Utilisation of exercise as part of guideline-based care for hip pain in the Australian workers’ compensation environment

BACKGROUND: Guidelines recommend early referral for exercise for hip pain. It is unclear if this occurs in the Australian workers’ compensation environment. OBJECTIVE: To investigate referral for exercise in workers with a compensable hip claim. METHODS: Retrospective audit of closed compensation files for workers with hip pain was performed. Exercise commencement was indicated by billing codes for physiotherapy or exercise specific consultations. Time to exercise commencement was calculated. Associations were analysed between time to exercise commencement with claim duration and diagnostic category. RESULTS: Exercise management occurred for 33/44 cases. Median time to commence exercise for those cases that had exercise was 14 days post-injury, with 33% commencing beyond 4 weeks. Longer time to commence exercise was associated with a longer claim duration (Spearman’s rho = 0.70). Workers with a diagnosis of hip joint pain had a longer time to exercise commencement (median 49.5 days) compared to those with a diagnosis of lateral hip pain (median 14 days) or non-specific hip pain (median 4.5 days). CONCLUSION: Findings indicate practice behaviours in the workers’ compensation environment for the management of hip pain with exercise. Further investigation is warranted to see if improved adherence to guideline recommendations improves outcomes for people with compensable hip pain.

Pathogenesis and contemporary diagnoses for lateral hip pain: a scoping review

Purpose Recent advances in diagnostic imaging techniques and soft tissue endoscopy now allow for precise diagnosis and management of extra-articular hip pathology. The aim of this scoping review is to present an evidence-based update of the relevant literature focussing only on the pathoanatomy, clinical assessment and the diagnosis of pathology in the peritrochanteric space. Methods A literature search was performed on PubMed to include articles which reported on the anatomy and diagnosis of greater trochanteric pain syndrome, trochanteric bursitis, gluteus medius tears and external snapping hip syndrome. Results A total of 542 studies were identified, of which 49 articles were included for full text analysis for the scoping review. Peritrochanteric space pathology can be broadly classified into (1) greater trochanteric pain syndrome (GTPS), (2) abductor tears and (3) external snapping hip syndrome. Anatomically, gluteus medius, gluteus minimus and tensor fascia lata work in conjunction to abduct and internally rotate the hip. The anterolateral part of the gluteus medius tendon is more prone to tears due to a thin tendinous portion. Increased acetabular anteversion has also been shown to be associated with gluteal and trochanteric bursitis. In terms of clinical examination, tests which were found to be most useful for assisting in the diagnoses of lateral hip pain were the single-leg stance, resisted external derotation of the hip, hip lag sign and the Trendelenburg’s test. Dynamic ultrasound along with guided injections and MRI scan do assist in differentiating the pathology and confirming the diagnosis in patients presenting with lateral hip pain. Finally, the assessment of baseline psychological impairment is essential in this group of patients to ensure outcomes are optimised. Conclusion Lateral hip pain used to be a poorly defined entity, but advances in imaging and interest in sports medicine have led to a better understanding of the pathology, presentation and management of this cohort of patients. A thorough appreciation of the anatomy of the abductor musculature, specific clinical signs and imaging findings will lead to an appropriate diagnosis being made and management plan instituted. Level of evidence IV.

Use of a Hip Spica for Management of an Acetabular Labral Tear in a Female Collegiate Gymnast: A Case Report

The patient was a 20-year-old female gymnast complaining of lateral hip pain, posterior to the greater trochanter, that increased with hip extension and external rotation. Over the course of 1 month during the season, pain progressively shifted to the groin and hip extension and external rotation became limited. A minimally painful exercise program was implemented in conjunction with a supportive hip spica, assisting extension and external rotation while limiting flexion and internal rotation during therapeutic exercise. The resulting implementation of a hip spica is a novel way to reduce pain and improve function to augment current conservative treatments.

The use of pelvic radiographs as a predictor for gluteal tendinopathy and bursitis

Aim: To evaluate the relationship between radiographic measurements of the hip and sonographic evidence of gluteal tendinopathy and bursitis in patients with lateral hip pain. Methods and materials: Patients with lateral hip pain referred for ultrasound of the hip in our institution over a 5-year period were identified. Findings of gluteal tendinopathy and subgluteal or trochanteric bursitis on ultrasound were recorded. Radiographs of the hip were also evaluated and femoral offset (FO), global offset (GO), abductor lever arm (ALA) and trochanteric impingement distance (TID) were recorded. The mean of each measurement was compared between patients with gluteal tendinopathy and subgluteal or trochanteric bursitis. Results: 273 patients were included in the study. 107 patients (39.2%) had a THA. In the asymptomatic hip, a range of normal measurements were obtained: FO 22.4–76.5 mm, GO 40.1–116.1 mm, ALA 45.0–98.4 mm and TID 13.8–63.1 mm. In the native hip and post THA, there was no statistically significant relationship between FO, GO, ALA and TID in patients with gluteal tendinopathy or trochanteric or subgluteal bursitis. Conclusions: Lateral hip pain is a common presenting complaint in patients with hip pain and is reported in a small proportion of patients post THA. No statistically significant relationship was found between radiographic measurements and ultrasound findings in our patient cohort. However, we describe the range of measurements obtained from the normal asymptomatic hip in this large cohort of patients, which may aid in the evaluation and management of patients with lateral hip pain.