Thursday, November 29, 2012

Hip pain and arthroscopy

For decades physicians and their patients have had the benefit of a minimally invasive option to treat a wide range of injuries of the shoulder, knee, wrist, and ankle. However options for the treatment of hip and groin disorders were more limited. Conditions often went undiagnosed, untreated, or worse, treated in fashions that made return to sport difficult. Many patients continue to be diagnosed with "pulled muscles" or "pre-arthritis." With the emergence of hip arthroscopy though, there have been dramatic advances in the diagnosis, treatment, and return to play for patients suffering from hip pain. Through the use of xray imaging, surgeons can safely introduce these small instruments into the hip, treat a multitude of issues, and preserve vital muscle and supporting tissue that would otherwise be disrupted through traditionally-used open surgical options. The most common indication for hip arthroscopy is currently a labrum tear. The labrum, similar to in the shoulder, is a ring of soft tissue circling the pelvic side of the hip joint. It serves to deepen the hip socket, provide a tight seal for the joint, and contains nerve endings that sense pain and aid in joint function.
Normal Hip Anatomy

When injured, patients will typically suffer from mechanical symptoms of the hip such as clicking and catching as well as limited range of motion. Other times the symptoms are less obvious, and only manifest with a dull groin pain with certain activities. At the time of arthroscopy, some labrum tears will need to be repaired with suture, and others will need to be trimmed to prevent continued symptoms.

Labrum tear

Coexistent with labrum tears, many surgeons are increasingly recognizing a condition termed femoroacetabular Impingement, or FAI. This condition refers to a mismatch in the shape of the two bones, the femur and acetabulum, which compose the hip joint. Deformity can be present in the femur, the acetabulum, or more commonly both. When on the femur it is termed a cam type impingement and if on the acetabulum, a pincer type impingement.

At a minimum FAI is felt to be the primary causative factor for labrum tears, and there are some who feel this condition is a significant contributor to osteoarthritis of the hip due the articular cartilage damage often seen when this condition exists. Treatment of this condition at the time of hip arthroscopy requires contouring the bone to recreate the natural shape of both bones, to minimize future trauma to the labrum and articular cartilage. In addition to these conditions, hip arthroscopy can successfully treat conditions such as loose bodies, cartilage defects, snapping hip, synovitis, tendon and ligament tears, and in certain cases osteoarthritis. Prior to hip arthroscopy, most patient will require specialized x-rays and MRI where dye is injected into the hip. Most patients will be on crutches approximately two weeks after their arthroscopy, and perform a combination of physical therapy and a home program for their rehabilitation. Return to athletic competition can take anywhere from four to six months.

Tuesday, November 27, 2012

Welcome

Welcome to a new forum for discussion of all aspects of sports medicine. My aim is to discuss a range of topics, focusing on the treatment of orthopaedic conditions common amongst athletes. I aim to respond to comments and questions as they arise, and provide a resource for those with questions as they pertain to the cause, diagnosis, and treatment of sports medicine injuries. Added focus will be placed on those issues important to the Kentuckiana area as we cheer on the Cards, Cats, and Hoosiers!