IC 201-2023: Hip Pain in the Athlete - Cases from the Court, Field and Ice-IC 201 - Hip Pain in the Athlete - Cases from the Court, Field and Ice (2/5)

Video Transcription

Video Summary

In this video, a water polo player is experiencing acute left hip pain while participating in the sport. They also have a history of minor symptoms on the right side. The player's exam reveals negative Trendelenburg signs, weakness in the right iliopsoas muscle, and better hip flexion and external rotation on the left side. Positive impingement and labral stress tests are observed bilaterally. X-rays reveal bilateral CAM lesions and posterior wall signs. Further imaging with an MRI or MR arthrogram confirms the presence of a labral tear. The player's hip anatomy is considered borderline dysplastic, with acetabular retroversion. Conservative treatment options, such as injections or rehab, are discussed to allow the player to continue playing in the current season. If conservative methods fail, a hip arthroscopy is suggested, but the potential need for a periacetabular osteotomy (PAO) is also considered. The decision is dependent on further studies, such as a CT scan, to better understand the coverage of the femoral head. Considerations are made for the player's ability to perform eggbeater kicking, and the potential impact of limited motion on play. The importance of determining if the player is symptomatic on the right side is discussed. Surgical findings, such as delamination of the articular cartilage, hypertrophied labrum, and signs of instability, may influence the choice between a hip arthroscopy or a PAO. Rehabilitation times vary for athletes in water polo compared to land-based sports, with water polo athletes potentially returning to competition sooner. The importance of long-term outcomes and providing informed decisions to the patient is emphasized. A hip arthroscopy is ultimately performed, which reveals a chondral delamination and intact labrum. The CAM lesion is resected, and the capsule is closed due to the player's borderline dysplasia. The player successfully returns to water polo and wins a national championship.

Asset Caption

Marc Safran, MD

Keywords

water polo

hip pain

labral tear

hip arthroscopy

periacetabular osteotomy