US Assessment of Sports-related Hip Injuries

Abstract

Traumatic and overuse hip injuries occur frequently in amateur and professional athletes. After clinical assessment, imaging plays an important role in diagnosis and in defining care management of these injuries. Ultrasonography (US) is being increasingly used in assessment of hip injuries because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability, which allows both static and dynamic evaluation as well as guidance of point-of-care interventions such as fluid aspiration and steroid injection. Accurate diagnosis of hip injuries is often challenging, given the complex soft-tissue anatomy of the hip and the wide spectrum of injuries that can occur. To conduct a skillful US evaluation of hip injuries, physicians must have pertinent knowledge of the normal anatomy and should make judicious use of surface anatomy landmarks while using a compartmentalized diagnostic approach. In this article, common sports-related injuries of the anterior, lateral, and posterior hip compartments are discussed. This review includes assessment of joint effusion, acetabular labral tear, acute and chronic tendon injuries including tendinopathy, partial and full-thickness tears, snapping hip syndromes, relevant US-guided procedures, and some other conditions such as Morel-Lavallée lesion and perineal nodular induration. Principles of care management and current knowledge on imaging findings that may affect return to activity are also presented. Using an oriented US examination technique and having knowledge of the normal hip anatomy will help physicians characterize US findings of common sports-related hip injuries and make accurate diagnoses. Online supplemental material is available for this article. RSNA, 2018.

Stop Searching under the Streetlight! A Primer and Practical Guide to the Diagnosis of Joint Pain and Inflammation

“…HADD around the hip is also a well-documented cause of ‘greater trochanter pain syndrome’ 58 or the involvement of the rectus femoris reflected head. 59 Rectus femoris strains are not rare. In skeletally immature athletes, avulsion of the apophysis by the direct head will cause groin pain.…”

“…In skeletally immature athletes, avulsion of the apophysis by the direct head will cause groin pain. 59 Strains of the reflected head are common among adult athletes. Apophysitis of the lesser trochanter with avulsion can appear in boys involved in athletics.…”

“…Apophysitis of the lesser trochanter with avulsion can appear in boys involved in athletics. 59 Internal snapping hip is caused by snapping of the psoas tendon and can be associated with iliopsoas bursitis. 59 Core muscle injury also known as athletic pubalgia or sportsmen hernia is a complex injury to the pubic plate in athletes that includes stress reaction of bone, tendinosis and tears of the pubic plate (rectus abdominis, short adductors and adductor longus tendon), accumulation of fluid and development of cysts and arthrosis.…”

“… 59 Internal snapping hip is caused by snapping of the psoas tendon and can be associated with iliopsoas bursitis. 59 Core muscle injury also known as athletic pubalgia or sportsmen hernia is a complex injury to the pubic plate in athletes that includes stress reaction of bone, tendinosis and tears of the pubic plate (rectus abdominis, short adductors and adductor longus tendon), accumulation of fluid and development of cysts and arthrosis. 60 External snapping hip syndrome is a painful subluxation of the junction between the iliotibial band and the gluteus maximus muscle over the greater trochanter.…”

Medico-legal considerations for Morel-Lavallée lesions

“…Road crashes are the main cause of MLLs [1,5]. Sports requiring sliding actions (such as football, soccer, or baseball) rank second in order of frequency [8,9].…”