microfracture of the hip in athletes. Clin Sports Med. 2006;2:327–335.

24.

Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). AJR Am J Roentgenol. 2004;1:137–143.

25.

DeAngelis NA, Busconi BD. Assessment and differential diagnosis of the painful hip. Clin Orthop Relat Res. 2003;406:11–18.PubMed

26.

Draovitch P, Edelstein J, Kelly BT. The layer concept: Utilization in determining the pain generators, pathology, and how structure determines treatment. Curr Rev Musculoskelet Med. 2012;1:1–18.

27.

Dreyfuss P, Dreyer SJ, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004;4:255–265.

28.

Dwek J, Pfirrmann C, Stanley A, Pathria M, Chung CB. MR imaging of the hip abductors: Normal anatomy and commonly encountered pathology at the greater trochanter. Magn Reson Imaging Clin N Am. 2005;4:691–704

29.

Gomes JL, Palma HM, Becker R. Radiographic findings in restrained hip joints associated with ACL rupture. Knee Surg Sports Traumatol Arthrosc. 2010 11: 1562–1567.

30.

Farber AJ, Wilckens JH. Sports hernia: Diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007;8:507–514.

31.

Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;2:171–178.

32.

Flanum ME, Keene JS, Blankenbaker DG, Desmet AA. Arthroscopic treatment of the painful “internal” snapping hip: Results of a new endoscopic technique and imaging protocol. Am J Sports Med. 2007;5:770–779.

33.

Fredericson M, Moore W, Guillet M, Beaulieu C. High hamstring tendinopathy in runners: Meeting the challenges of diagnosis, treatment, and rehabilitation. Phys Sportsmed. 2005;5:32–43.

34.

Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: A cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed

35.

Griffiths HJ, Utz R, Burke J, Bonfiglio T. Adhesive capsulitis of the hip and ankle. AJR Am J Roentgenol. 1985;1:101–105.

36.

Grissom L, Harcke HT, Thacker M. Imaging in the surgical management of developmental dislocation of the hip. Clin Orthop Relat Res. 2008;4:791–801.

37.

Haene RA, Bradley M, Villar RN. Hip dysplasia and the torn acetabular labrum: An inexact relationship. J Bone Joint Surg Br. 2007;10:1289–1292.

38.

Harvey WF, Yang M, Cooke TD, Segal NA, Lane N, Lewis CE, Felson DT. Association of leg-length inequality with knee osteoarthritis: A cohort study. Ann Intern Med. 2010;5:287–295.

39.

Hickman JM, Peters CL. Hip pain in the young adult: Diagnosis and treatment of disorders of the acetabular labrum and acetabular dysplasia. Am J Orthop (Belle Mead NJ). 2001;6:459–467.

40.

Howell GE, Biggs RE, Bourne RB. Prevalence of abductor mechanism tears of the hips in patients with osteoarthritis. J Arthroplasty. 2001;1:121–123.

41.

Ilizaliturri VM,Jr, Camacho-Galindo J, Evia Ramirez AN, Gonzalez Ibarra YL, McMillan S, Busconi BD. Soft tissue pathology around the hip. Clin Sports Med. 2011;2:391–415.

42.

Ilizaliturri VM,Jr, Villalobos FE,Jr, Chaidez PA, Valero FS, Aguilera JM. Internal snapping hip syndrome: Treatment by endoscopic release of the iliopsoas tendon. Arthroscopy. 2005;11:1375–1380.

43.

Irshad K, Feldman LS, Lavoie C, Lacroix VJ, Mulder DS, Brown RA. Operative management of “hockey groin syndrome”: 12 years of experience in national hockey league players. Surgery. 2001;4:759–64

44.

Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. report of three cases. J Bone Joint Surg Am. 1977;2:268–269.

45.

Kagan A,2nd. Rotator cuff tears of the hip. Clin Orthop Relat Res. 1999;368:135–140.PubMed

46.

Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. 2005;2:588–592.

47.

Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: Surgical technique and review of the literature. Arthroscopy. 2005;12:1496–1504.

48.

Kelly BT, Williams RJ,3rd, Philippon MJ. Hip arthroscopy: Current indications, treatment options, and management issues. Am J Sports Med. 2003;6:1020–1037.

49.

Khanduja V, Villar RN. The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;8:1035–1040.

50.

Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;3:423–429.

51.

Knockaert DC, D’Heygere FG, Bobbaers HJ. Ilioinguinal nerve entrapment: A little-known cause of iliac fossa pain. Postgrad Med J. 1989;767:632–635.

52.

Kong A, Van der Vliet A, Zadow S. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol. 2007;7:1772–1783.

53.

Kramer J, Recht MP. MR arthrography of the lower extremity. Radiol Clin North Am. 2002;5:1121–1132.

54.

Krych AJ, Larson CM, Byrd TW, Warren RF, Kelly BT. Low energy posterior wall fractures in athletes: Evidence of cam induced posterior hip subluxation. Presented at 2011 NFL Combine Physicians Society Meeting.

55.

Kusma M, Jung J, Dienst M, Goedde S, Kohn D, Seil R. Arthroscopic treatment of an avulsion fracture of the ligamentum teres of the hip in an 18-year-old horse rider. Arthroscopy. 2004;20:64–66.

56.

Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: Three representative case reports and proposed concept. Arthroscopy. 2011;12:1732–1737.

57.

Larson CM, Pierce BR, Giveans MR. Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: A case series. Arthroscopy. 2011;6:768–775.

58.

Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I. techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66.PubMed

59.

Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: Results of surgical management and histopathologic findings. Am J Sports Med. 2009;4:727–734.

60.

Lequesne M, Djian P, Vuillemin V, Mathieu P. Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. clinical and MRI results of tendon repair. Joint Bone Spine. 2008;4:458–464.

61.

Lequesne M, Mathieu P, Vuillemin-Bodaghi V, Bard H, Djian P. Gluteal tendinopathy in refractory greater trochanter pain syndrome: Diagnostic value of two clinical tests. Arthritis Rheum. 2008;2:241–246.

62.

Little TL, Mansoor J. Low back pain associated with internal snapping hip syndrome in a competitive cyclist. Br J Sports Med. 2008;4:308–9

63.

Longjohn D, Dorr LD. Soft tissue balance of the hip. J Arthroplasty. 1998;1:97–100.

64.

Margo K, Drezner J, Motzkin D. Evaluation and management of hip pain: An algorithmic approach. J Fam Pract. 2003;8:607–617.

65.

Martin HD, Kelly BT, Leunig M, Philippon MJ, Clohisy JC, Martin RL, Sekiya JK, Pietrobon R, Mohtadi NG, Sampson TG, Safran MR. The pattern and technique in the clinical evaluation of the adult hip: The common physical examination tests of hip specialists. Arthroscopy. 2010;2:161–172.

66.

Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: A quantitative report. Arthroscopy. 2008;2:188–195.

67.

Martin HD, Shears SA, Johnson JC, Smathers AM, Palmer IJ. The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy. 2011;2:172–181.

68.

Martin HD, Shears SA, Palmer IJ. Evaluation of the hip. Sports Med Arthrosc. 2010;2:63–75.

69.

Martinoli C, Miguel-Perez M, Padua L, Gandolfo N, Zicca A, Tagliafico A. Imaging of neuropathies about the hip. Eur J Radiol. 2011. doi:10.1016/j.ejrad.2011.04.034.

70.

Mattila VM, Niva M, Kiuru M, Pihlajamaki H. Risk factors for bone stress injuries: A follow-up study of 102,515 person-years. Med Sci Sports Exerc. 2007;7:1061–1066.

71.

McCarthy JC, Busconi BD, Owens BD. Assessment of the painful hip. In: IMcCarthy JC ed. Early hip disorders. New York: Springer; 2003:3–6.

72.

McCarthy J, Noble P, Aluisio FV, Schuck M, Wright J, Lee JA. Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res. 2003;406:38–47.PubMed

73.

Meyers WC, Foley DP, Garrett WE, Lohnes JH, Mandlebaum BR. Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (performing athletes with abdominal or inguinal neuromuscular pain study group). Am J Sports Med. 2000;1:2–8.

74.

Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;4:656–665.

75.

Moeller JL. Pelvic and hip apophyseal avulsion injuries in young athletes. Curr Sports Med Rep. 2003;2:110–115.PubMed

76.

Mullis BH, Dahners LE. Hip arthroscopy to remove loose bodies after traumatic dislocation. J Orthop Trauma. 2006;1:22–26.

77.

Murata Y, Ogata S, Ikeda Y, Yamagata M. An unusual cause of sciatic pain as a result of the dynamic motion of the obturator internus muscle. Spine J. 2009;6:e16–8.

78.

Niva MH, Kiuru MJ, Haataja R, Pihlajamaki HK. Fatigue injuries of the femur. J Bone Joint Surg Br. 2005;10:1385–1390.

79.

Northmore-Ball MD. Young adults with arthritic hips. BMJ. 1997;7103:265–266.

80.

O’Brien SD, Bui-Mansfield LT. MRI of quadratus femoris muscle tear: Another cause of hip pain. AJR Am J Roentgenol. 2007;5:1185–1189.

81.

Orava S, Ala-Ketola L. Avulsion fractures in athletes. Br J Sports Med. 1977;2:65–71.

82.

Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med. 2008;1:117–121.

83.

Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg. 2007;9:561–570.

84.

Patti JW, Ouellette H, Bredella MA, Torriani M. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skeletal Radiol. 2008;10:939–941.

85.

Petrigliano FA, Lieberman JR. Osteonecrosis of the hip: novel approaches to evaluation and treatment. Clin Orthop Relat Res. 2007;465:53–62.

86.

Philippon MJ. The role of arthroscopic thermal capsulorrhaphy in the hip. Clin Sports Med. 2001;4:817–829.

87.

Philippon MJ, Schenker ML, Briggs KK, Maxwell RB. Can microfracture produce repair tissue in acetabular chondral defects?. Arthroscopy. 2008;1:46–50.

88.

Pihlajamaki HK, Ruohola JP, Weckstrom M, Kiuru MJ, Visuri TI. Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults. J Bone Joint Surg Br. 2006;12:1574–1579.

89.

Pirouzmand F, Midha R. Subacute femoral compressive neuropathy from iliacus compartment hematoma. Can J Neurol Sci. 2001;2:155–158.

90.

Plante M, Wallace R, Busconi BD. Clinical diagnosis of hip pain. Clin Sports Med. 2011;2:225–238.

91.

Ranawat CS, Rodriguez JA. Functional leg-length inequality following total hip arthroplasty. J Arthroplasty. 1997;4:359–364.

92.

Rask MR. “Snapping bottom”: Subluxation of the tendon of the long head of the biceps femoris muscle. Muscle Nerve. 1980;3:250–251.PubMed

93.

Reider B, Martel J. Pelvis, hip and thigh. In: Reider B, Martel J, eds. The orthopedic physical examination. Philadelphia: Saunders; 1999:159–1199.

94.

Robb AJ, Fleisig G, Wilk K, Macrina L, Bolt B, Pajaczkowski J. Passive ranges of motion of the hips and their relationship with pitching biomechanics and ball velocity in professional baseball pitchers. Am J Sports Med. 2010;12:2487–2493.

95.

Robertson WJ, Gardner MJ, Barker JU, Boraiah S, Lorich DG, Kelly BT. Anatomy and dimensions of the gluteus medius tendon insertion. Arthroscopy. 2008;2:130–136.

96.

Robinson DE, Ball KE, Webb PJ (2001) Iliopsoas hematoma with femoral neuropathy presenting a diagnostic dilemma after spinal decompression. Spine (Phila Pa 1976) 6: 135–8.

97.

Schlegel TF, Bushnell BD, Godfrey J, Boublik M. Success of nonoperative management of adductor longus tendon ruptures in national football league athletes. Am J Sports Med. 2009;7:1394–1399.

98.

Schmid MR, Notzli HP, Zanetti M, Wyss TF, Hodler J. Cartilage lesions in the hip: Diagnostic effectiveness of MR arthrography. Radiology. 2003;2:382–386.

99.

Scillia A, Choo A, Milman E, McInerney V, Festa A. Snapping of the proximal hamstring origin: A rare cause of coxa saltans: A case report. J Bone Joint Surg Am. 2011;21:e1251–3.

100.

Scopp JM, Moorman CT,3rd. The assessment of athletic hip injury. Clin Sports Med. 2001;4:647–659.

101.

Segal NA, Harvey W, Felson DT, Yang M, Torner JC, Curtis JR, Nevitt MC, Multicenter Osteoarthritis Study Group. Leg-length inequality is not associated with greater trochanteric pain syndrome. Arthritis Res Ther. 2008;3:R62.

102.

Shaffer RA, Rauh MJ, Brodine SK, Trone DW, Macera CA. Predictors of stress fracture susceptibility in young female recruits. Am J Sports Med. 2006;1:108–115.

103.

Shbeeb MI, O’Duffy JD, Michet CJ,Jr, O’Fallon WM, Matteson EL. Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. 1996;12:2104–2106.

104.

Shindle MK, Ranawat AS, Kelly BT. Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient. Clin Sports Med. 2006;2:309–326.

105.

Shindle MK, Voos JE, Heyworth BE, Mintz DN, Moya LE, Buly RL, Kelly BT. Hip arthroscopy in the athletic patient: current techniques and spectrum of disease. J Bone Joint Surg Am. 2007;89:29–43.

106.

Stafford GH, Villar RN. Ischiofemoral impingement. J Bone Joint Surg Br. 2011;10:1300–1302.

107.

Stokes VP, Andersson C, Forssberg H. Rotational and translational movement features of the pelvis and thorax during adult human locomotion. J Biomech. 1989;1:43–50.

108.

Svoboda SJ, Williams DM, Murphy KP. Hip arthroscopy for osteochondral loose body removal after a posterior hip dislocation. Arthroscopy. 2003;7:777–781.

109.

Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008;12:1407–1421.

110.

Torriani M, Souto SC, Thomas BJ, Ouellette H, Bredella MA. Ischiofemoral impingement syndrome: An entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;1:186–190.

111.

Troum OM, Crues JV,3rd. The young adult with hip pain: Diagnosis and medical treatment, circa 2004. Clin Orthop Relat Res. 2004;418:9–17.PubMed

112.

Vandervliet EJ, Vanhoenacker FM, Snoeckx A, Gielen JL, Van Dyck P, Parizel PM. Sports-related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis. Br J Sports Med. 2007;11:827–831.

113.

Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport. 2007;6:463–466.

114.

Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;6:794–819.

115.

Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;11:1246

116.

Weir A, de Vos RJ, Moen M, Holmich P, Tol JL. Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain. Br J Sports Med. 2011;1:6–9.

117.

Williams JG. Limitation of hip joint movement as a factor in traumatic osteitis pubis. Br J Sports Med. 1978;3:129–133.

118.

Winston P, Awan R, Cassidy JD, Bleakney RK. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007;1:118–126.

119.

Yamamoto Y, Usui I. Arthroscopic surgery for degenerative rupture of the ligamentum teres femoris. Arthroscopy. 2006;6:689

Title: An Algorithmic Approach to Mechanical Hip Pain
Authors: Lazaros A. Poultsides, MD, MSc, PhD
Asheesh Bedi, MD
Bryan T. Kelly, MD
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: HSS Journal ® / Issue 3/2012
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-012-9304-x

2024 ASCO Annual Meeting

Springer Medicine

An Algorithmic Approach to Mechanical Hip Pain

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2012

Peripheral Sympathectomy as a Novel Treatment Option for Distal Digital Necrosis Following Parenteral Administration of Promethazine

A Mid-Term Analysis Suggests Ceramic on Ceramic Hip Arthroplasty Is Durable with Minimal Wear and Low Risk of Squeak

Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip

Labral Refixation: Current Techniques and Indications

Effect of Pelvic Osteotomy in the Skeletally Immature on Acetabular Coverage

Churg–Strauss Syndrome with Eosinophilic Myocarditis