Ask The Physician

Hip Injuries – Diagnosis and Treatment

Answers to Your Health Questions by John P. Salvo, Jr., M.D.

Q: How do you diagnose the cause of hip pain?

A: We start with a good history and physical examination to narrow down the possible causes of the symptoms and problem. We then evaluate radiological studies such as x-rays or MRI. With the hip, I want patients to get an MR arthrogram (an MRI with dye injected into the hip joint) to give more complete diagnostic results. Once all of the information is gathered, we figure out whether the patient’s symptoms are from the hip joint itself or from other injured body areas (e.g. low back pain, groin strain, etc.).

Q: What types of sports tend to have more hip problems?

A: We see hip problems and injuries more commonly in soccer, ice hockey, gymnastics, dance and cheerleading. They can happen in any sport and can be affected by an individual’s biomechanics within the sport. The types of diagnosis usually associated with these sports are “snapping” hip, labral tears, adductor strains, or apophyseal injuries.

Q: What Treatment options are there for Hip Pain?

A: Once a thorough evaluation and diagnosis has been established for hip pain in a patient, the treatment options will be reflective of the diagnosis. Some of the common treatment options are rehabilitation involving strengthening, stretching and modality utilization (to help decrease pain and increase function) decreasing activities that increase symptoms, anti-inflammatories, biomechanical evaluations or surgical intervention.

Q: What kind of hip problems can be treated with hip arthroscopy?

A: In general, most problems around the hip and groin are treated without surgery. If patients have pain in the hip and groin that is caused by a problem inside the hip joint, then it may be treated arthroscopically. The most common indications for hip arthroscopy are tears in the labrum, hip impingement (femoracetabular impingement or FAI), loose bodies, or synovitis (inflammation of the lining of the hip joint). If the cause of the pain is from outside the hip joint, then it cannot be treated arthroscopically.

Q: Who is a candidate for hip arthroscopy?

A: Obviously, someone has to have pathology in the hip joint to even be considered for arthroscopy (e.g labral tear, FAI, loose bodies). Once that is established, patients generally break down into 2 age groups. First is the younger athletic population (less than 25 years old). Most of these patients will have a labral tear due to an injury and can be treated arthroscopically. The second group is the older population (less than 45-50 years old). This group is more likely to have chronic problems such as FAI, synovitis, or degenerative labral tears and mild arthritis.

Q: Can you treat arthritis with hip arthroscopy?

A: No. Only the very early stages of arthritis can be treated with an arthroscopic procedure. Once patients have changes, seen on their x-rays, consistent with arthritis, it is too late for arthroscopy to help. Most patients with arthritis are treated with activity modification, weight loss, and medications as indicated. When this does not work, then they may need a hip replacement.