Topic of the Month : Hip Injuries at work
This month Dr. Shane Nho from Midwest Orthopaedics at Rush, discusses Hip Injuries at Work.
After a fellowship in sports medicine, Dr. Shane Nho underwent additional training in hip arthroscopy and hip joint preservation surgery. He evaluates and treats patients with hip, trochanteric, pelvic, and buttock pain
Hip pain can be difficult to diagnose. The hip labrum is a fibrocartilage structure around the acetabulum that can be torn after repetitive overuse or an acute traumatic event. If the labrum is torn, the patient will usually have deep groin pain but may also have buttock or lateral sided hip pain. The underlying problem is thought to be due to femoroacetabular impingement (FAI) in which there are subtle areas of excessive bone in the acetabulum or proximal femur.
Plain radiographs are very important to understand the three dimensional morphology of the hip structure. MR Arthrogram is often used to confirm the presence of hip labral tear, but many times I will use a diagnostic injection to confirm the diagnosis.
Treatment begins with a course of physical therapy to work on core strength and stretching of the muscles around the hip. If the patient fails non-surgical treatment, he/she may require operative intervention. Hip arthroscopy can be used to perform a labral repair and osteochondroplasty of the proximal femur and acetabulum (removal of excessive bone due to femoroacetabular impingement).
Physical therapy can take up to 4-6 months to work on restoration of range of motion and strength. Patients will begin passive motion with a CPM machine and active assisted motion with a stationary bicycle. The first phase of rehabilitation is focused on range of motion, deep tissue massage, and core strength. The second phase of rehabilitation is focused on progressive strengthening of the hip and core area. The patients will begin work specific activities and/or work conditioning.
RTW 3 - 6 months depending on the procedure and the type of job, and MMI can take up to 6 - 9 months after operative intervention.
Hip pain can be hard to diagnose. If any worker has pain in the groin, lateral aspect of the hip, or buttock, the worker may have suffered a hip injury. Delayed diagnosis may result in the development of other areas of pain. If there is any confusion about the diagnosis, the patient should be evaluated by a hip specialist.