Hip Pain

Aka: Hip Pain, Groin Pain, Groin Injury, Groin Injuries in Athletes

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II. Epidemiology: Groin Injury in Athletes

  1. Groin Injury accounts for 2-5% of sports injury
  2. Higher risk sports for Groin Injury
    1. Soccer (Incidence 5-7%)
    2. Ice hockey
    3. Fencing
    4. Handball
    5. Cross Country Skiing
    6. Hurdling
    7. High Jumping

III. Precautions: Risk Factors for serious pathology

  1. Age over 65 years
  2. Pain on Hip Range of Motion
    1. Intrinsic hip pathology
    2. Septic Arthritis of the hip
  3. Inability to bear weight
    1. Hip Stress Fracture
    2. Hip Septic Arthritis
    3. Avascular Necrosis of the Hip
    4. Femoral lesion (e.g. malignancy)
    5. Unstable Slipped Capital Femoral Epiphysis (8-15 years old)
  4. Abdominal Pain
    1. Abominal aortic aneurysm (may present with back pain if retroperitoneal bleeding)
    2. Appendicitis
    3. Renal Calculi
    4. Pelvic tumors
    5. Ectopic Pregnancy
    6. Pelvic Inflammatory Disease
    7. Abdominal Hernia or Inguinal Hernia
  5. History of malignancy (or Night Sweats, weight loss)
  6. Hip Trauma
  7. Alcohol Abuse
  8. Night pain, Constant pain, Weight loss
    1. Malignancy
  9. Fever
    1. Septic Arthritis of the hip
    2. Malignancy
    3. Perirectal Abscess
    4. Appendicitis
  10. Chronic Corticosteroids, Chronic inflammatory conditions or Coagulopathy
    1. Avascular necrosis of the hip
  11. Cardiovascular Risk Factors (e.g. Diabetes Mellitus, Tobacco abuse, Coronary Artery Disease, Carotid Stenosis)
    1. Aortoilliac Occlusive Disease

IV. Exam

  1. See Hip Exam
  2. Perform an abdominal exam and back exam on all Hip Pain patients
  3. Findings most suggestive of hip intra-articular cause
    1. Pain on external and internal hip rotation
    2. Pain on hip axial loading (force applied at foot or knee towards hip)

V. Differential Diagnosis

  1. See Hip Pain Causes
  2. Exclude serious hip causes
    1. Septic Arthritis of the Hip
    2. Hip Fracture or Hip Stress Fracture
    3. Hip Avascular Necrosis
    4. Slipped Capital Femoral Epiphysis (SCFE, peri-Puberty)
  3. Exclude serious external Hip Pain Causes
    1. Peripheral Arterial Disease (Aortoilliac Occlusive Disease, Abdominal Aortic Aneurysm)
    2. Peritonitis (or other surgical Abdomen)
    3. Malignancy involving hip or Pelvis (bony metastases, Multiple Myeloma, Chondrosarcoma)

VI. Imaging

  1. Hip XRay
    1. Obtain Anteroposterior View (AP View) and Frog-Leg Lateral View
    2. First-line study in hip Pain Evaluation
    3. Evaluate for bony lesions (e.g. malignancy), Femoral Neck Stress Fracture
    4. Low yield for Osteoarthritis (36% Test Sensitivity)
      1. Kim (2015) BMJ 351:h5983 +PMID:26631296 [PubMed]
    5. Hip XRay may miss non-displaced Femoral Fractures
      1. Consider MRI or CT for negative XRay with higher index of suspicion
      2. Parker (1992) Arch Emerg Med 9(1): 23-7 [PubMed]
      3. Hakkarinen (2012) J Emerg Med 43(20: 303-7 +PMID:22459594 [PubMed]
  2. Hip MRI (or Hip CT if MRI unavailable)
    1. Indicated in Hip Pain with non-diagnostic XRay
  3. Hip MRI with arthrography
    1. Indicated for suspected hip Labral Tear (Test Sensitivity 90% contrasted with 36% for standard MRI)
  4. Hip Ultrasound
    1. Long axis view detects hip effusion and can direct hip needle aspiration if septic hip is suspected
    2. Also indicated in Functional Evaluation of hip
    3. Test Sensitivity approaches 80-85% for identifying hip effusion in children
      1. Vieira (2010) Ann Emerg Med 55(3): 284-9 +PMID:19695738 [PubMed]

VII. References

  1. Fields (1997) Lecture: AAFP Sports Medicine, Dallas
  2. Ruane (1998) Physician SportsMed 26(4):78-103
  3. Shahideh (2013) Crit Dec Emerg Med 27(9):10-18
  4. Braly (2006) Clin Sports Med 199-210 [PubMed]
  5. Brunner (2003) Am Fam Physician 67(3):537-42 [PubMed]
  6. Fricker (1997) Br J Sports Med 31:97-101 [PubMed]
  7. Lynch (1999) Sports Med 28:137-44 [PubMed]
  8. Morelli (2001) Am Fam Physician 64(8):1405-14 [PubMed]
  9. Wilson (2014) Am Fam Physician 90(1): 27-34 [PubMed]

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Related Studies (from Trip Database) Open in New Window

Ontology: Hip pain (C0019559)

Concepts Sign or Symptom (T184)
ICD10 M25.559 , M25.55
SnomedCT 49218002, 268065004, 156598006, 202473003, 156592007, 202486007
LNC MTHU020861
English Coxalgia, Arthralgia (hip), Hip arthralgia, hip joint pain, hip joint pain (symptom), hip pain, Pain in hip, Painful hips, Pain in unspecified hip, painful hip, hip arthralgia, hip pains, Pain;musculoskeletal;hip, Pain;hip, hip joints pain, hips pain, pain in hip, hip joint pains, arthralgia - hip, arthralgia - pelvis / hip / femur, arthralgia of hip (diagnosis), arthralgia of hip, Pain in joint - coxalgia, Hip painful, Hip pain, Arthralgia of hip, Hip joint pain, Hip pain (finding), coxalgia, hip; joint pain, hip; pain, joint, Hip Pain, musculoskeletal hip pain
Dutch pijnlijke heupen, pijn in heup, coxalgia, heup; gewrichtspijn, heup; pijn, gewricht
French Coxalgie, Hanches douloureuses, Douleur dans la hanche
German schmerzhafte Hueften, Schmerz in der Huefte, Koxalgie
Italian Coxalgia, Anche doloranti, Dolore all'anca
Portuguese Dor na anca, Ancas dolorosas, Coxalgia
Spanish Coxalgia, Caderas dolorosas, Dolor en cadera, coxalgia (hallazgo), coxalgia, dolor de cadera
Japanese 股関節痛, ｺｶﾝｾﾂﾂｳ
Czech Bolest v kyčli, Bolestivé kyčle, Koxalgie
Hungarian Fájdalmas csípők, Fájdalom a csípőízületben, Coxalgia
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Inguinal pain (C0239783)

Concepts Sign or Symptom (T184)
SnomedCT 207217001, 102570003, 271856002
English PAIN GROIN, [D]Groin pain, Groin Pain, [D]Groin pain (context-dependent category), Inguinodynia, groin pain (symptom), groin pain, inguinal pain, Pain groin, groin pains, Pain;groin, inguinodynia, [D]Groin pain (situation), Groin pain (finding), Inguinal region painful, Groin pain, Inguinal pain, Inguinal pain (finding), groin; pain, pain; groin
Italian Dolore inguinale
Dutch pijn in de lies, lies; pijn, pijn; lies, liespijn
French Douleur à l'aine, DOULEUR INGUINALE, Douleur inguinale
German Schmerz in der Leiste, Leistenschmerzen
Spanish Dolor de ingle, [D]dolor en la ingle (categoría dependiente del contexto), [D]dolor en la ingle, [D]dolor inguinal, [D]dolor en la ingle (situación), dolor en la ingle, dolor inguinal (hallazgo), dolor inguinal, inguinodinia (hallazgo), inguinodinia, Dolor inguinal
Japanese 鼡径部痛, ｿｹｲﾌﾞﾂｳ
Portuguese DOR NA VIRILHA, Dor inguinal
Czech Bolest třísla
Hungarian Lágyék fájdalom, Lágyéktáji fájdalom
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Injury of groin (C0272438)

Concepts Injury or Poisoning (T037)
ICD10 S30-S39
SnomedCT 11805005
English injuries to the groin, groin injuries, groin injury, injury of lower extremity groin, Injury of groin (diagnosis), Injury of groin, Groin injury, Injury of groin (disorder), groin; injury, injury; groin, injury; iliac region
Dutch letsel; lies, letsel; regio iliaca, lies; letsel
Spanish injuria de la ingle, injuria inguinal, lesión traumática de la ingle (trastorno), lesión traumática de la ingle
Derived from the NIH UMLS (Unified Medical Language System)

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