Extra-articular hip pathology

Extra-articular hip pathology

). The Hip pain can also occur as a result of impingement of extra-articular structures resulting in restriction of activities. - Table 39.3 shows the common causes of extra-articular hip impingement. Snapping hip syndromes (shown in Table 39.3 ) can also present with hip pain. Imaging modalities such as ultrasound and MRI may aid the diagnosis. Treatment begins with non-operative measures such as physiotherapy with surgical procedures aimed at treating the primary pathology in refractory cases. See Further reading for additional . information.

(c) Figure 39.5 Radiograph showing cam femoroacetabular impingement deformity. (c) Anteroposterior radiograph and (d) a subtle cam lesion picked up on the lateral view. The alpha angle measurement is used to assess the severity of cam deformity (normal ≤ 55°). The lateral centre–edge angle (LCEA) is a measure of acetabular coverage (normal = 25–40°). LCEA Acetabular index LCEA Alpha angle (d) (a) , marked over the femoral head (b) with the arrow pointing to the cam Figure 39.6 Plain radiograph showing bilateral hip dysplasia: uncovering of the femoral head as measured by a centre–edge angle (CEA) of less than 20°. Normal CEA is 25–40°. A CEA of 20–25° is categorised as borderline dysplasia of the hip. An acetabular index of >10° is suggestive of hip dysplasia.

externally snapping hip syndromes. Pathology Description Extra-articular hip impingement Iliopsoas impingement Impingement between the iliopsoas muscle and the labrum, resulting in distinct anterior labral pathology Subspine Impingement between an enlarged or impingement malorientated anterior inferior iliac spine and the distal anterior femoral neck Ischiofemoral Compression of the quadratus femoris impingement muscle between the lesser trochanter and the ischial tuberosity Deep gluteal Entrapment of the sciatic nerve in the syndrome deep gluteal space resulting in pain in the buttock Snapping hip syndromes Internal snapping hip Iliopsoas tendon glides over the hip joint, syndrome producing a snapping sensation and eventually leading to labral tear External snapping hip Iliotibial band glides over the greater syndrome trochanter and snaps, producing an audible and/or visible snap

Extra-articular hip pathology

). The Hip pain can also occur as a result of impingement of extra-articular structures resulting in restriction of activities. - Table 39.3 shows the common causes of extra-articular hip impingement. Snapping hip syndromes (shown in Table 39.3 ) can also present with hip pain. Imaging modalities such as ultrasound and MRI may aid the diagnosis. Treatment begins with non-operative measures such as physiotherapy with surgical procedures aimed at treating the primary pathology in refractory cases. See Further reading for additional . information.

(c) Figure 39.5 Radiograph showing cam femoroacetabular impingement deformity. (c) Anteroposterior radiograph and (d) a subtle cam lesion picked up on the lateral view. The alpha angle measurement is used to assess the severity of cam deformity (normal ≤ 55°). The lateral centre–edge angle (LCEA) is a measure of acetabular coverage (normal = 25–40°). LCEA Acetabular index LCEA Alpha angle (d) (a) , marked over the femoral head (b) with the arrow pointing to the cam Figure 39.6 Plain radiograph showing bilateral hip dysplasia: uncovering of the femoral head as measured by a centre–edge angle (CEA) of less than 20°. Normal CEA is 25–40°. A CEA of 20–25° is categorised as borderline dysplasia of the hip. An acetabular index of >10° is suggestive of hip dysplasia.

externally snapping hip syndromes. Pathology Description Extra-articular hip impingement Iliopsoas impingement Impingement between the iliopsoas muscle and the labrum, resulting in distinct anterior labral pathology Subspine Impingement between an enlarged or impingement malorientated anterior inferior iliac spine and the distal anterior femoral neck Ischiofemoral Compression of the quadratus femoris impingement muscle between the lesser trochanter and the ischial tuberosity Deep gluteal Entrapment of the sciatic nerve in the syndrome deep gluteal space resulting in pain in the buttock Snapping hip syndromes Internal snapping hip Iliopsoas tendon glides over the hip joint, syndrome producing a snapping sensation and eventually leading to labral tear External snapping hip Iliotibial band glides over the greater syndrome trochanter and snaps, producing an audible and/or visible snap

Extra-articular hip pathology

). The Hip pain can also occur as a result of impingement of extra-articular structures resulting in restriction of activities. - Table 39.3 shows the common causes of extra-articular hip impingement. Snapping hip syndromes (shown in Table 39.3 ) can also present with hip pain. Imaging modalities such as ultrasound and MRI may aid the diagnosis. Treatment begins with non-operative measures such as physiotherapy with surgical procedures aimed at treating the primary pathology in refractory cases. See Further reading for additional . information.

(c) Figure 39.5 Radiograph showing cam femoroacetabular impingement deformity. (c) Anteroposterior radiograph and (d) a subtle cam lesion picked up on the lateral view. The alpha angle measurement is used to assess the severity of cam deformity (normal ≤ 55°). The lateral centre–edge angle (LCEA) is a measure of acetabular coverage (normal = 25–40°). LCEA Acetabular index LCEA Alpha angle (d) (a) , marked over the femoral head (b) with the arrow pointing to the cam Figure 39.6 Plain radiograph showing bilateral hip dysplasia: uncovering of the femoral head as measured by a centre–edge angle (CEA) of less than 20°. Normal CEA is 25–40°. A CEA of 20–25° is categorised as borderline dysplasia of the hip. An acetabular index of >10° is suggestive of hip dysplasia.

externally snapping hip syndromes. Pathology Description Extra-articular hip impingement Iliopsoas impingement Impingement between the iliopsoas muscle and the labrum, resulting in distinct anterior labral pathology Subspine Impingement between an enlarged or impingement malorientated anterior inferior iliac spine and the distal anterior femoral neck Ischiofemoral Compression of the quadratus femoris impingement muscle between the lesser trochanter and the ischial tuberosity Deep gluteal Entrapment of the sciatic nerve in the syndrome deep gluteal space resulting in pain in the buttock Snapping hip syndromes Internal snapping hip Iliopsoas tendon glides over the hip joint, syndrome producing a snapping sensation and eventually leading to labral tear External snapping hip Iliotibial band glides over the greater syndrome trochanter and snaps, producing an audible and/or visible snap