Hip Injuries

Hip pain or groin pain can be very debilitating and prevent many people from continuing with sports or other activities. This can commonly be caused by hip impingement or a labral tear in the hip.  We treat many hip conditions including using minimally invasive hip arthroscopy at both Rochester, MI or Shelby Township, MI locations:

Hip Arthroscopy

Hip arthroscopy is a recent advancement in sports medicine that has allowed us to better treat issues of the hip.  Hip arthroscopy involves using a minimally invasive approach by using 3-4 small incisions, less than 1 cm in size, to gain access to the hip. This has allowed us to treat conditions such as labral tears and hip impingement.

Hip Labral Tears

Labral tears of the hip can cause significant issues with playing sports and continuing to remain active. A labral tear of the hip typically presents with pain deep in the groin and is usually worse with activity or certain positions.

Cause

Labral tears in the hip can occur for multiple reasons. An acute trauma to the hip can create a tear to the labrum causing significant pain. Often times, labral tears are caused by a common issue that can occur in the hip known as impingement or FAI (Femoroacetabular impingement). Hip dysplasia or less than normal coverage of the head of the femur by the cup (acetabulum) can also lead to instability and tearing of the labrum.

Anatomy

The labrum is a semi-circular ring that surrounds the cup of the hip (acetabulum). The labrum has many functions, but mainly serves to give a suction seal in the hip and aid in lubrication and stability. When a labral tear occurs in the hip, this creates a micro instability of the hip that leads to significant pain and can lead to chondral damage. Hip impingement is a common cause of labral tears and will be discussed more in the hip impingement section.

Imaging

X-rays are initially obtained and this helps to evaluate for any arthritis of the hip as well as any bony deformity that may be the cause of the problem. An MRI is commonly obtained, and this can be performed with contrast depending on the type of MRI used. An MRI will allow better evaluation of the labrum and cartilage to help with treatment.

Treatment

Initially treatment will begin with conservative care including relative rest from activity, physical therapy and possibly injections, depending on your symptoms and activity. If you have continued pain and issues in your hip because of your labral tear, you would likely benefit from surgical fixation. Surgery would entail hip arthroscopy with repair of your injured labrum using strong suture and suture anchors. At the same time of surgery, there is typically treatment to shave down and remove any bone that is causing impingement on the labrum and this will be discussed more in the impingement section.

Recovery

Immediately after surgery, you will be on crutches and place limited weight on your operative leg. You will be given medication to help prevent the formation of excess bone in you hip (known as heterotopic ossification). Initially it is important to continue with range of motion of the hip. As your labrum heals, you will be allowed to place more weight on the leg and continue to get stronger. Recovery to full activity will take several months.

Hip Impingement

Hip impingement occurs when an abnormal, excess about of bone is formed on the femoral head or the cup of the hip (acetabulum). Because of this abnormal amount of bone, certain positions of the hip can cause pinching of the bone or impingement (FAI or femoroacetabular impingement). Due to this impingement, this can cause damage to the labrum and underlying cartilage leading to pain.

Cause

The abnormal formation of bone on the femoral head or cup of the hip (acetabulum) leads to impingement in the hip. This impingement in certain positions of the hip causes the labrum to tear and damage to the cartilage which causes significant hip and groin pain. The formation of bone is not completely understood. It is likely that this excess bone formation occurs during development and is present for years.

Anatomy

The hip is made up of the femoral head and the acetabulum (cup). The labrum is a semi-circular ring that surrounds the cup of the hip (acetabulum). The labrum has many functions, but mainly serves to give a suction seal in the hip and aid in lubrication and stability. When a labral tear occurs in the hip, this creates a micro instability of the hip that leads to significant pain and can lead to chondral damage. A labral tear commonly occurs because of the femoral head impinging on the acetabulum in certain hip positions. The most common position of impingement is the hip flexed up to about 90 degrees and crossed over the body (adducted) and rotated inward (internal rotation).

Imaging

X-rays are initially obtained and this helps to evaluate for any arthritis of the hip as well as any bony deformity that may be the cause of the problem. An MRI is commonly obtained, and this can be performed with contrast depending on the type of MRI used. An MRI will allow better evaluation of the labrum and cartilage to help with treatment.

Treatment

Initially treatment will begin with conservative care including relative rest from activity, physical therapy and possibly injections, depending on your symptoms and activity. If you have continued pain and issues in your hip because of your labral tear and impingement, you would likely benefit from surgical fixation. Surgery would entail hip arthroscopy with repair of your injured labrum, if present, using strong suture and suture anchors. At the same time of surgery, the impingement from the bone growth or abnormality will be shaved down to make a more spherical head and prevent any further impingement.

Recovery

Immediately after surgery, you will be on crutches and place limited weight on your operative leg. You will be given medication to help prevent the formation of excess bone in you hip (known as heterotopic ossification). Initially it is important to continue with range of motion of the hip. As your labrum heals, you will be allowed to place more weight on the leg and continue to get stronger. Recovery to full activity will take several months.

Hamstring Rupture

The hamstrings are some of the largest muscles in the leg and serve an important function in everyday activities as simple as walking to high level activities such as running and sprinting.  A sprain of the hamstrings can be common in running athletes and commonly occurs in the middle of the thigh and can take weeks to return to running.  However, a complete rupture or tear of the hamstrings occurs higher at the tendon and can cause significantly disability if not treated appropriately.

Cause

Complete hamstring tears occur at the insertion of the tendon into the bone (ischium).  This can occur in a chronic fashion with wear and tear of the tendon, however, most commonly occurs after an acute event.  An acute traumatic event typically occurs with a forceful extension of the leg.  These events can commonly occur during waterskiing, a slip and fall, doing the “splits” or during running.  This will typically present with significant pain mostly noted behind the thigh near the buttock.  Swelling and bruising is common.

Anatomy

The hamstrings are made up of the combination of three tendons at the hamstrings insertion on the ischium (the bone of the pelvis you sit on).  The muscles tendons are called the biceps femoris, the semimembranosus and the semitendinosus.  Injury to these tendons typically invovles a tear at the insertion, tearing all three tendons from the bone and these can retract into the back of the thigh causing a lump.  The sciatic nerve runs very close to these tendons and can become irritated during injury as well causing some numbness with injury.

Imaging

Much of the diagnosis can be made based off of history of injury and physical exam.  However, MRI is very useful in identifying the extent of the tear and the amount of retraction that is present.

Treatment

Because of the importance of the hamstring tendons, these injuries often require surgery to regain full function.  Certain patients may not require surgery, but this depends on activity level and extent of injury.  We have studied hamstring injuries and the return to sport and running after surgical repair and our research study can be seen in the research section.  Our study showed overall high rates of satisfaction after surgery and high rates of return to sport and running after surgery.  Surgical treatment involves an incision over the insertion of the hamstrings insertion, typically this scar will be hidden in the gluteal crease.  The hamstring tendon stump is then identified and secured back to the bone insertion using strong sutures and multiple suture anchors.

Recovery

After surgery, you will be using crutches and putting limited weight on your repaired leg.  It is important to protect the tendon as it heals back into place.  It will take several months to return to running and full activity, but repair of the hamstrings should allow you to return to your previous activity level.

Rochester

1135 W. University Drive

Suite 450

248-650-2400

Shelby Township

13350 24 Mile Road

Suite 700

586-254-2777