Evaluation of Athletes with Hip Pain
Hip pain is a common complaint in athletes and can result in a significant amount of time lost from sport. Diagnosis of the source of hip pain can be a clinical challenge because of the deep location of the hip and the extensive surrounding soft tissue envelope. Establishing whether the source of hip pain is intra-articular or extra-articular is the first step in the process. A thorough history and a consistent and comprehensive physical examination are the foundation for the proper management of athletes with hip pain. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - March 3, 2021 Category: Sports Medicine Authors: Jacob G. Calcei, Marc R. Safran Source Type: research
Athletic Injuries of the Hip
CLINICS IN SPORTS MEDICINE (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - March 3, 2021 Category: Sports Medicine Authors: Dustin L. Richter, F. Winston Gwathmey Source Type: research
Hip Instability in the Athlete
In this review, the recent literature evaluating the anatomic considerations, etiology, and management options for athletes with hip instability are investigated. Studies on the osseous, chondrolabral capsuloligamentous, and dynamic muscular contributions to hip stability are highlighted. Microinstability, iatrogenic instability, and femoroacetabular impingement-induced instability are discussed with a focus on demographic and outcomes research in athletes. Surgical techniques including both open and arthroscopic approaches are additionally evaluated. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - February 10, 2021 Category: Sports Medicine Authors: Kevin C. Parvaresh, Jonathan Rasio, Eric Azua, Shane J. Nho Source Type: research
Core Muscle and Adductor Injury
Core muscle injury is a common but difficult problem to treat. Although it can affect all individuals, it is most commonly seen in male athletes in cutting, twisting, pivoting, and explosive sports. Owing to the high association of femoroacetabular impingement, we believe these individuals are best treated with a multidisciplinary approach involving both orthopedic and general surgeons. Conservative treatment should be the first step in management. When conservative means are unsuccessful, operative intervention to correct all the pathologic issues around the pubis can have extremely high success rates. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - February 10, 2021 Category: Sports Medicine Authors: Timothy J. Mulry, Paul E. Rodenhouse, Brian D. Busconi Source Type: research
Rehabilitation of Soft Tissue Injuries of the Hip and Pelvis
The athlete ’s hip is complex when it comes to the surrounding musculature—approximately 21 different muscles can cross the hip and pelvis region, all synchronously working to maintain pelvic stability and functional hip activities. Commonly injured muscle groups for high-level athletes include flexors, add uctors, abductors, and/or proximal hamstring musculotendinous complex. These muscle groups work in harmony; however, each has an independent function and propensity for injury. Rehabilitation phases for each injury group can be broken down into 3 phases: acute management, strengthening, and return-t o-sport ...
Source: Clinics in Sports Medicine - February 10, 2021 Category: Sports Medicine Authors: Kyle E. Hammond, Lee Kneer, Pete Cicinelli Source Type: research
Proximal Hamstring Injuries
Proximal hamstring injuries can present as chronic tendinosis, acute strain, partial tendinous avulsions, or complete 3-tendon rupture. Nonoperative management for chronic insertional tendinosis and low-grade tears includes activity modification, anti-inflammatories, and physical therapy. Platelet-rich plasma injections, corticosteroid injections, dry needling, and shock wave therapy are newer therapies that also may provide benefit. Surgical indications include complete, proximal avulsions; partial avulsions with least 2 tendons injured with more than 2 cm of retraction in young, active patients; and partial avulsion inju...
Source: Clinics in Sports Medicine - February 10, 2021 Category: Sports Medicine Authors: Amanda N. Fletcher, Jonathan W. Cheah, Shane J. Nho, Richard C. Mather Source Type: research
Hip, Hip, Hurrah!
In the sports medicine world, you are either a “hipster” or you are not. If you are not, you need to have one (or more) of them on your team, and you need to know enough about the hip to know who to refer. This issue of Clinics in Sports Medicine is primarily focused on us “nonhipsters,” and it is hoped, will make us just a little bit sm arter in the eyes of the true “hipsters.” It is also an update and treatise on athletic hip injuries for those of us who take care of these problems, and all aspiring “hipsters” out there. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - February 10, 2021 Category: Sports Medicine Authors: Mark D. Miller Tags: Foreword Source Type: research
Pelvic Avulsion Injuries in the Adolescent Athlete
This article reviews the etiology, presentation, and management of the more common pelvic avulsion fractures, including anterior superior iliac spine, anterior inferior iliac spine, ischial tuberosity, and iliac crest avulsions. Adolescent pelvic avulsion fractures rely on the amount of fracture displacement to guide treatment. Conservative management includes rest and avoiding use of the muscle(s) that attach to the avulsed fragment. Operative treatment is reserved for widely displaced fractures or symptomatic nonunions. With appropriate treatment, young athletes frequently return to their same level of sport. (Source: Cl...
Source: Clinics in Sports Medicine - February 4, 2021 Category: Sports Medicine Authors: Kathryn C. Yeager, Selina R. Silva, Dustin L. Richter Source Type: research
Hip Injuries in the Adolescent Athlete
This article provides concise and up-to-date information on the most common hip pathologies that affect adolescent athletes. We cover the evaluation and treatment of avulsion injuries, stress fractures, slipped capital femoral epiphysis (SCFE), femoroacetabular impingement, developmental dysplasia of the hip, Legg-Calve-Perthes disease, and coxa saltans focusing on minimizing advanced imaging and using conservative therapy when applicable. Although this is not an all-encompassing list of disorders, it is key to understand these hip pathologies because these injuries occur commonly and can also have detrimental complication...
Source: Clinics in Sports Medicine - February 4, 2021 Category: Sports Medicine Authors: Paul B. Schroeder, Marc A. Nicholes, Matthew R. Schmitz Source Type: research
Sex-Related Differences in Hip Injury Rates and Strength and Conditioning
Hip injuries are common in the athletic population, typically occurring in sports as a result of contact or overuse. Previous literature describes differences in injury rates between male and female athletes, clinical presentation, treatment, and outcomes. In addition, anatomic differences in acetabular and femoral version, hip alpha angles, lateral center-edge angles, pelvic tilt, and knee biomechanics have been demonstrated. These differences may alter injury patterns between male and female athletes and contribute to differences in hip pathology. Therefore, individualized treatment and rehabilitation strategies should b...
Source: Clinics in Sports Medicine - February 4, 2021 Category: Sports Medicine Authors: Arianna L. Gianakos, John W. Yurek, Mary K. Mulcahey Source Type: research
Hip Abductor and Peritrochanteric Space Conditions
The hip trochanteric bursa, tendinous insertions of the gluteal muscles, and the origin vastus lateralis make up the main structures of the peritrochanteric space. Greater trochanteric pain syndrome (GTPS) refers to pain generated by one or multiple disorders of the peritrochanteric space, such as trochanteric bursitis, gluteus medius and minimus tendinopathy or tear, and disorders of the proximal iliotibial band. Patients with GTPS might present with associated intra-articular hip pathology, which requires further investigation and appropriate management. Successful midterm outcomes have been reported in patients undergoi...
Source: Clinics in Sports Medicine - February 4, 2021 Category: Sports Medicine Authors: Alexander E. Weber, Jennifer A. Bell, Ioanna K. Bolia Source Type: research
Hip Pain in the Athlete: The Source is Key
Compared with the diagnosis and management of pain in the knee and shoulder, diagnosis and management of hip pain in the adolescent and young adult population had been relatively neglected until the twenty-first century. During the past 2 decades, there has been an explosion in the understanding of hip pathologic condition and management of hip conditions in the younger population without arthritis. Improved indications and modern techniques have been developed that make the field of hip arthroscopy relatively safe with a low complication rate. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - February 4, 2021 Category: Sports Medicine Authors: Dustin L. Richter, F. Winston Gwathmey Tags: Preface Source Type: research
Hip Imaging and Injections
Athletic injuries of the hip often require radiographs and advanced imaging for diagnosis. Plain radiographs evaluate for osseous injury, provide a structural context behind an athlete ’s symptoms and examination, and offer a backdrop for interpretation of advanced imaging. An understanding of normal anatomy, imaging findings, and radiographic measurements allows for recognition of pathoanatomy and ability to diagnose accurately. Advanced imaging modalities, including magnetic r esonance imaging, computed tomography, and ultrasonography, each play a role in evaluation of the athlete’s hip. Although MRI and CT p...
Source: Clinics in Sports Medicine - January 18, 2021 Category: Sports Medicine Authors: Timothy P. Lancaster, Christopher C. Chung, Winston F. Gwathmey Source Type: research
Femoroacetabular Impingement and Management of Labral Tears in the Athlete
This article reviews the hip joint anatomy and complex interplay between alterations on the femoral and acetabular sides, in addition to evaluation of soft tissue stabilizers and spinopelvic parameters. Symptom management with a focus on arthroscopic treatment of abnormal bony morphology and labral repair or reconstruction is discussed. In select patients with persistent pain who have failed conservative measures, hip arthroscopy with correction of bony impingement and labral repair or reconstruction has yielded good to excellent results in recreational and professional athletes. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - January 18, 2021 Category: Sports Medicine Authors: David A. Hankins, Lucas Korcek, Dustin L. Richter Source Type: research
Acetabular dysplasia represents a structural pathomorphology associated with hip pain, instability, and osteoarthritis. The wide spectrum of dysplasia anatomically refers to a 3-dimensional volumetric- and surface area-based insufficiency in coverage and is classified based on the magnitude and location of undercoverage. Borderline dysplasia has been variably defined and leads to management challenges. In symptomatic dysplasia, treatment addresses coverage with periacetabular osteotomy. Concomitant simultaneous or staged hip arthroscopy has significant advantages to address intra-articular pathology. In nonarthritic indivi...
Source: Clinics in Sports Medicine - January 18, 2021 Category: Sports Medicine Authors: Joshua D. Harris, Brian D. Lewis, Kwan J. Park Source Type: research
Hip Flexor Injuries in the Athlete
Athletic injuries to the hip flexors and iliopsoas have been described in populations across all levels of competitive sports. Overall estimates of hip flexor pathology have ranged from 5% to 28% of injuries among high-risk sport specific groups. Although most of these injuries are successfully treated with conservative management, and high rates of return to play are observed, significant rehabilitation time can be involved. As the understanding of hip pathology with imaging modalities such as MRI has advanced, greater importance has been placed on accurately diagnosing hip flexor injuries and initiating rehabilitation pr...
Source: Clinics in Sports Medicine - January 18, 2021 Category: Sports Medicine Authors: Zachary K. Christopher, Jeffrey D. Hassebrock, Matthew B. Anastasi, Kostas J. Economopoulos Source Type: research
Stress Fractures of the Hip and Pelvis
Stress fractures refer to overuse injuries of bone resulting from repetitive mechanical stress. Stress fractures of the hip and pelvic region, while relatively uncommon, have become increasingly recognized in certain populations, particularly long-distance runners and military recruits. The diagnosis of such injuries can be challenging, often hampered by a nonspecific physical examination and limited sensitivity of plain radiography. Early recognition is important to direct appropriate management, lessen time lost from sport, and avoid potential complications. The present article reviews the epidemiology, diagnosis, and ma...
Source: Clinics in Sports Medicine - January 18, 2021 Category: Sports Medicine Authors: Rebecca A. Dutton Source Type: research
The Molecular Pathophysiology of Concussion
After a concussion, a series of complex, overlapping, and disruptive events occur within the brain, leading to symptoms and behavioral dysfunction. These events include ionic shifts, damaged neuronal architecture, higher concentrations of inflammatory chemicals, increased excitatory neurotransmitter release, and cerebral blood flow disruptions, leading to a neuronal crisis. This review summarizes the translational aspects of the pathophysiologic cascade of postconcussion events, focusing on the role of excitatory neurotransmitters and ionic fluxes, and their role in neuronal disruption. We review the relationship between p...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: David R. Howell, Julia Southard Source Type: research
Neuropsychological Assessment of Sport-Related Concussion
Neuropsychological assessment is a key component in a comprehensive, multidisciplinary approach to assessment of sport-related concussion (SRC). Currently computerized tests are the most commonly used modality of neurocognitive testing and involve both baseline and postinjury assessments. A comprehensive neuropsychological assessment should not only include neurocognitive testing but also incorporate symptom inventories, vestibular-ocular screening, and a psychological evaluation. Neuropsychological assessments are most effective when completed by a Clinical Neuropsychologist, given their specialized training in test inter...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Sabrina Jennings, Michael W. Collins, Alex M. Taylor Source Type: research
Rehabilitation of Sport-Related Concussion
This article provides a summary of clinical assessment methods and nonpharmacologic rehabilitation techniques used for concussed patients. It describes concussion-relevant physical examination methods to identify underlying symptom generators. This approach allows practitioners to prescribe targeted rehabilitation therapies to treat postconcussion symptoms. Evidence-based rehabilitation approaches include cervical rehabilitation, vestibulo-ocular rehabilitation, and sub –symptom threshold aerobic exercise. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Mohammad Nadir Haider, Lenore Herget, Ross D. Zafonte, Adam G. Lamm, Bonnie M. Wong, John J. Leddy Source Type: research
Neuroimaging in Sports-Related Concussion
This article focuses on the current status of imaging and future directions in concussion-related research. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Gaurav Jindal, Rajan R. Gadhia, Prachi Dubey Source Type: research
Medical Therapies for Concussion
The medications used in postconcussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds. These medications are not routinely used in most concussions that recover within days to weeks. However, it is beneficial to be aware of medication options that may be used in athletes with prolonged concussion symptoms or for those that have symptom burdens that preclude entry into basic concussion protocols. Medications and supplements remain a small part of the concussion treatment plan, which may include temporary academic adjustments, physical therapy, vestibular and ocular therapy...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Jacob C. Jones, Michael J. O ’Brien Source Type: research
Female Athlete and Sports-Related Concussions
Female athletes are participating in collision sports in greater numbers than previously. The overall incidence of concussion is known to be higher in female athletes than in male athletes participating in similar sports. Evidence suggests anatomic, biomechanical, and biochemical etiologies behind this sex disparity. Future research on female athletes is needed for further guidance on prevention and management of concussion in girls and women. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Katherine H. Rizzone, Kathryn E. Ackerman Source Type: research
Prevention of Sport-Related Concussion
Concussion remains a common injury among sports participants. Implementing risk-reduction strategies for sport-related concussion (SRC) should be a priority of medical professionals involved in the care of athletes. Over the past few decades, a multifaceted approach to reducing SRC risk has been developed. Protective equipment, rule and policy change/enforcement, educational programs, behavioral modifications, legislation, physiologic modifications, and sport culture change are a few of the programs implemented to mitigate SRC risk. In this article, the authors critically review current SRC risk-reduction strategies and of...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Peter K. Kriz, William O. Roberts Source Type: research
Considerations for Athlete Retirement After Sport-Related Concussion
The recommendation to retire from sport after concussion has evolved with the understanding of concussion. Age, sport, position, level of play, relevant medical and concussion history, severity and duration of symptoms, neuroimaging and neuropsychological testing should all be considered. Susceptibility to injury, persistence of symptoms, psychological distress, and personal values and support may also play a role. Pediatric athletes may require a more conservative approach, given ongoing growth and development. For professional and/or elite athletes, financial or career implications may be considerations. When possible, r...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Julie C. Wilson, Tatiana Patsimas, Kathleen Cohen, Margot Putukian Source Type: research
Future Directions in Sports-Related Concussion Management
This article focuses on 3 concepts that continue to be investigated in the search for the holy grail of concussion —a valid diagnostic test. Imaging advances are discussed with optimism that functional MRI and diffusion tensor imaging may be available clinically. Biomarkers and the use of genetic tests are covered. Sideline accelerometer use may help steer discussions of head trauma risk once technology exists to accurately estimate acceleration of the brain. In the meantime, strategies including allowing athletes to be substituted out of games for an evaluation and video review in elite sports can improve recognitio...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Hamish Kerr, Bj ørn Bakken, Gregory House Source Type: research
Sports-Related Concussions and the Pediatric Patient
Pediatric patients with concussions have different needs than adults throughout the recovery process. Adolescents, in particular, may take longer to recover from concussion than adults. Initially, relative rest from academic and physical activities is recommended for 24 to 48 hours to allow symptoms to abate. After this time period, physicians should guide the return to activity and return to school process in a staged fashion using published guidelines. Further concussion research in pediatric patients, particularly those younger than high-school age, is needed to adv ance the management of this special population. ...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Stessie Dort Zimmerman, Brian T. Vernau, William P. Meehan, Christina L. Master Source Type: research
Diagnosis and Sideline Management of Sport-Related Concussion
The diagnosis of sport-related concussion is still based primarily on history and physical examination. Use of a standardized history and examination form is recommended. There have been many tests investigated, but none have been proven to be sensitive and specific for the diagnosis of concussion. Sideline management is based on recognition, diagnosis, and initial treatment. It is clear that symptoms of a concussion can worsen with continued play, and so, if a concussion is suspected based on observation, history, and physical examination, then the athlete should be removed from play. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Andrew Gregory, Sourav Poddar Source Type: research
Long-Term Neurocognitive, Mental Health Consequences of Contact Sports
This article presents a brief history and literature review of chronic traumatic encephalopathy (CTE) in professional athletes that played contact sports. The hypothesis that CTE results from concussion or sub-concussive blows is based largely on several case series investigations with considerable bias. Evidence of CTE in its clinical presentation has not been generally noted in studies of living retired athletes. However, these studies also demonstrated limitation in research methodology. This paper aims to present a balanced perspective amidst a politically charged subject matter. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Barry S. Willer, Mohammad Nadir Haider, Charles Wilber, Carrie Esopenko, Michael Turner, John Leddy Source Type: research
Epidemiology of Sport-Related Concussion
Sport-related concussions are common in the United States. Concussion rates have increased over time, likely due to improved recognition and awareness. Concussion rates vary across level (high school vs college), sex, and sport. Concussion rates are the highest among men, particularly in football, wrestling, ice hockey, and lacrosse where collisions and contact are inherent to the sports, although girls ’/women’s soccer rates are high. In gender-comparable sports, women have higher concussion rates. Continued data collection will increase understanding of sport-related concussion and provide areas for targeted ...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Lauren A. Pierpoint, Christy Collins Source Type: research
Outpatient Management of Sport-Related Concussion, Return to Learn, Return to Play
Outpatient sports-related concussion (SRC) management continues to evolve as evidence emerges supporting a multidisciplinary approach to the clinical assessment of SRC. Early active rehabilitation has replaced strict cognitive and physical rest. With this paradigm shift in management, pragmatic approaches are highly sought by busy clinicians that provide direction to individualized treatment, which can potentially expedite symptom resolution. Treatment strategies that address domain-based symptom constellations continue to be developed by clinician researchers. Although the optimal timing and dose of these domain-specific ...
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Peter K. Kriz, James P. MacDonald Source Type: research
Biomechanics of Sport-Related Neurological Injury
As awareness on the short-term and long-term consequences of sports-related concussions and repetitive head impacts continues to grow, so too does the necessity to establish biomechanical measures of risk that inform public policy and risk mitigation strategies. A more precise exposure metric is central to establishing relationships among the traumatic experience, risk, and ultimately clinical outcomes. Accurate exposure metrics provide a means to support evidence-informed decisions accelerating public policy mandating brain trauma management through sport modification and safer play. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Clara Karton, Thomas Blaine Hoshizaki Source Type: research
It has been nearly a decade since Drs Meehan and Micheli were guest editors of an issue of Clinics in Sports Medicine dedicated entirely to sport-related concussion (SRC). It is an honor to follow these giants in their respective fields and provide an update on a condition that continues to impact millions of athletes annually in the United States. Recent data utilizing emergency department visits estimate that 1.0 to 1.8 million SRCs occur each year in individuals 18 years old and younger, with approximately 400,000 of these injuries occurring in high-school athletes. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Peter K. Kriz Source Type: research
Sport-Related Concussion: Heads Up!
There has been a lot of progress since the last time we covered this topic in Clinics in Sports Medicine a decade ago, including new research, an emphasis on no return to play the same day, and a better understanding of chronic traumatic encephalopathy. Nevertheless, there is still a great deal that we don ’t know. Thank you to Dr Kriz for putting together this treatise outlining the current state-of-the-art on sport-related concussion (SRC). This issue covers the entirety of this topic, beginning with the basics and bringing in both research and clinical management. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Mark D. Miller Tags: Foreword Source Type: research
CLINICS IN SPORTS MEDICINE (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - November 11, 2020 Category: Sports Medicine Authors: Peter K. Kriz Source Type: research
Chronic Lateral Ankle Instability
Surgical management for chronic lateral ankle ligament instability is useful when patients have failed nonoperative modalities. Open anatomic reconstruction is an effective method of stabilization. Ankle arthroscopy is a recommended to address intra-articular disorder before stabilization. An anatomic approach provides full range of motion, stability, and return to sport and activity. Allograft or suture tape augmentation can be useful for patients with generalized ligamentous laxity, patients with high body mass index, and elite athletes. Allograft reconstruction may be especially useful in revision procedures. Arthroscop...
Source: Clinics in Sports Medicine - September 4, 2020 Category: Sports Medicine Authors: Eric Ferkel, Shawn Nguyen, Cory Kwong Source Type: research
This article provides guidelines for treatment of a recurrent fracture or nonunion with a concomitant cavovarus foot deformity. (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - September 4, 2020 Category: Sports Medicine Authors: Carroll P. Jones Source Type: research
Foot and Ankle Injuries and Treatment
CLINICS IN SPORTS MEDICINE (Source: Clinics in Sports Medicine)
Source: Clinics in Sports Medicine - September 4, 2020 Category: Sports Medicine Authors: Anish R. Kadakia, Joseph S. Park Source Type: research