Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Other causes of Pain in the Hip and Groin

Overuse injury or rupture of other groin muscle-tendon units

A number of muscles and tendons affecting the groin region, including the pectineus, the sartorius, the tensor fasciae latae, and the gluteus medius, can be damaged during sporting activity. The precise location of the pain, together with an assessment of muscle function, can elucidate the diagnosis.

Symptoms and treatment are in principle the same as those described for overuse injuries of the adductor
muscle—tendon unit.

Hip joint changes

Pain in the groin may be referred from the hip joint and can be an early symptom of changes due to wear (osteoarthritis), rheumatoid arthritis, or osteochondritis. Loose bodies can occur in the joint, formed by a release of fragments of bone and cartilage (osteochondritis dissecans). In exceptional cases the edge (limbus) of cartilage that surrounds the joint cavity may have been displaced and driven into the joint. These conditions cause pain on exertion and loading, and also sometimes locking of the hip joint. Continuous and persistent aching discomfort is often precipitated by exertion. Pain during movements of the hip joint, especially during extension, should motivate an X-ray examination or MRI. This MRI can sometimes be carried out, with a contrast medium (arthrogram), with the hip held in the position which triggers the pain. Arthroscopy may also be considered.

Dislocation of the hip joint

The hip joint is extremely stable under normal circumstances, but can be dislocated (usually backwards) by very violent impact (e.g. in American football or motorsport). The injury is serious because the femoral head can be damaged permanently through impairment of its circulation. Dislocations of the hip joint rarely occur without simultaneous skeletal injuries, and prolonged follow-up treatment is needed before a return to sporting activity can be made. This injury may result in necrosis (tissue death) of the femoral head, which may
cause permanent dysfunction.

Fracture of the neck or upper shaft of the femur

Fractures of the neck of the femur and of the upper part of its shaft are comparatively common injuries in the elderly. The former, however, also occurs in younger individuals who have fallen directly on the hip
while skating or skiing, for example. It is typical of fractures of the neck of the femur that the injured leg is shortened and rotated outwards (externally) after the injury. These fractures are nearly always operated on, and healing and rehabilitation are a slow process. Return to pounding activities is often possible.

Stress fracture of the neck of the femur

Stress fractures can occur in the upper femur, in the neck of the femur, and in the pelvis bone, typically in long-distance runners, as a result of prolonged and repeated load. Women with the female triad are liable to this injury.

Symptoms and diagnosis

– Pain occurs during loading of the hip joint and also aching in the joint after exertion.
– Pain is felt in the hip joint on movement.
– When there is persistent pain in the hip region, X-rays should be carried out.
– A bone scan or an MRI can be useful, particularly in cases where there is a high risk of stress fractures.

Treatment

– Rest the leg until the fracture has healed, which usually takes 5–8 weeks, depending on the location of the fracture and the age of the injured athlete. Unloading with crutches may be necessary. No return to sport until complete healing is secured.
– If the fracture is on the upper outside portion of the femoral neck, surgical placement of screws over the fracture may be the best treatment. This is because of the high incidence of complete fractures following this type of stress fracture.

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