Skip to main content

Advertisement

SpringerLink
Log in

Muscle–tendon-related abnormalities detected by ultrasonography are common in symptomatic hip dysplasia

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Hip dysplasia is characterized by reduced acetabular coverage of the femoral head leading to an increased mechanical load on the hip joint and the acting hip muscles. Potentially, the muscles and tendons functioning close to the hip joint may present with overuse-related ultrasonography findings. The primary aim was to report the prevalence of muscle–tendon-related abnormalities detected by ultrasonography in 100 patients with symptomatic hip dysplasia. The secondary aim was to investigate correlations between muscle–tendon-related abnormalities detected by ultrasonography and clinically identified pain related to muscles and tendons.

Materials and methods

One hundred patients (17 men) with a mean age of 29 ± 9 years were included. Muscle–tendon-related abnormalities were detected with a standardized ultrasound examination. Correlations between muscle–tendon-related abnormalities detected by ultrasonography and clinically identified pain related to muscles and tendons were tested with Spearman’s rank correlation coefficient.

Results

The most prevalent ultrasonography findings were identified in the iliopsoas tendon [50% (95% CI 40; 60)], the adductor longus tendon [31% (95% 22; 40)] and the gluteus medius/minimus tendons [27% (18; 36)]. Significant correlations between ultrasonography findings and pain related to muscles and tendons were only found for the iliopsoas tendon (ρ = 0.24 and p = 0.02) and the gluteus medius/minimus tendons (ρ = 0.35 and p < 0.001).

Conclusions

Muscle–tendon-related abnormalities detected by ultrasonography in the hip and groin region are common in patients with symptomatic hip dysplasia, and the ultrasonography findings of the iliopsoas and gluteus medius/minimus tendons are weakly to moderately correlated to pain related to muscles and tendons in these structures. Both the iliopsoas and the gluteus medius/minimus have a pronounced stabilizing role in the dysplastic hip joint, and the common muscle–tendon-related abnormalities in these patients may be caused by injuries related to excessive use or degenerative changes in the muscle–tendon tissue.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Klaue K, Durnin CW, Ganz R (1991) The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Jt Surg Br 73:423–429

    Article  CAS  Google Scholar 

  2. Mechlenburg I, Nyengaard JR, Rømer L, Søballe K (2004) Changes in load-bearing area after Ganz periacetabular osteotomy evaluated by multislice CT scanning and stereology. Acta Orthop Scand 75:147–153. https://doi.org/10.1080/00016470412331294395

    Article  PubMed  Google Scholar 

  3. Kuroda D, Maeyama A, Naito M, Moriyama S, Yoshimura I, Nakamura Y, Kiyama T (2013) Dynamic hip stability, strength and pain before and after hip abductor strengthening exercises for patients with dysplastic hips. Isokinet Exerc Sci 21:95–100. https://doi.org/10.3233/IES-130480

    Article  Google Scholar 

  4. Gupta A, Chandrasekaran S, Redmond JM, Hammarstedt JE, Cramer TL, Liu Y, Domb BG (2015) Does labral size correlate with degree of acetabular dysplasia? Orthop J Sport Med 3:1–5. https://doi.org/10.1177/2325967115572573

    Article  Google Scholar 

  5. Dilani Mendis M, Hides JA, Wilson SJ, Grimaldi A, Belavý DL, Stanton W, Felsenberg D, Rittweger J, Richardson C (2009) Effect of prolonged bed rest on the anterior hip muscles. Gait Posture 30:533–537. https://doi.org/10.1016/j.gaitpost.2009.08.002

    Article  CAS  PubMed  Google Scholar 

  6. Babst D, Steppacher SD, Ganz R, Siebenrock KA, Tannast M (2011) The iliocapsularis muscle: an important stabilizer in the dysplastic hip. Clin Orthop Relat Res 469:1728–1734. https://doi.org/10.1007/s11999-010-1705-x

    Article  CAS  PubMed  Google Scholar 

  7. Henak CR, Ellis BJ, Harris MD, Anderson AE, Peters CL, Weiss JA (2011) Role of the acetabular labrum in load support across the hip joint. J Biomech 44:2201–2206. https://doi.org/10.1016/j.jbiomech.2011.06.011

    Article  PubMed  PubMed Central  Google Scholar 

  8. Retchford T, Crossley KM, Grimaldi A, Kemp JL, Cowan SM (2013) Can local muscles augment stability in the hip? A narrative literature review. J Musculoskelet Neuronal Interact 13:1–12. https://doi.org/10.1136/bjsm.2009.066944

    Article  CAS  PubMed  Google Scholar 

  9. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J (2001) The Otto E. Aufranc Award: the role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res 25–37

  10. Ross JR, Zaltz I, Nepple JJ, Schoenecker PL, Clohisy JC (2011) Arthroscopic disease classification and interventions as an adjunct in the treatment of acetabular dysplasia. Am J Sports Med 39(Suppl):72S–78S. https://doi.org/10.1177/0363546511412320

    Article  PubMed  Google Scholar 

  11. Alpert JM, Kozanek M, Li G, Kelly BT, Asnis PD (2009) Cross-sectional analysis of the iliopsoas tendon and its relationship to the acetabular labrum: an anatomic study. Am J Sports Med 37:1594–1598. https://doi.org/10.1177/0363546509332817

    Article  PubMed  Google Scholar 

  12. Fabricant PD, Bedi A, De La Torre K, Kelly BT (2012) Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. Arthroscopy 28:965–971. https://doi.org/10.1016/j.arthro.2011.11.028

    Article  PubMed  Google Scholar 

  13. Grimaldi A (2011) Assessing lateral stability of the hip and pelvis. Man Ther 16:26–32. https://doi.org/10.1016/j.math.2010.08.005

    Article  PubMed  Google Scholar 

  14. Jacobsen JS, Hölmich P, Thorborg K, Bolvig L, Jakobsen SS, Søballe K, Mechlenburg I (2018) Muscle–tendon-related pain in 100 patients with hip dysplasia: prevalence and associations with self-reported hip disability and muscle strength. J Hip Preserv Surg 5:39–46. https://doi.org/10.1093/jhps/hnx041

    Article  PubMed  Google Scholar 

  15. Nunley RM, Prather H, Hunt D, Schoenecker PL, Clohisy JC (2011) Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Jt Surg Am 93(Suppl 2):17–21. https://doi.org/10.2106/JBJS.J.01735

    Article  Google Scholar 

  16. Domb BG, Lareau JM, Baydoun H, Botser I, Millis MB, Yen Y-M (2014) Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy? Clin Orthop Relat Res 472:674–680. https://doi.org/10.1007/s11999-013-3140-2

    Article  PubMed  Google Scholar 

  17. Branci S, Thorborg K, Bech BH, Boesen M, Nielsen MB, Hölmich P (2015) MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med 49:681–691. https://doi.org/10.1136/bjsports-2014-093710

    Article  PubMed  Google Scholar 

  18. Kälebo P, Karlsson J, Sward L, Peterson L (1992) Ultrasonography of chronic tendon injuries in the groin. Am J Sports Med 20:634–639. https://doi.org/10.1177/036354659202000603

    Article  PubMed  Google Scholar 

  19. Jansen JACG., Mens JMA, Backx FJG, Stam HJ (2008) Diagnostics in athletes with long-standing groin pain. Scand J Med Sci Sports 18:679–690. https://doi.org/10.1111/j.1600-0838.2008.00848.x

    Article  CAS  PubMed  Google Scholar 

  20. Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Søballe K (2009) What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Acta Orthop 80:314–318. https://doi.org/10.3109/17453670902988402

    Article  PubMed  PubMed Central  Google Scholar 

  21. Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J, American Medical Society for Sports Medicine (2015) American Medical Society for Sports Medicine position statement: interventional musculoskeletal ultrasound in sports medicine. Clin J Sport Med 25:6–22. https://doi.org/10.1097/JSM.0000000000000175

    Article  PubMed  Google Scholar 

  22. Bancroft LW, Merinbaum DJ, Zaleski CG, Peterson JJ, Kransdorf MJ, Berquist TH (2007) Hip ultrasound. Semin Musculoskelet Radiol 11:126–136. https://doi.org/10.1055/s-2007-1001878

    Article  PubMed  Google Scholar 

  23. Nestorova R, Petranova T, Porta F, Radunovic G, Micu MC, Iagnocco A (2012) Ultrasonography of the hip. Med Ultrason 14:217–224

    PubMed  Google Scholar 

  24. Whittaker JL, Emery CA (2014) Sonographic measures of the gluteus medius, gluteus minimus, and vastus medialis muscles. J Orthop Sports Phys Ther 44:627–632. https://doi.org/10.2519/jospt.2014.5315

    Article  PubMed  Google Scholar 

  25. Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Orthop Scand Suppl 58:1–132

    Google Scholar 

  26. Troelsen A, Elmengaard B, Søballe K (2008) A new minimally invasive transsartorial approach for periacetabular osteotomy. J Bone Jt Surg Am 90:493–498. https://doi.org/10.2106/JBJS.F.01399

    Article  CAS  Google Scholar 

  27. Tönnis D (1987) Congenital dysplasia and dislocation of the hip in children and adults. Springer, Berlin

    Book  Google Scholar 

  28. Thorborg K, Hölmich P, Christensen R, Petersen J, Roos EM (2011) The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med 45:478–491. https://doi.org/10.1136/bjsm.2010.080937

    Article  CAS  PubMed  Google Scholar 

  29. Martin HD, Kelly BT, Leunig M, Philippon MJ, Clohisy JC, Martin RL, Sekiya JK, Pietrobon R, Mohtadi NG, Sampson TG, Safran MR (2010) The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. Arthrosc J Arthrosc Relat Surg 26:161–172. https://doi.org/10.1016/j.arthro.2009.07.015

    Article  Google Scholar 

  30. Tibor LM, Sekiya JK (2008) Differential diagnosis of pain around the hip joint. Arthrosc J Arthrosc Relat Surg 24:1407–1421. https://doi.org/10.1016/j.arthro.2008.06.019

    Article  Google Scholar 

  31. Hölmich P, Hölmich LR, Bjerg AM (2004) Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med 38:446–451. https://doi.org/10.1136/bjsm.2003.004754

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hölmich P (2007) Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients. Br J Sport Med 41:247–252. https://doi.org/10.1136/bjsm.2006.033373

    Article  Google Scholar 

  33. Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, Lovell G, Meyers WC, Muschaweck U, Robinson P, De Vos R-J, Vuckovic Z (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sport Med 49:768–774. https://doi.org/10.1136/bjsports-2015-094869

    Article  Google Scholar 

  34. Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374

    Article  CAS  Google Scholar 

  35. Robinson P, Grainger AJ, Hensor EMA, Batt ME, O’Connor PJ (2015) Do MRI and ultrasound of the anterior pelvis correlate with, or predict, young football players’ clinical findings? A 4-year prospective study of elite academy soccer players. Br J Sports Med 49:176–182. https://doi.org/10.1136/bjsports-2013-092932

    Article  PubMed  Google Scholar 

  36. Nakahara I, Takao M, Sakai T, Miki H, Nishii T, Sugano N (2014) Three-dimensional morphology and bony range of movement in hip joints in patients with hip dysplasia. Bone Jt J 96B:580–589. https://doi.org/10.1302/0301-620X.96B5.32503

    Article  Google Scholar 

  37. Wells J, Nepple JJ, Crook K, Ross JR, Bedi A, Schoenecker P, Clohisy JC (2017) Femoral morphology in the dysplastic hip: three-dimensional characterizations with CT. Clin Orthop Relat Res 475:1045–1054. https://doi.org/10.1007/s11999-016-5119-2

    Article  PubMed  Google Scholar 

  38. Skalshøi O, Iversen CH, Nielsen DB, Jacobsen J, Mechlenburg I, Søballe K, Sørensen H (2015) Walking patterns and hip contact forces in patients with hip dysplasia. Gait Posture 42:529–533. https://doi.org/10.1016/j.gaitpost.2015.08.008

    Article  PubMed  Google Scholar 

  39. Bass CJ, Connell DA (2002) Sonographic findings of tensor fascia lata tendinopathy: another cause of anterior groin pain. Skelet Radiol 31:143–148. https://doi.org/10.1007/s00256-001-0459-7

    Article  CAS  Google Scholar 

  40. Long SS, Surrey DE, Nazarian LN (2013) Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. Am J Roentgenol 201:1083–1086. https://doi.org/10.2214/AJR.12.10038

    Article  Google Scholar 

  41. O’Connor PJ, Grainger AJ, Morgan SR, Smith KL, Waterton JC, Nash AFP Ultrasound assessment of tendons in asymptomatic volunteers: a study of reproducibility. Eur Radiol 14:1968–1973. https://doi.org/10.1007/s00330-004-2448-4

  42. Ingwersen KG, Hjarbaek J, Eshoej H, Larsen CM, Vobbe J, Juul-Kristensen B (2016) Ultrasound assessment for grading structural tendon changes in supraspinatus tendinopathy: an inter-rater reliability study. BMJ Open 6:e011746. https://doi.org/10.1136/bmjopen-2016-011746

    Article  PubMed  PubMed Central  Google Scholar 

  43. Troelsen A, Jacobsen S, Bolvig L, Gelineck J, Rømer L, Søballe K (2007) Ultrasound versus magnetic resonance arthrography in acetabular labral tear diagnostics: a prospective comparison in 20 dysplastic hips. Acta Radiologica 48:1004–1010

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank physiotherapist Charlotte Møller Sørensen (CMS) for her invaluable assistance in carrying out the clinical examinations.

Funding

This work was funded by the Danish Rheumatism Association (Grant number A3280) and the Aase and Ejnar Danielsen Fund (Grant number 10-000761/LPJ).

Author information

Authors and Affiliations

  1. Department of Physiotherapy, Faculty of Health Sciences, VIA University College, Hedeager 2, 8200, Aarhus N, Denmark

    Julie Sandell Jacobsen

  2. Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark

    Julie Sandell Jacobsen

  3. Department of Radiology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark

    Lars Bolvig

  4. Department of Orthopaedic Surgery, Sports Orthopaedic Research Center-Copenhagen (SORC-C), Copenhagen University Hospital, Amager and Hvidovre, Italiensvej 1, 2300, Copenhagen S, Denmark

    Per Hölmich & Kristian Thorborg

  5. Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark

    Stig Storgaard Jakobsen, Kjeld Søballe & Inger Mechlenburg

  6. Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens, Boulevard 82, Building 2, 8200, Aarhus N, Denmark

    Inger Mechlenburg

Authors
  1. Julie Sandell Jacobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars Bolvig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Per Hölmich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristian Thorborg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stig Storgaard Jakobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kjeld Søballe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Inger Mechlenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie Sandell Jacobsen.

Ethics declarations

Conflict of interest

Julie Sandell Jacobsen, Lars Bolvig, Per Hölmich, Kristian Thorborg, Stig Storgaard Jakobsen, Kjeld Søballe, and Inger Mechlenburg declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16369 KB)

Supplementary material 2 (DOCX 18 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jacobsen, J.S., Bolvig, L., Hölmich, P. et al. Muscle–tendon-related abnormalities detected by ultrasonography are common in symptomatic hip dysplasia. Arch Orthop Trauma Surg 138, 1059–1067 (2018). https://doi.org/10.1007/s00402-018-2947-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-018-2947-4

Keywords

Search

Navigation