Dolor de cadera en adolescentes: estudio y tratamiento / Hip pain in adolescent: assessment and treatment

En adolescentes que consultan por dolor de cadera o pelvis, es crucial una adecuada historia clínica para orientarnos sobre la etiología del dolor y comprender los mecanismos que lo generan. Es importante conocer y realizar un exhaustivo examen físico, con especial énfasis en la cadera, incluyendo pruebas específicas para diferentes patologías, además de comprender las indicaciones de los diferentes estudios de imágenes, para así lograr un correcto diagnóstico.Entre las causas más frecuentes de coxalgia en adolescentes debemos considerar la epifisiolisis, el pinzamiento femoroacetabular con o sin roturas del labrum, las lesiones avulsivas de la pelvis, la coxa saltans, entre otras. Aunque son poco frecuentes, patologías sistémicas como reumatológicas y oncológicas también deben ser descartadas en adolescentes. Un diagnóstico de certeza nos permitirá realizar una adecuada estrategia de tratamiento, a fin de lograr una rehabilitación precoz y evitar futuras complicaciones.

In adolescents presenting with hip or pelvis pain, an adequate medical history is crucial to guide the etiology and understand the mechanisms that generate it. It is important to know and carry out an exhaustive physical examination, with special attention to the hip, including specific tests for different pathologies, in addition to understand the indications of the different imaging studies, in order to achieve a correct diagnosis. Among the most frequent causes of hip pain in adolescents, we must rule out slipped capital femoral epiphysis, femoroacetabular impingement with or without labral tears, avulsion lesions of the pelvis, snapping hip, among others. Although rare, systemic pathologies such as rheumatologic and oncologic diseases must also be ruled out in adolescents. An accurate diagnosis will allow us to carry out an adequate treatment strategy, in order to achieve early rehabilitation and avoid future complications.

Imagenological findings of external snapping hip syndrome. case report

ABSTRACT Introduction: External snapping hip syndrome is characterized by a painful sensation accompanied by an audible snapping noise in the hip when moving. Even though orthopedists are widely aware of this condition, imaging findings still need to be recognized by all radiologists in order to provide more information that allows for the best multidisciplinary treatment. Z-plasty of the iliotibial band is the most used treatment with the best results. Case presentation: Female patient with bilateral external hip snapping syndrome on the right side, who was treated initially in a conservative manner without adequate response; hence, she required surgical management with arthroscopy. All treatment options used for this patient were not successful, and symptoms recurred. Discussion: The diagnosis of snapping hip syndrome is mainly clinical. However, the contribution of diagnostic imaging is important to characterize the structures involved in this nosological process, in order to develop the therapeutic planning and do the follow-up. Conclusion: Knowledge on ultrasound and magnetic resonance findings related to this pathology allows radiologists to identify this syndrome and contribute to a timely treatment.

RESUMEN Introducción. El síndrome de cadera en resorte externa es una entidad en la cual hay una sensación de dolor acompañada de un sonido palpable durante el movimiento de la cadera. Esta es una condición ampliamente conocida por los ortopedistas, pero aún es necesario que los hallazgos imagenológicos sean reconocidos por todos los radiólogos con el fin de brindar mayor información que permita un adecuado manejo multidisciplinario. La Z-plastia de la banda iliotibial es la técnica de tratamiento más reconocida y con mejores resultados. Presentación del caso. Paciente femenino con síndrome de cadera en resorte externo bilateral sintomático en el lado derecho, quien fue manejada de forma conservadora sin adecuada respuesta y requirió manejo quirúrgico por vía artroscópica. Las técnicas utilizadas en la paciente no fueron exitosas y se presentó recurrencia de los síntomas. Discusión. El diagnóstico del síndrome de cadera en resorte es principalmente clínico. Sin embargo, el aporte de las imágenes diagnósticas es importante para caracterizar las estructuras involucradas en este proceso nosológico, para realizar el planeamiento terapéutico y para hacer el seguimiento. Conclusión. Conocer los hallazgos imagenológicos en ultrasonido y resonancia magnética del síndrome en cadera en resorte externa permite a los radiólogos identificarlo y hacer aportes al manejo de esta patología en forma oportuna.

Research progress on clinical diagnosis and treatment for external snapping hip / 中国骨伤

External snapping hip(ESH) is a vague term used to describe palpable or auditory snapping with hip movements with or without pain. The pathogenesis of ESH is related to the specific anatomical structure and friction factor. The clinical symptom is auditory snapping during activities, physical examination, X-ray, magnetic resonance imaging(MRI), dynamic ultrasound and other imaging techniques can be used to diagnose. Conservative medical management includes rest, avoidance of aggravating activities, and antiinflammatory medications. Treatment Patients with mild symptoms can achieve good results by medication, rest and physiotherapy. Surgical treatment for patients with ineffective conservative treatment was performed. All kinds of open surgery method can achieve good clinical curative effect, arthroscopic surgery is gradually been promoted due to small trauma, less complications. Besides, there are some reports that traditional treatments such as massage, acupuncture and acupotomology have achieved good clinical results, which deserve further study and promotion.

External Snapping Hip Treated by Effective Designed N-plasty of the Iliotibial Band / 대한고관절학회지

PURPOSE: The purpose of this study is to present the effective design of N-plasty of the iliotibial band and surgical results of its use as a treatment for refractory external snapping hip. MATERIALS AND METHODS: We evaluated 17 patients (24 cases) with external snapping hip who underwent N-plasty between October 2013 and May 2016 and who were followed up for at least 12 months. All patients were male and the mean age was 20.8 years. The mean duration of symptoms prior to surgical intervention was 28.5 months with an average follow up of 24.5 months. Surgery was defined as being successful when patients could carry out their daily activities and exercise without a clicking sensation or pain 6 months after surgery until their last follow-up. Failure was defined when either a clicking sensation or pain was present. The visual analog scale (VAS) and modified Harris hip score (mHHS) were measured and compared preoperatively and at last follow-up. RESULTS: All patients had complete resolution of pain and snapping. The VAS decreased from 6.77 preoperatively to 0.09 postoperatively and mHHS improved from 69.5 to 97.8 after surgery. CONCLUSION: Modified designed N-plasty is considered to be an excellent treatment method facilitating operation reproducibility with maximum elongation effect of the iliotibial band.

External Snapping Hip Treated by Effective Designed N-plasty of the Iliotibial Band / 대한고관절학회지

PURPOSE: The purpose of this study is to present the effective design of N-plasty of the iliotibial band and surgical results of its use as a treatment for refractory external snapping hip. MATERIALS AND METHODS: We evaluated 17 patients (24 cases) with external snapping hip who underwent N-plasty between October 2013 and May 2016 and who were followed up for at least 12 months. All patients were male and the mean age was 20.8 years. The mean duration of symptoms prior to surgical intervention was 28.5 months with an average follow up of 24.5 months. Surgery was defined as being successful when patients could carry out their daily activities and exercise without a clicking sensation or pain 6 months after surgery until their last follow-up. Failure was defined when either a clicking sensation or pain was present. The visual analog scale (VAS) and modified Harris hip score (mHHS) were measured and compared preoperatively and at last follow-up. RESULTS: All patients had complete resolution of pain and snapping. The VAS decreased from 6.77 preoperatively to 0.09 postoperatively and mHHS improved from 69.5 to 97.8 after surgery. CONCLUSION: Modified designed N-plasty is considered to be an excellent treatment method facilitating operation reproducibility with maximum elongation effect of the iliotibial band.

Arthroscopic Treatment of Symptomatic Internal Snapping Hip with Combined Pathologies

BACKGROUND: Arthroscopic iliopsoas tendon release was introduced in 2000. The purpose of this study was to evaluate clinical outcomes of arthroscopic iliopsoas tendon release for painful internal snapping hip with concomitant hip pathologies. METHODS: Between January 2009 and December 2011, we performed arthroscopic iliopsoas tendon release and related surgeries in 25 patients (20 men and 5 women; mean age, 32 years; range, 17 to 53 years) with combined intraarticular hip pathologies. The patients were followed for a minimum of 2 years postoperatively. Clinical and radiological evaluations were performed. RESULTS: Snapping sounds had disappeared by the 2-year follow-up in 24 of the 25 patients. All patients who had presented with loss of flexion strength postoperatively showed recovery at postoperative week 6 to 10. Harris hip score improved from 65 points (range, 46 to 86 points) preoperatively to 84 points (range, 67 to 98 points) postoperatively (p < 0.001). Seven hips (28%) had an excellent score, 15 hips (60%) a good score, 2 hips (8%) a fair score, and one hip (4%) a poor score (p < 0.001). The Tonnis grade of osteoarthritis did not change in any of the patients at the last follow-up. CONCLUSIONS: Patients with painful internal snapping hip have combined hip pathologies. Therefore, the surgeon should keep in mind that painful internal snapping hips are frequently combined with concomitant intraarticular pathologies.

Arthroscopic Treatment for External Snapping Hip / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the clinical outcome of arthroscopic treatment for recalcitrant external snapping hip. MATERIALS AND METHODS: Between September 2011 and June 2013, we evaluated 7 patients (10 cases) with snapping hip who were refractory to conservative treatments for at least 3 months. Two patients (4 cases) were impossible to adduct both knees in 90degreesof hip flexion. Surgery was done in lateral decubitus position, under spinal anesthesia. We made 2 arthroscopic portals to operate the patients, and used cross-cutting with flap resection technique to treat the lesion. We performed additional gluteal sling release in those 2 patients (4 cases) with adduction difficulty. Average follow-up length was 19 months (range, 12-33 months). Clinical improvement was evaluated with visual analog scale (VAS), modified Harris hip score (mHHS), and also investigated for presence of limping or other complications as well. RESULTS: The VAS decreased from 6.8 (range, 6-9) preoperatively to 0.2 (range, 0-2) postoperatively, and the mHHS improved from 68.2 to 94.8 after surgery. None of the patients complained of post-operative wound problem or surgical complications. CONCLUSION: The clinical outcome of arthroscopic treatment for recalcitrant external snapping hip was encouraging and all patients were also satisfied with the cosmetic results.

Surgical Treatment of Snapping Hip by Modified Z-plasty of the Iliotibial Band / 대한스포츠의학회지

We performed modified Z-plasty (N-plasty) in the patients with snapping hip syndrome arising from the iliotibial band whose pain and clicking sensation persisted despite conservative treatments. We analyzed clinical results to evaluate the effectiveness of this new technique. Among 51 patients (65 cases) who still felt pain and reported clicking sensation during daily life despite hospitalization for at least 2 months from January 1999 to November 2011, we evaluated a total of 32 patients (37 cases) who underwent N-plasty and followed up for more than 6 months. All patients were male whose average age was 24 years. Initial symptoms developed an average of 10 months before hospital visit. Surgery was defined success by postoperative 6 months at which time the patient could be able to carry on with daily life and to exercise without clicking sensation and pain, and defined failure when either clicking sensation or pain was present. We observed that the posterior portion of the iliotibial band was thickened by an average of 8.4 mm. Tenotomy of the iliotibial band lengthened the band by an average of 23mm and narrowed the width of the iliotibial band anterior to posterior. Success was in 33 cases (89%) after surgery. Failure was observed in 4 cases. Three were improved after resurgery and 1 was treated conservatively. We found that N-plasty performed in external type snapping hip patients was an effective method yielding a high success rate.

The Surgical Treatment of External Snapping Hip by Modified Z-plasty (N-plasty) of the Iliotibial Band

PURPOSE: Modified Z-plasty(N-plasty) was performed on patients with snapping hip syndrome arising from the iliotibial band, whose pain and clicking sensation persisted despite conservative treatment. The effectiveness of this new technique was evaluated from an analysis of the clinical results. MATERIALS AND METHODS: Among the 44 patients (58 cases), who still felt pain and reported a clicking sensation during daily life despite hospitalization for at least 2 months from January 1999 to August 2007, this study evaluated a total of 25 patients (30 cases) who underwent N-plasty and were followed up for more than 6 months. All patients were male with a mean age of 21 years. The initial symptoms developed an average of 11.5 months prior to the hospital visit (range, 1 month to 4 years). The affected side was the right side in 6 cases and the left in 10. Among 9 patients affected bilaterally, 5 patients (10 cases) underwent surgery on both sides, 1(1 case) on the right side, and 3 (3 cases) on the left side. Surgery was defined as being successful when at 6 months after surgery the patient could carry out their daily activities and exercise without a clicking sensation or pain. Failure was defined when either a clicking sensation or pain was present. RESULTS: The posterior portion of the iliotibial band was thickened by an average of 8.9 mm (range, 6~14 mm). A tenotomy of the iliotibial band lengthened the band by an average of 25 mm (range, 20~35 mm) and narrowed the width of the iliotibial band anterior to posterior. Twenty-nine cases (97%) had a successful outcome after surgery. Recurrence occurred in 1 case. After additional surgery, the recurrence was found to be due to the insufficient length of the tenotomy. CONCLUSION: N-plasty performed in external type snapping hip patients is an effective method with a high success rate.