Slideshow
-
Figure 1. Anteroposterior radiograph of right hip. Image courtesy of Dagan Cloutier, MPAS, PA-C
-
Figure 2. Lateral view of hip. Image courtesy of Dagan Cloutier, MPAS, PA-C
A 13-year-old adolescent presents with right hip pain while running. She started track practices a few weeks ago and has noticed “pain and a snapping feeling” in her right hip after running a few laps around the track. She denies a previous injury or precipitating event, although she says her aunt has hip instability from hip dysplasia. The anteroposterior (AP) radiographic view of the patient’s right hip, the lateral center-edge angle measures 30 degrees (Figure 1). Lateral radiograph can be seen in Figure 2. On physical examination, the patient has a negative FABER test and pain with resisted hip flexion.
Submit your diagnosis to see full explanation.
The differential diagnosis for hip pain in a teenage athlete can be broad. Coxa saltans, otherwise known as snapping hip syndrome, can include a tight iliotibial (IT) band snapping over the greater trochanter and catching of the iliopsoas tendon at the iliopectineal eminence or on the femoral head.1 Other common diagnoses may include tight hip flexors, hip dysplasia, acetabular labral tear, and femoroacetabular impingement (FAI).1,2
Hip dysplasia generally produces symptoms of hip instability (popping sensation, pain with activities) and is associated with chronic symptoms for years.2 Radiographs of the hip will show decreased femoral head coverage with a lateral center-edge angle (LCEA) of less than 20 degrees. Femoroacetabular impingement causes pain with hip flexion and rotation and patients may describe their pain using a C sign by cupping the anterior lateral aspect of the hip with the thumb and forefingers. Femorocetabular impingement is opposite to hip dysplasia as the condition is caused by excessive coverage of the femoral head by the acetabulum. The condition usually has an increased LCEA of more than 40 degrees.2
Conservative treatment is initially recommended for all adolescent patients presenting with sports-related hip pain. A period of rest and nonsteroidal anti-inflammatory drugs (NSAIDs) can usually provide relief for an inflammatory condition such as tendinitis or hip joint synovitis. Physical therapy is also important to stretch tight muscles and tendons and to strengthen the hip joint for athletic performance.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
References
1. Allen WD, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg. 1995;3(5):303-308. doi:10.5435/00124635-199509000-00006
2. Schmitz MR, Murtha AS, Clohisy JC; ANCHOR Study Group. Developmental dysplasia of the hip in adolescents and young adults. J Am Acad Orthop Surg. 2020;28(3):91-101. doi:10.5435/JAAOS-D-18-00533
QUESTION
