Abstract
Pediatric pelvic, hip, and thigh injuries are becoming increasingly more common. Careful clinical diagnosis with considerations of broad differentials and appropriate treatment in this age group is crucial. This chapter will review basic hip anatomy. Much more attention will be applied to clinical history and physical evaluation. It will also include in-depth discussion of some of the most common acute and chronic injuries seen in the pediatric hip, as well as provide some basic steps for management. Brief discussion is provided regarding prevention of sports injuries as well as timing for return to play. At its conclusion, the reader should feel more confident in differentiating, diagnosing, and managing a wide spectrum of pediatric sports injuries.
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Frank JS, Gambacorta PL, Eisner EA. Hip Pathology in the adolescent athlete. J Am Acad Orthop Surg. 2013;21(11):665–74.
Waters PM, Hip MMB. pelvic injuries in the young athlete. Clin Sports Med. 1988;7(3):513–26.
Joyce MJ, Mankin HJ. Caveat arthroscopos: extra-articular lesions of bone simulating intra-articular pathology of the knee. J Bone Joint Surg Am. 1983;65(3):289–92.
Kovacevic D, Maniscalco M, Goodwin RC. Injuries about the hip in the adolescent athlete. Sports Med Arthrosc. 2011;19(1):64–74.
Ogden JA. Trauma, hip development, and vascularity. In: Tronzo RG, editor. Surgery of the hip joint. New York: Springer-Verlag; 1984.
Herring J. Tachdjian’s pediatric orthopaedics: from the Texas Scottish Rite hospital for children. 5th ed: Saunders; 2013.
Outerbridge AR, Micheli LJ. Overuse injuries in the young athlete. Clin Sports Med. 1995;14(3):503–16.
Soyuncu Y, Our S. Avulsion injuries of the pelvis in adolescents. Acta Orthop Traumatol Tur. 2004;(Suppl 1):88–92.
Micheli LJ, Fehlandt AF. Overuse tendon injuries in pediatric sports medicine. Sports Med Arthrosc. 1996;4(2):190–5.
Micheli LJ. Lower extremity overuse injuries. Acta Med Scand. 1986;711(Suppl):171–7.
White KK, Williams SK, Murarack SJ. Definition of two types of anterior superior iliac spine avulsions fractures. Ped Orthop. 2002;22(5):578–82.
Metzmaker JN, Pappas AM. Avulsion fractures of the pelvis. Am Sports Med. 1985;13(5):349–58.
Schiller J, DeFroda S, Blood T. Lower extremity avulsion fractures in the pediatric and adolescent athlete. J Am Acad Orthop Surg. 2017;25(4):251–9.
Puranene J, Orava S. The hamstring syndrome: a new diagnosis of gluteal sciatic pain. Am J Sports Med. 1988;16(5):517–21.
Gidwani S, Jagiello J, Bircher M. Avulsion fracture of the ischial tuberosity in adolescents: an easily missed diagnosis. Brit Med J. 2004;329(7457):99–100.
O’Leary JA, Bernard K, Vail TP. The relationship between diagnosis and outcomes in arthroscopy of the hip. Arthroscopy. 2001;17(2):181–8.
Burnett RSJ, Della Rocca GJ, Prather H, et al. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg. 2006;88A(7):1448–57.
Byrd JW. Hip arthroscopy in athletes. Instr Course Lect. 2003;52:701–9.
Byrd JW. Hip arthroscopy: patient assessment and indications. Instr Course Lect. 2003;52:711–9.
Merrifield HH, Cowan RJF. Groin strain injuries in ice hockey. J Sports Med. 1973;1(2):41–2.
Tyler TF, Silvers HJ, Gerhardt MB, et al. Groin injuries in sports medicine. Sports Health. 2010;2(3):231–6.
Cross TM, Gibbs N, Houang MT, et al. Acute quadriceps muscle strains: magnetic resonance imaging features and prognosis. Am J Sports Med. 2004;32(3):710–9.
Hoskins W, Pollard H. Hamstring injury management—Part 2: treatment. Man Ther. 2005;10(3):189–90.
Witvrouw E, Asselman DL, D’Have P, Cambier T. Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players: a prospective study. Am J Sports Med. 2003;31(1):41–6.
Yamamoto T. Relationship between hamstring strains and leg muscle strength: a follow-up study of collegiate track and field athletes. J Sports Med Phys Fitness. 1993;33(2):194–9.
Taylor DC, Dalton JD Jr, Seaber AV, et al. Experimental muscle strain injury: early functional and structural deficits and the increased risk for re-injury. Am J Sport Med. 1993;21(2):190–4.
Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg. 2007;15(6):350–5.
Ishakawa K, Koichi K, Mizuta H. Avulsion of the hamstring muscles from the ischial tuberosity. Clin Orthop. 1988;(232):153–5.
Proske U, Morgan DL, Brockett CL, et al. Identifying athletes of hamstring strains and how to protect them. Clin Exp Pharmacol Physiol. 2004;31(8):546–50.
Croisier JL, Forthomme B, Namurois MH, et al. Hamstring muscle strain recurrence and strength performance disorders. Am J Sports Med. 2002;30(2):199–203.
Klingele KE, Sallay PI. Surgical repair of complete proximal hamstring tendon rupture. Am J Sports Med. 2003;30(5):742–7.
Omololu B, Ogunlade SO, Alonge TO. Quadriceps tendon rupture in an adolescent. West Afr J Med. 2001;20(3):272–3.
Cross TM, Gibbs N, Houang MT, et al. Acute quadriceps muscle strains: magnetic resonance imagining features and prognosis. Am J Sports Med. 2004;32(3):710–9.
Ryan JB, Wheller JH, Hopkinson WJ, et al. Quadriceps contusions. West Point update. Am J Sports Med. 1991;19(3):299–304.
Beiner J, Jokl P. Muscle contusion injuries: current treatment options. J Am Acad Orthop Surg. 2001;9(4):227–37.
Jackson DW, Feagin JA. Quadriceps contusions in young athletes: relation of severity of injury to treatment and prognosis. J Bone Joint Surg Am. 1973;55(1):95–105.
Nalley J, Jay MS, Durant RH. Myositis ossificans in an adolescent following sports injury. J Adolesc Health Care. 1985;6(6):460–2.
Walczak B, Johnson C, Howe M. Myositis ossificans. J Am Acad Orthop Surg. 2015;23(10):612–22.
Brown, TD, Brunet ME. Pediatric thigh. In: DeLee, Drez, Miller, eds. Orthopaedic sports medicine: principles and practice. Saunders (Elsevier), Philadelphia; 2003. p. 1517–19.
Kransdorf MJ, Meis JM, Jeliniek JS. Myositis Ossificans: MR appearance with radiographic-pathologic correlation. Am J Roentgenol. 1991;157(6):1243–8.
Nuccion SL, Junter DM, Finnerman GA. Hip and pelvis: adult. In: DeLee, Drez and Miller, eds. Orthopedic sports medicine: principles and practice. Saunders (Elsevier), Philadelphia; 2003. p. 1443–62.
Nelson C. Which athletes are most at risk for stress fractures? Sports. Med Dig. 2001;23(1):1–5.
Coady CM, Micheli LJ. Stress fractures in the pediatric athlete. Clin Sports Med. 1997;16(2):225–38.
Yeager KK, Agostini R, Nattiv A, et al. The female athlete triad: disordered eating, amenorrhea, osteoporosis. Med Sci Sports Exerc. 1993;25:775–7.
Loud KJ, Micheli LJ. Correlates of stress fractures among preadolescent and adolescent girls. Pediatrics. 2005;115(4):399–406.
Micheli LJ. Overuse injuries in the young athlete. In: Bar-Or O, editor. The child and adolescent. Champaign, IL: Blackwell Science Ltd; 1996. p. 189–201.
Micheli LJ. Injuries to the hip and pelvis. In: Sullivan JA, Grana WA, editors. The pediatric athlete. Park Ridge, IL: American Academy of Orthopedic Surgeons; 1990. p. 167–72.
Miller C, Major N, Toth A. Pelvic stress injuries in the athlete: management and prevention. Sports Med. 2003;33(13):1003–12.
Roman M, Recio R, Moreno JC, et al. Stress fractures of femoral neck in a child. Acta Orthop Belg. 2001;67(3):286–9.
Bettin D, Pankalla T, Bohm H, et al. Hip pain related to femoral neck stress fracture in a 12-year-old boy performing intensive soccer playing activities: a case report. Int J Sports Med. 2003;24(8):593–6.
StPierre P, Shaheli LT, Smith JB, Green NE. Femoral neck stress fractures in children and adolescents. J Ped Orthop. 1995;15(4):470–3.
Clough TM. Femoral neck stress fracture: the importance of clinical suspicion and early review. Br J Sports Med. 2002;36(4):308–9.
Maezawa K, Nozawa M, Sugimoto M, et al. Stress fractures of the femoral neck in a child with open capital femoral epiphysis. J Pediatr Orthop B. 2004;13(6):407–11.
Meaney JEM, Carty H. Femoral stress fractures in children. Skeletal Radiol. 1992;21(3):173–6.
Johansson C, Ekenman I, Tornkvist H, et al. Stress fractures of the femoral neck in athletes. The consequence of a delayed diagnosis. Am J Sports Med. 1990;18(5):524–8.
Caine D, DiFiori J, Maffulli N. Physeal injuries in children’s and youth sports: reasons for concern. Br J Sports Med. 2006;40(9):749–60.
Micheli LJ, Santopietro F, Gerbino P, et al. Etiologic assessment of overuse stress fractures in athletes. Nova Scotia Med Bull. 1980;59:43–7.
Walker RN, Green NE, Spindler KP. Stress fractures in skeletally immature patients. J Ped Orthop. 1996;16(5):578.
Weber PC. Salter Harris type II stress fracture in a young athlete. A case report. Orthopedics. 1988;11(2):309–11.
Engh CA, Robinson R, Milgram J. Stress fractures in children. J Trauma. 1970;10(7):532–41.
Shelat NH, El-Khoury GY. Pediatric stress fractures: a pictorial essay. Iowa Orthop J. 2016;36:138–46.
Davies AM, Carter SR, Grimmer RJ, et al. Fatigue fractures of the femoral diaphysis in the skeletally immature simulating malignancy. Br J Radiol. 1989;62(742):893–6.
Waters PM, Millis MB. Hip and pelvic injuries in the young athlete. Clin Sports Med. 1988;7(3):513–26.
Spahn G, Schiele R, Langlotz A, et al. Hip pain in adolescents: results of a cross-sectional study in German pupils and a review of the literature. Acts Paediatr. 2005;94(5):568.
Berend KR, Vail TP. Hip arthroscopy in the adolescent and pediatric athlete. Clin Sports Med. 2001;20(4):763–78.
Dorell J, Catterall A. The torn acetabular labrum. J Bone Joint Surg Am. 1986;68(3):400–4.
McCarthy JC, Noble PC, Schuck MR, et al. The watershed labral lesion: its relationship to early arthritis of the hip. J Arthroplasty. 2001;16(8 Suppl 1):81–7.
Fitzgerald RH. Acetabular labral tears. Diagnosis and treatment. Clin Orthop. 1995;(311):60–8.
Erb RE. Current concepts in the adult hip. Clin Sports Med. 2001;20(4):661–96.
Byrd JW. Labral lesions: an elusive source of hip pain. Arthroscopy. 1996;12(5):603–12.
Kelly BT, Williams RJ, Phillipon MJ. Hip arthroscopy: current indications, treatment options, and management issues. Am J Sports Med. 2003;31(6):1020–37.
Ward D, Parvizi J. Management of hip pain in young adults. Orthop Clin North Am. 2016;47(3):485–96.
Kelly BT, Weiland DE, Schenker ML, et al. Arthroscopic labral repair in the hip: surgical technique options, and management issues. Arthroscopy. 2005;21(12):1496–502.
Kocher MS, Kim YJ, Millis MB, et al. Hip arthroscopy in children and adolescents. J Ped Orthop. 2005;25(5):680–6.
Byrd JWT. Femoroacetabular impingement in athletes. Am J of Sports Med. 2014;42(3):737–51.
Nepple J, Prather H, Trousdale R, et al. Clinical diagnosis of femoroacetabular impingement. J Am Acad Orthop Surg. 2013;21(Suppl 1):S16–9.
Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick agreement on femoroacetabular impingement syndrome: an international consensus statement. Br J Sports Med. 2016;50(19):1169–76.
Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001;27:521–33.
Johnson R. Osteitis pubis. Curr Sports Med Rep. 2003;2(2):98–102.
Koch R, Jackson D. Pubic symphysis in runners. Am J Sports Med. 1981;9(1):62–3.
Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. 2005;86(4):697–702.
Paajanen H, Heikkinen J, Hermunen H, et al. Successful treatment of osteitis pubis by using totally extra peritoneal endoscopic technique. Int J Sports Med. 2005;26(4):303–6.
Lynch TS, Bedi A, Larson C. Athletic hip injuries. J Am Acad Orthop Surg. 2017;25(4):269–79.
Muschaweck U, Berger L. Minimal repair technique of sportsmen’s groin: an innovative open-suture repair to treat chronic inguinal pain. Hernia. 2010;14(1):27–33.
Farber A, Wilckens J. Sports hernia: diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007;15(8):507–14.
Zoga AC, Kavanagh EC, Omar IM, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247(3):797–807.
LeBlanc KE, LeBlanc KA. Groin pain in athletes. Hernia. 2003;7(2):68–71.
LeBlanc KE. Sacroiliac sprain: an overlooked cause of back pain. Am Fam Physician. 1992;46(5):1459–63.
Harrison DE, Harrison DD, Troyanovich SJ. The sacroiliac joint: a review of anatomy and biomechanics with clinical implications. J Manipulative Physiol Ther. 1997;20(9):607–17.
Brolinson PG, Kozar AJ, Cibor G. Sacroiliac joint dysfunction in athletes. Curr Sports Med Rep. 2003;2(1):47–56.
Allen WC, Cope R. Coxa Saltans: the snapping hip syndrome. J Am Acad Othop Surg. 1995;3(5):303–8.
Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med. 1990;18(5):470–4.
Dobbs MB, Gordon JE, Luhmann SJ, et al. Surgical correction of the snapping iliopsoas tendon in adolescent. J Bone Joint Surg AM. 2002;84-A(3):420–4.
Gruen GS, Sciascia TN, Lowenstein JE. The surgical treatment of internal snapping hip. Am J Sports Med. 2002;30(4):606–13.
Broadhurst NA, Simmons DN, Bond MJ. Piriformis syndrome: correlation of muscle morphology with symptoms and signs. Arch Phys Med Rehab. 2004;85(12):2036–9.
Lee EY, Margherita AJ, Gierada DS, et al. MRI of piriformis syndrome. Am J Roentgenol. 2004;183(1):63–8.
Dezawa A, Kusano S, Miki H. Arthroscopic release for the piriformis muscle under local anesthesia for piriformis syndrome. Arthroscopy. 2003;19(5):554–7.
Aaron D, Patel A, Kayiaros S, et al. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011;19(6):359–67.
Zoltan DJ, Clancy WG, Keene JS. A new operative approach to snapping hip and refractory trochanteric bursitis in athletes. Am J Sports Med. 1986;14:201–4.
Arsonson J. Osteoarthritis of the young adult hip: Etiology and treatment. Instr Course Lect. 1986;35:119–28.
Aronsson D, Loder R, Breur G, et al. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg. 2006;14(12):666–79.
Carney BT, Weinstein SL, Noble J. Long-term follow up of slipped capital femoral epiphysis. J Bone Joint Surg AM. 1991;73(5):667–74.
Schoenecker P, Clohisy J, Millis M, et al. Surgical management of the problematic hip in adolescent and young adult patients. J Am Acad Orthop Surg. 2011;19(5):275–86.
Bradshaw C, McCrory P, Bell S, et al. Obturator nerve entrapment. A case of groin pain in athletes. Am J Sports Med. 1997;25(3):402–8.
Harvey G, Bell S. Obturator neuropathy. An anatomic perspective. Clin Orthop. 1999;(363):203–11.
Delagi EF, Perotto A. Anatomical guide for the electromyographer: the limb. 2nd ed. Springfield, IL: Charles C. Thomas; 1980. p. 207.
Rassner L. Lumbar plexus nerve entrapment syndromes as a cause of groin pain in athletes. Curr Sports Med Rep. 2011;10(2):115–20.
Grossman MG, Ducey SA, Nadler SS, et al. Meralgia pareasthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(5):336–4.
Nahabedian MY, Delton AL. Meralgia pareasthetica: etiology, diagnosis and outcome of surgical decompression. Ann Plast Surg. 1995;35(6):590–5.
Sui TL, Chandran KN. Neurolysis for meralgia pareasthetica: an operative series of 45 cases. Surg Neurol. 2005;63(1):19–23.
Rossler R, Donath L, Verhagen E, et al. Exercise-based injury prevention in child and adolescent sport: a systematic review and meta-analysis. J Sport Med. 2014;44(12):1733–48.
O’Neill DB, Micheli LJ. Overuse injuries in the young athlete. Clin Sports Med. 1988;7(3):591–610.
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Nielson, J.H., Kent, T.J. (2018). Pelvic, Hip, and Thigh Injuries. In: Micheli, L., Purcell, L. (eds) The Adolescent Athlete. Contemporary Pediatric and Adolescent Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-56188-2_11
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