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What are the symptoms for hip instability?

Exit forum ID Forum Discussion What are the symptoms for hip instability?

This topic contains 5 replies, has 4 voices, and was last updated by   Keith Puri, DC January 17, 2020 at 4:15 pm.

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  • #8968

    Brandon Cohen DC, CSCS
    Participant

      15 yr old female (softball player)
      L: Anterior hip (lateral to asis, superior and posterior towards the mid iliac crest), B. Lower lumbar spine (over the past 3 weeks).
      Q: Throbbing all the time, also “popping out,” “weak” with higher load activity (specifically running)
      I: Current 5/10, avg 7/10, worst 10/10 (This was Tuesday after running hills at practice, mom said she was just lying on the floor on her back crying)
      Provocative: Running, getting in and out of a catcher’s crouch, lateral deviation of the femoral head (like a standing TFL or glute med. stretch.) It’s important to note that the popping out is not painful, but when it “goes back in” the throbbing increases and persists for varying time periods.
      Palliative: rest, light adductor type stretches (standing hip openers)
      FASTMAP: F/S: 75 M: 10 P: 10 (The M and P are due to the fact that I am unclear as to whether the symptom location is known for hip.

      2nd order: 9/2018 R. posterior horn meniscus repair and patellar tendon repair. Returned to activity that spring for softball. Did not play catcher throughout that season, hip pain started in May 2019.
      Plain film is unremarkable
      Getting worse over time, more intense and more frequent.

      Exam is tomorrow 1/16 around noon.

      Post Consult dx:
      Labral tear

      My thinking is that she has a tear in the labrum creating instability in the hip, and that the throbbing in the joint after the “popping out” is from the joint crashing into itself over and over again. The low back issue seems to be compensatory to the hip complaint, and I suspect that the hip has been a problem longer considering the knee issues on the same side. Durability seems like it could be a big component as well. Is it worth asking her mother about her injury history, or will that just cloud the picture?

      I love you all.

      #8969

      Seth Schultz, DC
      Participant

        I think you’re right in thinking labral tear. I would also evaluate for FAI and hip dysplasia especially if she has been a catcher for the majority of her softball days. That position alone will put huge amounts of load on the joint during adolescence when her growth plates were open. If I remember correctly, hip growth plates in females typically close by 16.

        The durability conversation needs to happen early but I don’t necessarily think it should be done on the exam as that could cloud the picture. But her having a history of surgery at a young age is not a good sign for her future and she would benefit in re-calibration of healthy activity.

        #8970

        Brandon Cohen DC, CSCS
        Participant

          Thanks, Seth. Her primary ordered a diagnostic ultrasound, and maybe she was doing this for hip dysplasia, but all the stuff I saw doesn’t indicate ultrasound for infants over 6 months.

          Any specific tests to rule in/out dysplasia, or a resource to check out? I have done a quick search this morning, but haven’t seen anything that looks very reliable. Thanks!

          #8971

          Adam Holen D.C.

            So far it makes sense for a labrum problem from the high load on a developing growth plate.
            My only input would be to consider EDS or a connective tissue or extensibility disorder. I would imagine this is more difficult to diagnose in adolescents as their ranges of motion should generally be pretty good (not limited from adhesion/overuse). So if she’s hyper-flexible on the exam, that would be a consideration.
            Especially for having had knee surgery at the ripe age of 14, genetic durability is a problem, unless that was due to trauma.
            Interesting case, let us know how the exam goes.

            #8974

            Brandon Cohen DC, CSCS
            Participant

              Thanks Adam. No specific traumas to report other than regular softball and soccer experiences. Connective tissue disorders are on the radar.

              #8975

              Keith Puri, DC
              Participant

                Plain films XR of the hip and pelvis would probably be the easiest way to ddx between FAI and dysplasia. For dysplasia look at the lateral center edge angle to determine if there is any uncovering of the femoral head. A dysplastic hip is defined by a lateral center edge angle of less than 20 degrees and borderline dysplasia if 20-25 degrees. Normal values should be between 25-40 degrees.

                For hypermobility spectrum disorders, I use the Beighton score and revised Beighton diagnostic criteria to help determine if additional diagnostic workup is needed to rule in/out EDS-h and/or dysautonomia.

                Pending the results of your exam, additional ddx’s to consider are femoral neck/pelvis stress fx and relative energy deficiency in sport (RED-S).

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