Ortho on the go
Ortho on the go
A case of hip injury in track athlete!
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Welcome to the Ortho on the Go podcast. My name is Chuck Dowell, the host of the podcast. This is an educational orthopedic podcast focused on discussing both clinical and functional orthopedics. We will discuss a variety of topics within the field of orthopedics, including reviewing interesting cases, hearing from different professionals throughout the orthopedic profession, and discussing common musculoskeletal injuries and complaints. This podcast is meant for anyone that wants a better understanding of orthopedics, including all levels of practitioners, coaches, parents, and athletes themselves. Today we're doing the case of the week. So this was an interesting case, something that we do frequently see in the family practice urgent care and orthopedic urgent care clinic where I work. So it was a 13-year-old female who presented STED the day before she was a track athlete. She was running the 100 meters in track and she immediately felt a pop as well as increasing pain within the anterior hip area. She had difficulty with weight bearing and was on crutches, secondary to her weight-bearing restrictions and her pain with weight bearing after this time. So I'll give you a few seconds if you're kind of thinking about this. Young, healthy, athletic track athlete was running doing high-level sprinting and the 100-meter track and felt a pop in the front of the hip. So, what are kind of your immediate thoughts regarding that? So her examination did show some mild edema noted throughout the anterior hip and throughout her kind of iliac crest area. She had quite a bit of tenderness around her anterior superior iliac spine and diffusely throughout the anterior hip and hip flexor area. She had significant increasing pain with active hip flexion activities, passive hip internal, external rotation activities and log rolling, as well as passive hip flexion, did not cause pain. Her x-rays, as you can see, if you are following this along on the YouTube channel, the x-rays are available to review. Her x-rays, including an AP pelvis, which you can see here. A little bit of a different view. As you can see, the pelvic ring is not concentric, and so she's a little bit internally rotated on that right side, which is the side of pain compared to that left side. But you can see there seems to be a small little kind of deformity around that anterior superior iliac spine. Her direct view of an AP of the hip shows that as well. And so oftentimes kids will have these kind of phyceal changes there. I think that's where it's important to get these bilateral hip views to see if one compares to the other. Unfortunately, on this case, I wasn't able to get it, but sometimes, as you can see on the screen now, these kind of false profile views or these frog leg views can show that you know anterior superior iliac spine a little bit better. But the diagnosis for this patient was an anterior superior iliac spine avulsion injury. So if we remember, you can see from the illustration here that your anterior superior iliac spine is where your sartorius and tensor fasciulata kind of attach at, and your anterior inferior iliac spine is where your rectus femoris attach at. So for this patient, it was more of this avulsion type injury of that tensor fasciata or sartorius that attaches in that area. Now, typically these can be treated non-operatively and patients do quite well. Oftentimes the diagnosis can be made clinically, but can be confirmed via either CT scan or MRI. If there is displacement, so let's say there's more than three centimeters of displacement where this fiseal attachment is at, oftentimes, and or sometimes we can treat those surgically. But if the X-ray or MRI confirms less than three centimeters of displacement, we can treat these with protective weight bearing. So oftentimes this is the sartorius attachment, as we discussed, and you can kind of see on the diagram that we have of the athlete will typically report a pop or snap at the time of the injury. Often can be misdiagnosed or confused for just an acute muscle strain within the area. Again, radiographs can be used to show the bony abnormalities, as such in our view. And sometimes you can get advanced imaging if necessary. Again, treatment typically is protective weight bearing with crutches. Now I will say that because of the sartorius and if it's the AIIS, the rectus femoris attachment, oftentimes non-weight bearing and having them hold that hip up in the air kind of overactivates that area and can cause some increasing pain. So a lot of the times we will protect their weight bearing, but we will do touchdown weight bearing so they don't have to put as much stress or strain across that anterior hip and hip flexor area. We'll have them start early passive range of motion activities as not to get any stiffness within the hip. They can start some early stretching activities. Typically, it takes about four weeks or so for these to heal, and then they can start progressing back into more sports-related activities. There is a slight increased propensity for these to re-injure as they're healing, so we don't want them to go directly back into sports activities. We want them to progress back into those activities after a few weeks. But a very interesting case, oftentimes something that we will see, young athletic uh patients come in complaining of anterior hip pain after doing explosive type activities. If they did feel uh a pain, a pop, um, and or they're not able to weight bear, definitely keep in mind a possible avulsion of this ASIS where that sartorius and tetrafascialata attach is at, or this AIIS where the rectus formoris attaches at. If you don't feel like you could see it well on the images, but the clinical uh evaluation is concerning, definitely consider getting advanced imaging. And again, do that protective weight bearing until they're able to get that advanced imaging. Thank you very much. I hope you enjoyed this case, and we'll see you at the next one.