Patient Selection and Physical Examination



Successful hip arthroscopy is most clearly dependent on proper patient selection and relies on the clinical acumen of the surgeon. Arthroscopy has been instrumental in defining the existence of numerous previously unrecognized hip disorders that can cause disabling symptoms. This has subsequently led to marked improvement in interpreting the history and symptoms and in physical examination skills. This has also necessitated a more comprehensive strategy in assessing the complexities of the hip region beyond just the joint itself. This chapter details the history and examination for the hip joint but also the entirety of the lumbopelvic region. There are numerous disorders that may mimic and coexist with one another. A complete assessment is important in establishing a cohesive strategy, both nonsurgical and surgical, for the intricacies of this region. It would be an egregious error for one to isolate the exam to the joint alone. The comprehensive nature of this chapter will prepare the reader for the challenges of evaluating these complex issues.


External Rotation Labral Tear Iliotibial Band Posterior Impingement Trochanteric Bursitis 
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  1. 1.
    McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Med. 1999;27(4):261–74.PubMedCrossRefGoogle Scholar
  2. 2.
    Byrd JWT, Jones KS. Hip arthroscopy in athletes. Clin Sports Med. 2001;20(4):749–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Byrd JWT. Snapping hip. Oper Tech Sports Med. 2005;13(1): 46–54.CrossRefGoogle Scholar
  4. 4.
    Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy with 10-year follow up. Clin Orthop Relat Res. 2010;468(3):741.PubMedCrossRefGoogle Scholar
  5. 5.
    Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy with two year follow up. Arthroscopy. 2000;16(6):578–87.PubMedCrossRefGoogle Scholar
  6. 6.
    O’Leary JA, Berend K, Vail TP. The relationship between diagnosis and outcome in arthroscopy of the hip. Arthroscopy. 2001;17(2): 181–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Aufranc OE. The patient with a hip problem. In: Aufranc OE, editor. Constructive surgery of the hip. St. Louis: CV Mosby; 1962. p. 15–49.Google Scholar
  8. 8.
    Hilton J. Rest and pain. London: Bell; 1863.Google Scholar
  9. 9.
    Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis in the hip. Clin Orthop. 2003;417:112–20.PubMedGoogle Scholar
  10. 10.
    Philippon MJ. New frontiers in hip arthroscopy: the role of arthroscopic repair and capsulorrhaphy in the treatment of hip disorders. Instr Course Lect. 2006;55:309–16.PubMedGoogle Scholar
  11. 11.
    Sierra RJ, Trousdale RT, Ganz R, Leunig M. Hip disease in the young, active patient: evaluation and nonarthroplasty surgical options. J Am Acad Orthop Surg. 2008;16:689–703.PubMedGoogle Scholar
  12. 12.
    Byrd JWT. Adhesive capsulitis of the hip. Arthroscopy. 2006;22(1): 89–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Rydell NW. Forces acting on the femoral head-prosthesis. Department of Orthop Surgery, University of Goteborg, Sweden, Munksgaard, Copenhagen. 1966. p. 77.Google Scholar
  14. 14.
    Philippon MJ, Schenker ML. Athletic hip injuries and capsular laxity. Oper Tech Orthop. 2005;15:261–6.Google Scholar
  15. 15.
    Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br. 1969;51(3):444–53.PubMedGoogle Scholar
  16. 16.
    Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008;24(12):1407–21.PubMedCrossRefGoogle Scholar
  17. 17.
    Meyers WC, McKechnie A, Philippon MJ, Horner MA, et al. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;248(4):656–64.PubMedGoogle Scholar
  18. 18.
    Byrd JWT. Piriformis syndrome. Oper Tech Sports Med. 2005;13(1): 71–9.CrossRefGoogle Scholar
  19. 19.
    Clohisy JC, Carlisle JC, Beaule PE, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90:47–66.PubMedCrossRefGoogle Scholar
  20. 20.
    Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop. 2007;472:115–21.Google Scholar
  21. 21.
    Meyer DC, Beck M, Ellis T, et al. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–5.PubMedGoogle Scholar
  22. 22.
    Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, MRI, gadolinium MRI, and intraarticular injection in hip arthroscopy patients. Am J Sports Med. 2004;32(7):1668–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Mintz DN, Hooper T, Connell D, et al. Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy. 2005;21(4):385–93.PubMedCrossRefGoogle Scholar
  24. 24.
    Ziegert AL, et al. Comparison of standard hip MR arthrographic imaging planes and sequences for detection of arthroscopically proven labral tears. Am J Roentgenol. 2009;192(5):1397–400.PubMedCrossRefGoogle Scholar
  25. 25.
    Martin HD, Kelly BT, Leunig M, et al. The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. Arthroscopy. 2010;26(2):161–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York  2013

Authors and Affiliations

  1. 1.Nashville Sports Medicine FoundationNashvilleUSA

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