Hip & Groin Common Injuries

Hip & Groin Common Injuries

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Adductor Strain (Groin Strain)

Adductor Strain (Groin Strain) is an acute injury to the groin muscles on the inside of the thigh. Tears can occur at muscle origin or insertion, at the muscle-tendon junction, or within the belly of the muscle(s). Most commonly, tears occur at the muscle-tendon junction. Grade I involve a mild strain with some injury, bleeding, tenderness, but no significant fiber disruption. Grade II injury involves injury to the muscle-tendon fibers, but the overall integrity of the muscle-tendon unit is preserved. A Grade III injury involves disruption leading to a loss of overall tendon integrity. Most adductor muscle strains are Grades I or II.

Symptoms include sudden onset of pain, sometimes accompanied by the sensation of a pop in the inner thigh.

Treatment is based on the grade of injury and often includes a period of rest, activity modification, physical therapy, with possible crutches. Dr. Sampson uses ultrasound for accurate diagnosis and guides return to activity.

Athletic Pubalgia (Sports Hernia)

Athletic Pubalgia (Sports Hernia) is pain of the groin region. It has also been called sportsman hernia and hockey groin. It often happens occurs in sports that require running, twisting, or kicking including soccer, hockey, rugby, and football. Many conditions can cause athletic pubalgia, including tendon strains, nerve injuries, joint problems, and true hernias.

Symptoms include pain in the groin region, which can occasionally radiate up into the stomach or down into the thigh, and are frequently increased with running, kicking, twisting, sit ups, coughing, or sneezing.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Deep Gluteal Space Syndrome

Deep gluteal space syndrome is the presence of pain in the buttock region caused from entrapment of the sciatic nerve beyond the level of the spine. Several structures can be involved in sciatic nerve entrapment within the gluteal space. The structures that can be involved in sciatic nerve entrapment within gluteal space include the piriformis muscle, fibrous bands containing blood vessels, gluteal muscles, hamstring muscles, the deep external rotators, vascular abnormalities, and space-occupying lesions. Patients with sciatic nerve entrapment often have previous history of trauma and symptoms of sit pain, radicular pain of the lower back or hip and paresthesias of the affected leg.

Symptoms may include neurological symptoms or motor weakness. Some symptoms may mimic a hamstring tear or hip injury such as aching, burning sensation or cramping in the buttock or posterior thigh.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Femoroacetabular Impingement (FAI) and Labral Injuries

Femoroacetabular impingement (FAI) is a common cause of hip pain. Impingement occurs because of an abnormal shape of the ball or socket of the hip joint. The pinching or friction may cause damage to the labrum and/or the articular cartilage. FAI is common in high level athletes, but also occurs in active individuals. There are two types of FAI impingement: Cam and Pincer. The Cam form describes extra bone formation on the femoral head and neck. The Pincer form describes over coverage of the socket. Many patients have a mixed type with both Cam and Pincer. Most frequently the Cam type of impingement tends to affect young male athletes in their 20s, while Pincer tends to occur more commonly in women in their 30s and 40s. Sports associated with FAI include martial arts, ballet, cycling, rowing, golf, tennis, soccer, football, ice hockey, baseball, lacrosse, field hockey, rugby, water polo, and deep squatting activities such as power lifting. It is often confused with other sources of pain, such as hip flexor tendonitis, pain from the back, testicular pain, sports hernia.

Symptoms may include hip and groin pain. The pain may occur with sports, or it may occur with walking, running, or prolonged sitting. Patients may also feel clicking or catching in the groin if there is a labral tear present. There may be no pain or symptoms.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases. Dr. Sampson also works closely with a world class orthopedic hip specialist for patients that fail conservative treatment.

Gluteus Medius/Minimus Tendinopathy or Partial Rupture

Lateral hip pain was previously characterized as greater trochanteric bursitis. It is now recognized that many cases of lateral hip pain are from wear and tear, or even complete tears, of the gluteus medius and minimus tendons. These tendons attach on the greater trochanter. There are several bursa in this region that may become irritated secondarily to the partial or complete tears. Thus, some have called the gluteus medius and minimus tendons the “rotator cuff of the hip”.

Symptoms include pain on the outside of their hip. Often there is pain rolling over in bed on the affected side. Patients may note that they fatigue easily with prolonged walking.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Hamstring Strain/Rupture

A hamstring injury is a strain or tear to the tendons or large muscles at the back of the thigh. It is a common injury in athletes and can occur in different severities. The term “hamstring” refers to the group of three muscles that run along the back of the thigh, from the hip to just below the knee. Grade 1 is a mild muscle pull or strain, grade 2 is a partial muscle tear, and grade 3 is a complete muscle tear. Injuries often occur during sudden, explosive movements, such as sprinting, lunging or jumping. But they can also occur more gradually, or during slower movements that overstretch your hamstring. Recovery from a hamstring injury will depend on how severe the injury is.

Symptoms include sudden pain and tenderness at the back of the thigh. It may be painful to move the leg. Swelling, bruising, and loss of strength occur with high grade injuries.

Treatment often includes a period of rest, activity modification, physical therapy, and crutches. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Hip Arthritis

Hip arthritis occurs at the joint between the femur and acetabulum. Over time the cartilage wears down and causes the bones to rub together causing pain. There are many causes including wear and tear over time, trauma, infection, chronic injury, etc.

Symptoms include pain, weakness, and loss of motion. Patients may note catching, locking, or popping.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Iliopsoas Bursitis

Iliopsoas bursitis is inflammation in the bursa located under the iliopsoas muscle. A bursa is a sac that can be filled with fluid between tissues (bone, skin, tendons and muscle). It acts to decrease the friction and the irritation between the tissues. When a bursa is not irritated, joints move smoothly and painless. But when it becomes inflamed and swollen, they become painful. This is referred to as a bursitis. The iliopsoas muscle is a group of two muscles located toward the front of the inner hip that acts as a hip flexor.

Symptoms include pain or soreness in the groin or front of the hip. The pain may also be worsened with any activity involving hip flexion such as prolonged sitting or climbing stairs.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Iliotibial Band Syndrome

The iliotibial band (IT band) is a thick band of fascia that extends down the outside of the upper thigh. It begins on the pelvis, crosses the hip and knee, and attaches just below the knee. Pain is a result of friction or rubbing of the iliotibial band against the bone on the outside of the knee, which results in irritation of the band. It is one of the most common injuries especially seen in runners. Athletes involved in cycling, weightlifting, football, soccer and tennis may also experience pain from the IT band.

Symptoms include pain on the outer part of the knee with sporting activities, popping or rubbing sensation on the outer knee, pain after sitting for long periods of time with the knee bent.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Meralgia Paresthetica

Meralgia paresthetica is a condition characterized by tingling, numbness and burning pain in the thigh. It is caused by compression of the lateral femoral cutaneous nerve that supplies sensation to the skin surface of the thigh. It is commonly caused by tight clothing, obesity or weight gain, and pregnancy.

Symptoms include tingling and numbness in the outer part of your thigh or burning pain on the surface of the outer part of the thigh.

Treatment often includes wearing looser clothing or weight loss. In pregnancy it typically resolves following delivery. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Piriformis Syndrome

Piriformis Syndrome is a disorder of one of the deep hip external rotators located in the buttock region. Now considered a part of ‘deep gluteal space syndrome’, referring to entrapment of the sciatic nerve beyond the level of the spine. The piriformis is the most common structure involved in sciatic nerve entrapment within gluteal space. It has a relationship where the nerve runs directly below the muscle with variations including the nerve going through or around the muscle. Patients with sciatic nerve entrapment often have previous history of trauma and symptoms of sit pain, radicular pain of the lower back or hip and paresthesias of the affected leg.

Symptoms include pain, tingling, and/or numbness in the buttocks that may radiate down the leg. Often worse after prolonged sitting, climbing stairs, walking, or running.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Stress Fracture

A stress fracture is a fracture that is caused by too much stress being put on a bone. It is not typically caused by trauma and it develops gradually over time. It most commonly affects bones of the lower extremity, such as the tibia in the lower leg, the metatarsal bones of the foot, and the femoral neck at the hip joint. However, it can occur in any bone. Upper extremity stress fractures can occur in overhead athletes and gymnasts. Causes include repetitive high-impact exercise, increase in training volume or intensity, poor fitting athletic equipment, low bone density, and poor nutrition.

Symptoms include a gradual onset of pain with activity that progresses to affect daily activities. The pain will develop at the site of the fracture.

Treatment often includes an extended period of rest with immobilization in a cast, walking boot, and/or crutches. Dr. Sampson helps identify cause of injury and supervises healing and a return to activity.

Trochanteric Bursitis

Trochanteric Bursitis is pain in the bursa located in the outside of the hip. A bursa is a fluid-filled sac that provides cushioning and reduces the friction from tendons and muscles rubbing on underlying bones. One of these is located on the outer side of the thigh bone near the hip, called the greater trochanteric bursa. This can be a source of pain as the result of a direct injury or from overuse. This is commonly seen in women, people ages 30-50, and runners. Common causes include an increase in training, weakness of the muscles around the greater trochanter, and tightness of the iliotibial (IT) band.

Symptoms include pain of the outer aspect of the hip and thigh which may worsen with activity. These symptoms can get worse with walking and by applying pressure to the affected side. Many patients complain of difficulty sleeping on the affected side at night due to pain.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

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