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An Algorithmic Approach to Mechanical Hip Pain

  • Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip
  • Published:
HSS Journal ®

Abstract

Background

As our understanding of hip pathology evolves, the focus is shifting toward earlier identification of hip pathology. Therefore, it is vitally important to elucidate intra-articular versus extra-articular pathology of hip pain in every step of the patient encounter: history, physical examination, and imaging.

Questions/Purposes

The objective was to address the following research questions: (1) Can an algorithmic approach to physical examination of a painful non-arthritic hip provide a more accurate diagnosis and improved treatment plan? (2) Does an anatomical layered concept of clinical diagnosis improve diagnostic accuracy? (3) What are the diagnostic tools necessary for the accurate application of a four-layer (osteochondral, inert, contractile, and neuromechanical) diagnosis?

Methods

An unrestricted computerized search of MEDLINE was conducted. Different terms were used in various combinations.

Results

An algorithmic approach to physical examination of a painful nonarthritic hip, including history, physical examination (specific tests), and advanced imaging allow for better interpretation of debilitating intra- and extra-articular disorders and their effect on core performance. Additionally, it improves our understanding as to how underlying abnormal joint mechanics may predispose the hip joint and the associated hemipelvis to asymmetric loads. These abnormal joint kinematics (layer I) can lead to cartilage and labral injury (layer II), as well as resultant injury to the musculotendinous (layer III) and neural structures (layer IV) about the hip joint and the hemipelvis. The layer concept is a systematic means of determining which structures about the hip are the source of hip pathology and how to best implement treatment.

Conclusions

A clear understanding of the differential diagnosis of hip pain through a detailed and systematic physical examination, diagnostic imaging assessment, and the interpretation of how mechanical factors can result in such a wide range of compensatory injury patterns about the hip can facilitate the diagnosis and treatment recommendations.

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References

  1. Allen WC, Cope R. Coxa saltans: The snapping hip revisited. J Am Acad Orthop Surg. 1995;5:303–308.

    Google Scholar 

  2. Antolak SJ,Jr, Hough DM, Pawlina W, Spinner RJ. Anatomical basis of chronic pelvic pain syndrome: The ischial spine and pudendal nerve entrapment. Med Hypotheses. 2002;3:349–353.

    Google Scholar 

  3. Babst D, Steppacher SD, Ganz R, Siebenrock KA, Tannast M. The iliocapsularis muscle: An important stabilizer in the dysplastic hip. Clin Orthop Relat Res. 2011;6:1728–1734.

    Google Scholar 

  4. Baker CL,Jr, Massie RV, Hurt WG, Savory CG. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. 2007;8:827–832.

    Google Scholar 

  5. Bano A, Karantanas A, Pasku D, Datseris G, Tzanakakis G, Katonis P. Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: A case report. J Med Case Reports. 2010;4:236.

    Google Scholar 

  6. Bedi A, Dolan M, Leunig M, Kelly BT. Static and dynamic mechanical causes of hip pain. Arthroscopy. 2011;2:235–251.

    Google Scholar 

  7. Bellabarba C, Sheinkop MB, Kuo KN. Idiopathic hip instability. an unrecognized cause of coxa saltans in the adult. Clin Orthop Relat Res. 1998;355:261–271.

    PubMed  Google Scholar 

  8. Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;9:2138–2145.

    Google Scholar 

  9. Bittersohl B, Hosalkar HS, Apprich S, Werlen SA, Siebenrock KA, Mamisch TC. Comparison of pre-operative dGEMRIC imaging with intra-operative findings in femoroacetabular impingement: Preliminary findings. Skeletal Radiol. 2011;5:553–561.

    Google Scholar 

  10. Braly BA, Beall DP, Martin HD. Clinical examination of the athletic hip. Clin Sports Med. 2006;2:199–210

    Google Scholar 

  11. Brown RA, Mascia A, Kinnear DG, Lacroix V, Feldman L, Mulder DS. An 18-year review of sports groin injuries in the elite hockey player: Clinical presentation, new diagnostic imaging, treatment, and results. Clin J Sport Med. 2008;3:221–226.

    Google Scholar 

  12. Brunner A, Horisberger M, Herzog R. Evaluation of a computed tomography-based navigation system prototype for hip arthroscopy in the treatment of femoroacetabular cam impingement. Arthroscopy. 2009;4:382–91.

    Google Scholar 

  13. Bunker TD, Esler CN, Leach WJ. Rotator-cuff tear of the hip. J Bone Joint Surg Br. 1997;4:618–620.

    Google Scholar 

  14. Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;7:1448–1457.

    Google Scholar 

  15. Busconi BD OB. Differential diagnosis of the painful hip. In: McCarthy JC, ed. Early hip disorders. New York: Springer; 2003:7–16.

  16. Byrd JW. Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect. 2006;55:347–355.

    Google Scholar 

  17. Byrd JW. Hip arthroscopy: Surgical indications. Arthroscopy. 2006;12:1260–1262.

    Google Scholar 

  18. Byrd JW, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;7:1668–1674.

    Google Scholar 

  19. Byrd JW, Jones KS. Traumatic rupture of the ligamentum teres as a source of hip pain. Arthroscopy. 2004;4:385–391.

    Google Scholar 

  20. Byrd JW, Jones KS. Adhesive capsulitis of the hip. Arthroscopy. 2006;1:89–94.

    Google Scholar 

  21. Casartelli NC, Maffiuletti NA, Item-Glatthorn JF, Staehli S, Bizzini M, Impellizzeri FM, Leunig M. Hip muscle weakness in patients with symptomatic femoroacetabular impingement. Osteoarthritis Cartilage. 2011;7:816–821.

    Google Scholar 

  22. Cho KH, Lee SM, Lee YH, Suh KJ, Kim SM, Shin MJ, Jang HW. Non-infectious ischiogluteal bursitis: MRI findings. Korean J Radiol. 2004;4:280–286.

    Google Scholar 

  23. Crawford K, Philippon MJ, Sekiya JK, Rodkey WG, Steadman JR. Microfracture of the hip in athletes. Clin Sports Med. 2006;2:327–335.

    Google Scholar 

  24. Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). AJR Am J Roentgenol. 2004;1:137–143.

    Google Scholar 

  25. DeAngelis NA, Busconi BD. Assessment and differential diagnosis of the painful hip. Clin Orthop Relat Res. 2003;406:11–18.

    PubMed  Google Scholar 

  26. Draovitch P, Edelstein J, Kelly BT. The layer concept: Utilization in determining the pain generators, pathology, and how structure determines treatment. Curr Rev Musculoskelet Med. 2012;1:1–18.

    Google Scholar 

  27. Dreyfuss P, Dreyer SJ, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004;4:255–265.

    Google Scholar 

  28. Dwek J, Pfirrmann C, Stanley A, Pathria M, Chung CB. MR imaging of the hip abductors: Normal anatomy and commonly encountered pathology at the greater trochanter. Magn Reson Imaging Clin N Am. 2005;4:691–704

    Google Scholar 

  29. Gomes JL, Palma HM, Becker R. Radiographic findings in restrained hip joints associated with ACL rupture. Knee Surg Sports Traumatol Arthrosc. 2010 11: 1562–1567.

    Google Scholar 

  30. Farber AJ, Wilckens JH. Sports hernia: Diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007;8:507–514.

    Google Scholar 

  31. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;2:171–178.

    Google Scholar 

  32. Flanum ME, Keene JS, Blankenbaker DG, Desmet AA. Arthroscopic treatment of the painful “internal” snapping hip: Results of a new endoscopic technique and imaging protocol. Am J Sports Med. 2007;5:770–779.

    Google Scholar 

  33. Fredericson M, Moore W, Guillet M, Beaulieu C. High hamstring tendinopathy in runners: Meeting the challenges of diagnosis, treatment, and rehabilitation. Phys Sportsmed. 2005;5:32–43.

    Google Scholar 

  34. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: A cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.

    PubMed  Google Scholar 

  35. Griffiths HJ, Utz R, Burke J, Bonfiglio T. Adhesive capsulitis of the hip and ankle. AJR Am J Roentgenol. 1985;1:101–105.

    Google Scholar 

  36. Grissom L, Harcke HT, Thacker M. Imaging in the surgical management of developmental dislocation of the hip. Clin Orthop Relat Res. 2008;4:791–801.

    Google Scholar 

  37. Haene RA, Bradley M, Villar RN. Hip dysplasia and the torn acetabular labrum: An inexact relationship. J Bone Joint Surg Br. 2007;10:1289–1292.

    Google Scholar 

  38. Harvey WF, Yang M, Cooke TD, Segal NA, Lane N, Lewis CE, Felson DT. Association of leg-length inequality with knee osteoarthritis: A cohort study. Ann Intern Med. 2010;5:287–295.

    Google Scholar 

  39. Hickman JM, Peters CL. Hip pain in the young adult: Diagnosis and treatment of disorders of the acetabular labrum and acetabular dysplasia. Am J Orthop (Belle Mead NJ). 2001;6:459–467.

    Google Scholar 

  40. Howell GE, Biggs RE, Bourne RB. Prevalence of abductor mechanism tears of the hips in patients with osteoarthritis. J Arthroplasty. 2001;1:121–123.

    Google Scholar 

  41. Ilizaliturri VM,Jr, Camacho-Galindo J, Evia Ramirez AN, Gonzalez Ibarra YL, McMillan S, Busconi BD. Soft tissue pathology around the hip. Clin Sports Med. 2011;2:391–415.

    Google Scholar 

  42. Ilizaliturri VM,Jr, Villalobos FE,Jr, Chaidez PA, Valero FS, Aguilera JM. Internal snapping hip syndrome: Treatment by endoscopic release of the iliopsoas tendon. Arthroscopy. 2005;11:1375–1380.

    Google Scholar 

  43. Irshad K, Feldman LS, Lavoie C, Lacroix VJ, Mulder DS, Brown RA. Operative management of “hockey groin syndrome”: 12 years of experience in national hockey league players. Surgery. 2001;4:759–64

    Google Scholar 

  44. Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. report of three cases. J Bone Joint Surg Am. 1977;2:268–269.

    Google Scholar 

  45. Kagan A,2nd. Rotator cuff tears of the hip. Clin Orthop Relat Res. 1999;368:135–140.

    PubMed  Google Scholar 

  46. Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. 2005;2:588–592.

    Google Scholar 

  47. Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: Surgical technique and review of the literature. Arthroscopy. 2005;12:1496–1504.

    Google Scholar 

  48. Kelly BT, Williams RJ,3rd, Philippon MJ. Hip arthroscopy: Current indications, treatment options, and management issues. Am J Sports Med. 2003;6:1020–1037.

    Google Scholar 

  49. Khanduja V, Villar RN. The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;8:1035–1040.

    Google Scholar 

  50. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;3:423–429.

    Google Scholar 

  51. Knockaert DC, D’Heygere FG, Bobbaers HJ. Ilioinguinal nerve entrapment: A little-known cause of iliac fossa pain. Postgrad Med J. 1989;767:632–635.

    Google Scholar 

  52. Kong A, Van der Vliet A, Zadow S. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol. 2007;7:1772–1783.

    Google Scholar 

  53. Kramer J, Recht MP. MR arthrography of the lower extremity. Radiol Clin North Am. 2002;5:1121–1132.

    Google Scholar 

  54. Krych AJ, Larson CM, Byrd TW, Warren RF, Kelly BT. Low energy posterior wall fractures in athletes: Evidence of cam induced posterior hip subluxation. Presented at 2011 NFL Combine Physicians Society Meeting.

  55. Kusma M, Jung J, Dienst M, Goedde S, Kohn D, Seil R. Arthroscopic treatment of an avulsion fracture of the ligamentum teres of the hip in an 18-year-old horse rider. Arthroscopy. 2004;20:64–66.

    Google Scholar 

  56. Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: Three representative case reports and proposed concept. Arthroscopy. 2011;12:1732–1737.

    Google Scholar 

  57. Larson CM, Pierce BR, Giveans MR. Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: A case series. Arthroscopy. 2011;6:768–775.

    Google Scholar 

  58. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I. techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66.

    PubMed  Google Scholar 

  59. Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: Results of surgical management and histopathologic findings. Am J Sports Med. 2009;4:727–734.

    Google Scholar 

  60. Lequesne M, Djian P, Vuillemin V, Mathieu P. Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. clinical and MRI results of tendon repair. Joint Bone Spine. 2008;4:458–464.

    Google Scholar 

  61. Lequesne M, Mathieu P, Vuillemin-Bodaghi V, Bard H, Djian P. Gluteal tendinopathy in refractory greater trochanter pain syndrome: Diagnostic value of two clinical tests. Arthritis Rheum. 2008;2:241–246.

    Google Scholar 

  62. Little TL, Mansoor J. Low back pain associated with internal snapping hip syndrome in a competitive cyclist. Br J Sports Med. 2008;4:308–9

    Google Scholar 

  63. Longjohn D, Dorr LD. Soft tissue balance of the hip. J Arthroplasty. 1998;1:97–100.

    Google Scholar 

  64. Margo K, Drezner J, Motzkin D. Evaluation and management of hip pain: An algorithmic approach. J Fam Pract. 2003;8:607–617.

    Google Scholar 

  65. Martin HD, Kelly BT, Leunig M, Philippon MJ, Clohisy JC, Martin RL, Sekiya JK, Pietrobon R, Mohtadi NG, Sampson TG, Safran MR. The pattern and technique in the clinical evaluation of the adult hip: The common physical examination tests of hip specialists. Arthroscopy. 2010;2:161–172.

    Google Scholar 

  66. Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: A quantitative report. Arthroscopy. 2008;2:188–195.

    Google Scholar 

  67. Martin HD, Shears SA, Johnson JC, Smathers AM, Palmer IJ. The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy. 2011;2:172–181.

    Google Scholar 

  68. Martin HD, Shears SA, Palmer IJ. Evaluation of the hip. Sports Med Arthrosc. 2010;2:63–75.

    Google Scholar 

  69. Martinoli C, Miguel-Perez M, Padua L, Gandolfo N, Zicca A, Tagliafico A. Imaging of neuropathies about the hip. Eur J Radiol. 2011. doi:10.1016/j.ejrad.2011.04.034.

  70. Mattila VM, Niva M, Kiuru M, Pihlajamaki H. Risk factors for bone stress injuries: A follow-up study of 102,515 person-years. Med Sci Sports Exerc. 2007;7:1061–1066.

    Google Scholar 

  71. McCarthy JC, Busconi BD, Owens BD. Assessment of the painful hip. In: IMcCarthy JC ed. Early hip disorders. New York: Springer; 2003:3–6.

  72. McCarthy J, Noble P, Aluisio FV, Schuck M, Wright J, Lee JA. Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res. 2003;406:38–47.

    PubMed  Google Scholar 

  73. Meyers WC, Foley DP, Garrett WE, Lohnes JH, Mandlebaum BR. Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (performing athletes with abdominal or inguinal neuromuscular pain study group). Am J Sports Med. 2000;1:2–8.

    Google Scholar 

  74. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;4:656–665.

    Google Scholar 

  75. Moeller JL. Pelvic and hip apophyseal avulsion injuries in young athletes. Curr Sports Med Rep. 2003;2:110–115.

    PubMed  Google Scholar 

  76. Mullis BH, Dahners LE. Hip arthroscopy to remove loose bodies after traumatic dislocation. J Orthop Trauma. 2006;1:22–26.

    Google Scholar 

  77. Murata Y, Ogata S, Ikeda Y, Yamagata M. An unusual cause of sciatic pain as a result of the dynamic motion of the obturator internus muscle. Spine J. 2009;6:e16–8.

    Google Scholar 

  78. Niva MH, Kiuru MJ, Haataja R, Pihlajamaki HK. Fatigue injuries of the femur. J Bone Joint Surg Br. 2005;10:1385–1390.

    Google Scholar 

  79. Northmore-Ball MD. Young adults with arthritic hips. BMJ. 1997;7103:265–266.

    Google Scholar 

  80. O’Brien SD, Bui-Mansfield LT. MRI of quadratus femoris muscle tear: Another cause of hip pain. AJR Am J Roentgenol. 2007;5:1185–1189.

    Google Scholar 

  81. Orava S, Ala-Ketola L. Avulsion fractures in athletes. Br J Sports Med. 1977;2:65–71.

    Google Scholar 

  82. Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med. 2008;1:117–121.

    Google Scholar 

  83. Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg. 2007;9:561–570.

    Google Scholar 

  84. Patti JW, Ouellette H, Bredella MA, Torriani M. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skeletal Radiol. 2008;10:939–941.

    Google Scholar 

  85. Petrigliano FA, Lieberman JR. Osteonecrosis of the hip: novel approaches to evaluation and treatment. Clin Orthop Relat Res. 2007;465:53–62.

    Google Scholar 

  86. Philippon MJ. The role of arthroscopic thermal capsulorrhaphy in the hip. Clin Sports Med. 2001;4:817–829.

    Google Scholar 

  87. Philippon MJ, Schenker ML, Briggs KK, Maxwell RB. Can microfracture produce repair tissue in acetabular chondral defects?. Arthroscopy. 2008;1:46–50.

    Google Scholar 

  88. Pihlajamaki HK, Ruohola JP, Weckstrom M, Kiuru MJ, Visuri TI. Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults. J Bone Joint Surg Br. 2006;12:1574–1579.

    Google Scholar 

  89. Pirouzmand F, Midha R. Subacute femoral compressive neuropathy from iliacus compartment hematoma. Can J Neurol Sci. 2001;2:155–158.

    Google Scholar 

  90. Plante M, Wallace R, Busconi BD. Clinical diagnosis of hip pain. Clin Sports Med. 2011;2:225–238.

    Google Scholar 

  91. Ranawat CS, Rodriguez JA. Functional leg-length inequality following total hip arthroplasty. J Arthroplasty. 1997;4:359–364.

    Google Scholar 

  92. Rask MR. “Snapping bottom”: Subluxation of the tendon of the long head of the biceps femoris muscle. Muscle Nerve. 1980;3:250–251.

    PubMed  CAS  Google Scholar 

  93. Reider B, Martel J. Pelvis, hip and thigh. In: Reider B, Martel J, eds. The orthopedic physical examination. Philadelphia: Saunders; 1999:159–1199.

  94. Robb AJ, Fleisig G, Wilk K, Macrina L, Bolt B, Pajaczkowski J. Passive ranges of motion of the hips and their relationship with pitching biomechanics and ball velocity in professional baseball pitchers. Am J Sports Med. 2010;12:2487–2493.

    Google Scholar 

  95. Robertson WJ, Gardner MJ, Barker JU, Boraiah S, Lorich DG, Kelly BT. Anatomy and dimensions of the gluteus medius tendon insertion. Arthroscopy. 2008;2:130–136.

    Google Scholar 

  96. Robinson DE, Ball KE, Webb PJ (2001) Iliopsoas hematoma with femoral neuropathy presenting a diagnostic dilemma after spinal decompression. Spine (Phila Pa 1976) 6: 135–8.

    Google Scholar 

  97. Schlegel TF, Bushnell BD, Godfrey J, Boublik M. Success of nonoperative management of adductor longus tendon ruptures in national football league athletes. Am J Sports Med. 2009;7:1394–1399.

    Google Scholar 

  98. Schmid MR, Notzli HP, Zanetti M, Wyss TF, Hodler J. Cartilage lesions in the hip: Diagnostic effectiveness of MR arthrography. Radiology. 2003;2:382–386.

    Google Scholar 

  99. Scillia A, Choo A, Milman E, McInerney V, Festa A. Snapping of the proximal hamstring origin: A rare cause of coxa saltans: A case report. J Bone Joint Surg Am. 2011;21:e1251–3.

    Google Scholar 

  100. Scopp JM, Moorman CT,3rd. The assessment of athletic hip injury. Clin Sports Med. 2001;4:647–659.

    Google Scholar 

  101. Segal NA, Harvey W, Felson DT, Yang M, Torner JC, Curtis JR, Nevitt MC, Multicenter Osteoarthritis Study Group. Leg-length inequality is not associated with greater trochanteric pain syndrome. Arthritis Res Ther. 2008;3:R62.

    Google Scholar 

  102. Shaffer RA, Rauh MJ, Brodine SK, Trone DW, Macera CA. Predictors of stress fracture susceptibility in young female recruits. Am J Sports Med. 2006;1:108–115.

    Google Scholar 

  103. Shbeeb MI, O’Duffy JD, Michet CJ,Jr, O’Fallon WM, Matteson EL. Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. 1996;12:2104–2106.

    Google Scholar 

  104. Shindle MK, Ranawat AS, Kelly BT. Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient. Clin Sports Med. 2006;2:309–326.

    Google Scholar 

  105. Shindle MK, Voos JE, Heyworth BE, Mintz DN, Moya LE, Buly RL, Kelly BT. Hip arthroscopy in the athletic patient: current techniques and spectrum of disease. J Bone Joint Surg Am. 2007;89:29–43.

    Google Scholar 

  106. Stafford GH, Villar RN. Ischiofemoral impingement. J Bone Joint Surg Br. 2011;10:1300–1302.

    Google Scholar 

  107. Stokes VP, Andersson C, Forssberg H. Rotational and translational movement features of the pelvis and thorax during adult human locomotion. J Biomech. 1989;1:43–50.

    Google Scholar 

  108. Svoboda SJ, Williams DM, Murphy KP. Hip arthroscopy for osteochondral loose body removal after a posterior hip dislocation. Arthroscopy. 2003;7:777–781.

    Google Scholar 

  109. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008;12:1407–1421.

    Google Scholar 

  110. Torriani M, Souto SC, Thomas BJ, Ouellette H, Bredella MA. Ischiofemoral impingement syndrome: An entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;1:186–190.

    Google Scholar 

  111. Troum OM, Crues JV,3rd. The young adult with hip pain: Diagnosis and medical treatment, circa 2004. Clin Orthop Relat Res. 2004;418:9–17.

    PubMed  Google Scholar 

  112. Vandervliet EJ, Vanhoenacker FM, Snoeckx A, Gielen JL, Van Dyck P, Parizel PM. Sports-related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis. Br J Sports Med. 2007;11:827–831.

    Google Scholar 

  113. Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport. 2007;6:463–466.

    Google Scholar 

  114. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;6:794–819.

    Google Scholar 

  115. Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;11:1246

    Google Scholar 

  116. Weir A, de Vos RJ, Moen M, Holmich P, Tol JL. Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain. Br J Sports Med. 2011;1:6–9.

    Google Scholar 

  117. Williams JG. Limitation of hip joint movement as a factor in traumatic osteitis pubis. Br J Sports Med. 1978;3:129–133.

    Google Scholar 

  118. Winston P, Awan R, Cassidy JD, Bleakney RK. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007;1:118–126.

    Google Scholar 

  119. Yamamoto Y, Usui I. Arthroscopic surgery for degenerative rupture of the ligamentum teres femoris. Arthroscopy. 2006;6:689

    Google Scholar 

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  1. Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA

    Lazaros A. Poultsides MD, MSc, PhD & Bryan T. Kelly MD

  2. Sports Medicine and Shoulder Surgery, MedSport, University of Michigan Health System, Ann Arbor, MI, 48109, USA

    Asheesh Bedi MD

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  1. Lazaros A. Poultsides MD, MSc, PhD
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Correspondence to Lazaros A. Poultsides MD, MSc, PhD.

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Poultsides, L.A., Bedi, A. & Kelly, B.T. An Algorithmic Approach to Mechanical Hip Pain. HSS Jrnl 8, 213–224 (2012). https://doi.org/10.1007/s11420-012-9304-x

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