Nonsurgical Interventions
The aim of this chapter is to provide an overview of some of the more common injection therapies for sports-related disorders of the hip and pelvis in the primary care setting. A general overview and rational for use is presented for interventions includi
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Nonsurgical Interventions Michael D. Osborne, Tariq M. Awan, and Mark Friedrich B. Hurdle
Clinical Pearls • Given their relative safety, the ease of use in trained hands, and cost-effectiveness, injection therapies can be beneficial when more conservative treatment measures have failed. • Injection therapies containing local anesthetics may help confirm a diagnosis, particularly when performed with the precision of image guidance. • Informed consent should be obtained for all procedures and should include a discussion regarding the indications, anticipated outcome, potential risks and complications, possible side effects, and alternatives to the procedure. • It is incumbent on the proceduralist to have a thorough understanding of the relevant anatomy, procedural technique, potential risks, procedural contraindications, and to be prepared to manage any unforeseen complications prior to attempting injection therapies. • Injection therapies are very rarely indicated as first-line treatment.
M.D. Osborne, MD (*) • M.F.B. Hurdle, MD Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA e-mail: [email protected] T.M. Awan, DO Department of Orthopedics, Medsport Sports Medicine Program, University of Michigan, Ann Arbor, MI, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2017 P.H. Seidenberg et al. (eds.), The Hip and Pelvis in Sports Medicine and Primary Care, DOI 10.1007/978-3-319-42788-1_13
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Case Presentation
A 24-year-old male recreational basketball player presented with right hip and groin pain of 2 months duration. The patient was playing basketball and landed awkwardly on his right leg. He subsequently developed progressive pain with activity, sharp in quality, and predominantly over the anterior hip with radiation to the groin. He denied any mechanical catching or locking. He was unable to run or play basketball without discomfort. Pain could be relieved by laying supine with his hip and knee flexed. Mild relief was obtained with nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy.
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Physical Examination
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Normal appearance, gait, and station. Normal strength, reflexes, and full hip range of motion. Tenderness over iliopsoas at the pelvic brim and hip adductors. FABER test negative; Stinchfield test positive. Passive hip extension, internal rotation, and adduction caused discomfort but did not reproduce the typical pain. • Modified Thomas test was positive for anterior hip pain.
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Differential Diagnosis
Hip adductor strain Iliopsoas bursitis/tendonitis Hip labral tear Snapping hip syndrome Osteitis pubis Sports hernia/athletic pubalgia Femoral/pelvic stress fracture
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Imaging
• Plain radiographs were unremarkable. • Magnetic resonance imaging (MRI) arthrogram demonstrated a small linear extension of contrast beneath the superior acetabular labrum compatible with labral detachment (Fig. 13.1).
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Nonsurgical Interventions
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Fig. 13.1 MRI arthrogram of the hip demo
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