Groin pain is a common complaint in kicking athletes and must be recognized by the treating orthopaedic surgeon. A consensus statement during the Doha Agreement has defined 3 types of groin pain: defined clinical entities for groin pain, hip-related groin pain (femoroacetabular impingement, chondral, or labral tears) and other causes (such as anterior inferior iliac spine, ischial pathology). Clinical entities for groin pain are the most common, and strains/pain from the adductors, iliopsoas, and pubic areas are typically successfully treated with conservative treatment. Often, pain from inguinal-related groin pain requires surgical intervention from a general surgeon. Femoroacetabular impingement often coexists with a variety of other pathology and may result in labral tears and chondral damage. Open or arthroscopic osteoplasty is typically successful at alleviating symptoms and has high rates of return to sport. AIIS impingement from chronic hypertrophic overuse of the rectus femoris or trauma has recently been discovered as a cause of FAI that responds well to arthroscopic decompression and osteoplasty. Ischiofemoral impingement usually responds to conservative treatment with heel lifts, physical therapy and activity modification or image-guided corticosteroid injections into the quadratus femoris. The various causes of athletic groin pain if not recognized can cause significant disability and impair athletic performance. Further study is needed in this field to further clarify the relationship between clinical syndromes, determine optimal treatment/management algorithms and the most efficacious surgical techniques. The purpose of this article was to review the current evidence of hip injuries in kicking athletes.
Femoroacetabular impingement syndrome (FAIS) is a source of hip pain that can present in adolescent athletes and is related to sports participation and extreme use in these patients. FAIS is characterized by morphologic abnormalities of the acetabulum and/or proximal femur that leads to pathologic contact within the hip joint. FAIS is classified as cam-type, pincer-type, or combined. Early sports participation is a factor in the development of symptomatic FAIS. Adolescent patients with FAIS are also more likely to have associated extra-articular pathologies. History and physical exam findings in adolescents with FAIS are not considerably different than corresponding findings in adults with FAIS and include activity-related groin pain aggravated by pivoting and flexion activities. FAIS can be treated conservatively or surgically. In refractory cases, outcomes after surgical intervention have been shown to be significantly better than nonsurgical treatment. Surgical intervention involves repairing damage to the labrum and/or cartilage and decompressing the bony impingement. Open and arthroscopic approaches have been shown to be safe and effective in adolescents with good outcomes. Most adolescent athletes are able to return to participation in their sport and a majority returning to their preinjury level of play after surgical intervention.
Femoroacetabular impingement (FAI) can present with debilitating symptoms in an athlete, affecting both their level of performance and activities of daily life. The prevalence of FAI in the athletic population is greater than in the general population, but the reasons are unknown. The rate of return to sport following surgery for FAI has been a popular research topic, and results have been promising. However, there are still a significant number of athletes who do not return to their sport. Additionally, the rate of return to previous level of competition has largely been neglected in the literature, which is arguably more important than the rate of return to sport. The literature is varied regarding radiographic assessment of FAI, patient reported outcome measures, time to follow-up, and overall methodological quality. This chapter aims to review risk factors for failure of return to sport, and predictors affecting the return to previous level of competition in the athlete after FAI treatment.
Running and cycling have become among the top athletic activities in the United States. While endurance sports can lead to decreased cardiovascular disease and chronic comorbidities, it can lead to musculoskeletal injury. Hip injuries in endurance athletes can be associated with both intra-articular and extra-articular disorders, resulting in prolonged decrease physical function and inability to return to sport. This review provides physicians with a summary of hip injury commonly presented in long distance runners and cyclist, as well as clinical exam recommendations for the source of hip pain in these endurance athletes.
Hip and groin injuries are among the most common locations for sports-related injuries in ice hockey players due to the specialized movements and physical nature of the sport. Goaltenders are at particular risk for hip injuries due to the unique demands of their position, particularly with the widespread use of the “butterfly style” technique, placement of the hip in extremes of motion during play, and the emphasis on repetition of skills. Hip injuries in ice hockey goalies are mainly attributed to overuse, traumatic contact injuries, or a developmental process. These injuries can be acute or chronic and involve the intra-articular joint and/or extra-articular structures including core muscles, adductors, or hip flexors. They can be treated either conservatively or operatively, depending on the player's goals and level of play. A more complicated picture arises when intra- and extra-articular hip pathologies coexist, presenting challenges in diagnosis and treatment. Fundamental understanding of goaltenders’ hip kinematics, diagnostic physical exam maneuvers, and operative indications is crucial to accurately diagnosing, treating, and preventing hip-related injuries in goalies.
Despite being relatively uncommon when compared to injuries to the ankle and knee, hip injuries in the contact athlete account for 5%-6% of all athletic-related injuries with increasing prevalence over the last decade. Athletic hip injuries represent a spectrum of often overlapping intra- and extra-articular disorders with the potential to cause significant disability and time lost from sport. Advancements in imaging modalities, arthroscopic instrumentation, and surgical techniques have improved diagnostic capabilities and treatment outcomes of athletic hip injuries. Furthermore, increased screening and better recognition of the role of femoroacetabular impingement on the development of intra-articular hip pathology and instability has provided physicians with a treatable risk factor deterring further hip disorders. This chapter provides physicians with a brief overview of commonly encounter hip injuries in the contact athlete, namely: muscle strains, contusion, labral injuries, and hip instability secondary to dislocation or subluxation in the setting of femoroacetabular impingement, as well as the previously described “sports hip triad.”
Hip injuries in the overhead athlete have attracted little attention in the past; however, hip and groin injuries make up 5.5% of all professional baseball injuries and continue to increase in prevalence. Hip and groin injuries are exacerbated by the repetitive extremes of motion required for throwing, serving, and spiking a ball as well as the rapid acceleration and deceleration involved in overhead athletics. The diagnosis and management of these injuries in overhead athletes can be challenging, and often involves multiple pain sources. These athletes commonly experience adductor strains and athletic pubalgia/core muscle injuries which often occur concurrently with underlying bony pathology such as femoroacetabular impingement, which leads to limitations in hip range-of-motion. Hip and groin injuries in the overhead athlete can be debilitating and recurring; therefore, accurate and prompt diagnosis and management of these injuries are critical.