Spine & Sports Institute

Kyle Anderson, MD*†, Sabrina M. Strickland, MD‡ and Russell Warren, MD

Am J Sports Med July 2001 29:521-533.

Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Thus, an accurate diagnosis and well-organized treatment plan are critical. Because loads of up to eight times body weight have been demonstrated in the hip joint during jogging, presumably even greater loads can occur during vigorous athletic competition. The available imaging modalities are effective diagnostic tools when selected on the basis of a thorough history and physical examination. Considerable controversy exists as to the cause and optimal treatment of groin pain in athletes, or the so-called “sports hernia.” There has also been significant recent attention focused on intraarticular lesions that may be amenable to hip arthroscopy. This article briefly reviews several common hip and groin conditions affecting athletic patients and highlights some newer topics.

Athletic injuries about the hip and groin occur at a low frequency relative to injuries at the more distal lower extremities. Epidemiologic studies have shown that injuries to the hip region compose approximately 5% to 9% of the injuries in high school athletes.1530 Rehabilitation times can be prolonged, making early and accurate diagnosis essential.

The anatomic and biomechanical considerations for injuries in these areas are among the most complex in the musculoskeletal system, making the management of these injuries very challenging. The immature skeleton can add to this complexity and broaden the differential diagnosis.

Loads of up to eight times body weight have been demonstrated in the hip joint during jogging, with potentially greater loads present during vigorous athletic competition.13 The structures about the hip are uniquely adapted to transfer such forces. The body’s center of gravity is located within the pelvis, anterior to the second sacral vertebra; thus, the loads that are generated or transferred through this area are important in virtually every athletic endeavor.

Imaging modalities continue to be developed and refined to help clinicians diagnose more accurately, and these often provide prognostic information. These imaging studies are most effective when selected on the basis of a thorough history and physical examination. Both nonoperative and operative treatment options for injuries to the hip and groin have improved. For example, the importance of trunk stability rehabilitation is being increasingly recognized. Among the many surgical advances for these injuries are the use of hip arthroscopy for intraarticular abnormalities and laparoscopy for lower abdominal injuries.

W. Ben Kibler, MD

Am J Sports Med March 1998 26:325-337.

Abstract

The exact role and the function of the scapula are misunderstood in many clinical situations. This lack of awareness often translates into incomplete evaluation and diagnosis of shoulder problems. In addition, scapular rehabilitation is often ignored. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation. This knowledge will help the physician to provide more comprehensive care for the athlete. This “Current Concepts” review will address the anatomy of the scapula, the roles that the scapula plays in overhead throwing and serving activities, the normal biomechanics of the scapula, abnormal biomechanics and physiology of the scapula, how the scapula may function in injuries that occur around the shoulder, and treatment and rehabilitation of scapular problems.

Eric J. Strauss, MD*, Jennifer A. Hart, MPAS, PA-C†, Mark D. Miller, MD†, Roy D. Altman, MD‡ and Jeffrey E. Rosen, MD

Am J Sports Med August 2009 37:1636-1644.

Abstract

Intra-articular hyaluronic acid viscosupplementation is gaining popularity as a treatment option in the nonoperative management of patients with osteoarthritis. Recent clinical studies have demonstrated that the anti-inflammatory, anabolic, and chondroprotective actions of hyaluronic acid reduce pain and improve patient function. With evidence mounting in support of the efficacy of this treatment modality for patients with osteoarthritis, its potential use in additional patient populations and for other pathologies affecting the knee is being investigated. The current article reviews the use of intra-articular hyaluronic acid viscosupplementation in the management of knee osteoarthritis and presents the potential for expanding its indications for other joints and alternative patient subpopulations. Additionally, future directions for the use of hyaluronic acid and areas of active research are discussed.

Summary

Intra-articular HA injection is gaining popularity as part of the nonoperative management of patients with OA. The anti-inflammatory, anabolic, and chondroprotective actions of HA have been shown in recent clinical studies to reduce pain and improve function. With evidence mounting in support of the efficacy of this treatment modality for patients with OA, its potential use in additional patient populations and other pathologies affecting the knee is being investigated. Although continued study is needed, intra-articular HA injection is proving to be a safe, effective, and evolving tool for clinicians treating patients with symptomatic OA.