Does your Hip have a painful snap or pop?

Case: 15 year old athletic male presenting with complaints of right hip pain. The onset of pain occurred for several weeks without an acute injury. Located in the right anterior aspect of the hip and radiating towards the groin, the pain described ranging from dull to sharp was consistent throughout the day and exacerbated with flexion/extension exercises. As an active soccer player, actvities such as running and kicking were described as painful and limited. The patient had no significant history or prior injuries. Upon assessment, the only deviation from normal included pain elicited on flexion/extension movements, as well as clicking and stiffness with movement. 

Complaints of hip pain is relatively common among adolescent and adult athletes as well as non-athletes. Similarly to other types of joint and muscular pain, hip and groin pain can occur with or without injury, making the need to complete a thorough history and assessment vital to determine a root cause and develop an effective treatment plan.

The diagnosis of hip pain is broad and can have various differential diagnoses. Most commonly intra-articular hip pain presents in the groin but may also present on the side of the hip. In this case, femoroacetabular impingement (FAI) was noted as the cause for discomfort and was further discussed as the treatment plan was formed.

Hip impingement can be caused by 1) structural abnormalities of the femoral head and ball-and-socket joint resulting in abnormal contact and creating premature wear and tear on the joint, 2) repetitive motion that is often seen in various sports and activities or 3) caused by an injury. Diagnosis is confirmed through diagnostic testing such as x-rays, MRI and/or CT which reveal the abnormality. Treatment for hip impingement is contingent upon the individual and initial cause of injury. Appropriate treatment options begin with conservative approaches such as physical therapy to stretch and strengthen the surrounding muscles and intermittent NSAID use can often help alleviate symptoms. In select patients, the judicious use of corticosteroid injections can also be a plausible option for symptom relief. If the conservative treatments are not successful, the more invasive surgical options such as hip arthroscopy followed by physical therapy may be indicated.

It is important to note that untreated hip impingement is thought to not only limit activity and exasperate chronic pain complaints but can also hasten osteoarthritis in the hip.

 

Disclaimer:  Articles are based on real cases seen at Scottsdale Sports Medicine. The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Please consult your medical professional for individualized healthcare.

References:

Cross, M., Fabricant, PD., Maak, TG. & Kelly, BT. (2011). Hip Impingement (acetabular side) in Sports-related Injuries of the Hip. Clinics Sports Medicine. 30(2):379-90. doi: 10.1016/j.csm.2011.01.002.

Johnson, R. (2016). Approach to hip and groin pain in the athlete and active adult. UpToDate. Retrieved from https://www-uptodate-com.ezproxy2.library.arizona.edu/contents/approach-...

Rankin, AT., Bleakley, C. & Cullen, M. (2015). Hip Joint Pathology as a Leading Cause of Groin Pain in the Sporting Population: A 6-Year Review of 894 Cases. American Journal of Sports Medicine. 43(7):1698-703. doi: 10.1177/0363546515582031.