Kategoriarkiv: Fluid accumulation in the hip joint


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Longstanding groin pain in athletes. A multidisciplinary approach.

Ekberg O, Persson NH, Abrahamsson PA, Westlin NE, Lilja B. Sports Med 1988 Jul;6(1):56-61.

In 21 male athletes (age 20 to 40 years) with longstanding unexplained groin pain, a multidisciplinary investigation was performed in order to reveal the underlying cause. These examinations included general surgery for detection of inguinal hernia and neuralgia, orthopaedic surgery for detection of adductor tenoperiostitis and symphysitis, urology for detection of prostatitis, radiology for performing herniography and plain film of the pelvic bones, nuclear medicine for isotope studies of the pubic bone and symphysis. In 19 patients there was a positive diagnosis for 2 or more of the diseases (10 patients had 2 diseases, 6 patients had 3 diseases, 3 patients had 4 diseases). Two patients had only signs of symphysitis. Our results show the complexity of longstanding groin pain in athletes. It also explains why therapy for one specific disease entity may fail. We conclude that this clinical setting demands the recruitment of a team with experience of different aspects of groin pain.


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Legg-Calve-Perthes’ disease.

Wall EJ. Curr Opin Pediatr 1999 Feb;11(1):76-9.

The etiology, radiographic classification, and treatment of Legg-Calve-Perthes’ disease remain controversial. Several recent papers focus on these issues in an effort to provide guidance in the clinical care of Perthes’ disease. The research studied in this paper lends further support to the hypothesis of clotting abnormalities with vascular thrombosis, which seems to be the most likely etiology for Legg-Calve-Perthes’ disease. Several studies focus on use of magnetic resonance imaging for the early diagnosis and prognosis of Perthes’ disease. A few researchers whose work is featured in this paper add information on the treatment of Perthes’ disease, supporting surgical treatment for older patients with more severe disease and non-surgical treatment for younger patients with less extensive femoral head involvement.


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Diagnosis and treatment of slipped capital femoral epiphysis.

Reynolds RA. Curr Opin Pediatr 1999 Feb;11(1):80-3
Slipped capital femoral epiphysis remains a diagnostic problem despite numerous papers written on the subject. The most important factor in the diagnosis of slipped capital femoral epiphysis is suspicion by the practitioner. The history, physical examination, and radiographic imaging are important in the confirmation of the diagnosis. Imaging is the topic of 1998 with advances in the areas of ultrasound. Ultrasound may be better in experienced hands than plain radiography in the diagnosis of slipped capital femoral epiphysis. Magnetic resonance imaging is used for diagnosis of slipped capital femoral epiphysis and in the assessment of pre-slips. The magnetic resonance image can be oriented to a plane orthoganol to the plane of the physis to assess the width of the physis and to detect edema in the area of the physis.


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Hip pain in athletes.

Adkins SB 3rd, Figler RA. Am Fam Physician 2000 Apr 1;61(7):2109-18.

Hip pain in athletes involves a wide differential diagnosis. Adolescents and young adults are at particular risk for various apophyseal and epiphyseal injuries due to lack of ossification of these cartilaginous growth plates. Older athletes are more likely to present with tendinitis in these areas because their growth plates have closed. Several bursae in the hip area are prone to inflammation. The trochanteric bursa is the most commonly injured, and the lesion is easily identified by palpation of the area. Iliotibial band syndrome presents with similar lateral hip pain and may be identified by provocative testing (Ober’s test). A methodical physical examination that specifically tests the various muscle groups that move the hip joint can help determine a more specific diagnosis for the often vague complaint of hip pain. A number of hip conditions are more prevalent in athletes of certain ages. Transient synovitis is a common diagnosis in the very young, Legg-Calve-Perthes disease causes bony disruption of the femoral head in prepubescents, and slipped capital femoral epiphysis is seen most commonly in obese adolescent males. Femoral neck stress fractures are seen in adult athletes, especially those involved in endurance sports, and can progress to necrosis of the femoral head if not found early. Older athletes may be limited by degenerative joint disease but nonetheless should be encouraged to stay active.


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NSAID (rheumatism medicine)

Use of NSAID is widespread in sport as a painkiller, and as treatment to subdue inflammation.

Indication. Over-load symptoms from tendons. A considerable number of scientific studies have been performed comprising NSAID treatment on acute tendon injuries. In the majority of studies, but not all, healing was achieved slightly quicker, and inflammation was slightly reduced compared with placebo treatment. Some studies have shown increased instability and reduced mobility in the joints after NSAID treatment.
Acute muscle injuries. There are only a handful of animal studies dealing with NSAID treatment of acute muscle injuries. Increased muscle strength has been proven, however, also reduced healing of damaged tissue.
Myositis ossifans (calcification in muscles after bleeding). One study shows that calcification in the muscles following a hip operation is reduced in patients who are treated with NSAID after the operation.
Chronic muscle and tendon injury. There is no conclusive scientific evidence supporting use of NSAID on chronic muscle or tendon injuries.

Side effects. Side effects from the abdomen and intestines (heartburn, gastric ulcer and sour eructation) are frequent following treatment with NSAID. The new rheumatism pills (“selective COX-2 inhibitors”, as for example, Vioxx) are by and large free of serious side effects from the abdomen and intestines. Serious side effects are rare, but allergic shock, kidney damage and bone marrow damage has been described. Only moderate side effects are seen following localised treatment with NSAID (allergy).

Contraindications. Allergy is on the whole the only contraindication for NSAID treatment in healthy athletes. Patients with gastric ulcer, high blood pressure, liver, heart and kidney illnesses should be cautious with NSAID treatment.

Administration. Tablet treatment is recommended. Some placebo controlled studies show that local NSAID as gel is better than placebo on acute injuries, despite the concentration of blood following localised treatment constituting less than 10% of the level after tablet treatment or after injection in the muscles. There are no scientific grounds for using injection methods. There are no studies which document the ideal point in time to start NSAID treatment, or the length of duration.

Discussion. There is no conclusive clarification as to whether inhibiting the acute inflammation is an absolute advantage. Pain and discomfort are in any event partially conditional upon the inflammation. By reducing the inflammation the symptoms are reduced, thereby allowing rehabilitation to start at an earlier stage. On the other hand, the inflamed cells are responsible for the decomposition of the tissue which has been destroyed, which is necessary for removal of dead muscle fibre and the like.

Conclusion. Several clinical studies have documented that treatment with NSAID has some effect on sports injuries. There are, however, still many unanswered questions preventing a sure, unequivocal indication for treatment with NSAID to be given. If systematic NSAID treatment is indicated, the new rheumatism pills (“selective COX-2 inhibitors” for example Vioxx), can be recommended. As mentioned above, NSAID treatment is merely a supplement to the base treatment which is “active rest” with increasing intensity in training within the pain threshold. If NSAID is misused as a painkiller to continue a potentially damaging sports activity, the treatment will indirectly increase the risk of the chronic injury. It is for this reason that all NSAID treatment on athletes must be administered by a physician with knowledge of the basic rehabilitation principles.