Imaging of hip disorders in athletes

Normal hip joint function is fundamental in running-, jumping-, and kicking-based sporting activities. Hip disorders do not account for a large portion of exercise-related injuries, but they can pose a clinical dilemma since symptoms tend to be non-specific. Conventional radiographs may demonstrate some causes of hip pain, such as stress fractures and degenerative joint disease. Magnetic resonance (MR) imaging of the hip has proven valuable in the diagnosis of radiographically occult osseous abnormalities and periarticular soft tissue disorders such as stress fractures, avulsion injuries, musculotendinous abnormalities, and bursitis. Conventional MR imaging has been less useful in the evaluation of intra-articular lesions including acetabular labral tears, intra-articular loose bodies, and cartilage lesions. The visualization of intra-articular structures and their abnormalities can be improved by the injection of diluted Gadolinium, which distends the capsule and leaks into labral tears. This article will focus on the use of conventional radiography and MR imaging in recreational and professional athletes with painful hip joints, and where possible it will compare MR imaging with other diagnostic modalities such as bone scan and CT.     

Microfracture of the hip in athletes

Most studies addressing treatment of chondral injuries have involved the knee. Various techniques have been used in the knee. Microfracture has shown excellent results in the knee. Chondral injuries of the hip are common in athletes with labral tears and femoroacetabular impingement. The microfracture technique is now being used in the hip joint. Indications include full-thickness cartilage loss or unstable flap on a weight-bearing surface. An important contraindication is the patients unwillingness to follow the postoperative protocol and rehabilitation plan. The microfracture technique in the hip is similar to that in the knee. Postoperatively, patients use a continuous passive motion and are flat foot (20 lbs.) weightbearing for 8 weeks. Early results following microfracture in the hip have been encouraging.     

Traumatic hip dislocation in athletes

Sports injuries are increasingly prevalent. Dislocations of the hip are rare; however, they are seen in high-velocity sports such as football and rugby. The injuries may be described as anterior or posterior, and classified according to severity of injury. It is critical to the sports medicine practitioner to promptly recognize and manage this complex injury. This article presents a functional management algorithm including reduction techniques for the simple hip dislocation. Early reduction minimizes complications in all studies. Immediate on-field reduction has been performed successfully and safely in a limited number of cases. An aggressive rehabilitation protocol is proposed to assist the athlete back to sporting activity as soon as possible. The potential benefits of early reduction limit the risk of avascular necrosis of the femoral head and sciatic neuropathy; therefore, further investigation into the standard use of this immediate reduction technique is warranted.     

Menstrual disorders in athletes

Conclusions No one should interpret warnings to physically active women about the hazards of undernutrition as discouraging them from participating in vigorous physical activity. The 1997 ACSM position stand on the female athlete triad opens by stating that "the majority of girls and women derive significant health benefits from regular physical activity without incurring health risks. They should be encouraged to be physically active at all phases of their lives." Nevertheless, the ACSM has a long history of warning against exercising in an unhealthful manner. The ACSM position stand on the female athlete triad is in that responsible tradition.     

Menstrual disorders in athletes

The various menstrual disorders in athletes may reflect different degrees of exposure to a disrupting factor or differences in the susceptibility of various women to disruption. The incidences of these disorders are not well documented, but they appear to be highest in aesthetic, endurance and weight-class sports, and at younger ages, higher training volumes and lower bodyweights. The morbid effects of these disorders include infertility, low bone mass, impaired endothelium-dependent vasodilation, and impaired skeletal muscle oxidative metabolism. The high incidences of menstrual disorders in athletes may derive in part from the self-selection of extraneously affected women into athletics, but many women acquire their menstrual disorders in athletics by failing to adequately increase dietary energy intake in compensation for exercise energy expenditure. Applied research is needed to develop effective dietary interventions that are acceptable to athletes.     

Lipid disorders in athletes

The treatment of lipid disorders in athletes presents several unique issues. The effects of exercise on lipid subfractions are explained and the evidence supporting the treatment of dyslipidemia is reviewed. Screening for dyslipidemia with a discussion of novel risk factor assessment is examined. The National Cholesterol Education Program Adult Treatment Panel III treatment guidelines are presented as a template for the management of dyslipidemia in athletes. Special cautions in the use of statins in athletes, as well as complementary and alternative medical treatments are discussed. Treatment regimens must be tailored to both the risk status and sport of each individual athlete.     

Pulmonary disorders in athletes

Exercise is rarely limited by pulmonary causes in normal individuals. Cardiac output and peripheral muscle disease are usually the limiting factors. Although minute ventilation rises steeply during exercise, normal individuals maintain a substantial breathing reserve. Exercise in patients, however, can be limited by pulmonary disorders. Acute pulmonary causes (exercise-induced bronchospasm, vocal cord dysfunction, exercise-induced anaphylaxis, and exercise-induced urticaria) or chronic disorders (obstructive and restrictive lung disorders) reduce exercise tolerance. Exercise?testing has proved the mainstay for diagnosis and treatment of these disorders.     

Common cutaneous disorders in athletes

Athletic activity may cause or aggravate skin disorders, which in turn may diminish athletic performance. Since many sporting activities necessitate prolonged exposure to the sun, athletes must avoid painful sunburn which will adversely affect their performance. Drugs and chemicals also may cause photoallergic and/or phototoxic reactions, including polymorphous light eruption and athletes should thus avoid photosensitising drugs and chemicals. The effects of chronic ultraviolet exposure include ageing, pigmentation and skin cancers. The most effective protection against excessive exposure to sunlight is the use of sunscreens, although inadequate application and poor protection in the UVA spectrum may diminish their effectiveness and contact allergies may create other problems. Viral, bacterial and fungal infections are common in athletes due to heat, friction and contact with others. Herpes simplex may be treated with any drying agents (e.g. alcohol) as they are as effective as more expensive topical agents such as acyclovir. Molluscum contagiosum may be spread by close contact or water contact and is treated by superficial incision, cryotherapy or standard wart varnishes. Plantar wart infection is transmitted by swimming pool decks, changing rooms and hand-to-hand from weights in gymnasiums. Plantar warts presenting with pain may be aggressively treated, by blunt dissection, but painless ones are best treated conservatively. Impetigo and folliculitis often develop after trauma. Antibiotics are effective against mild infections while abrasions and lacerations should be cleansed and dressed with occlusive dressings. Diphtheroid bacteria in moist footwear may produce pitted keratolysis and erythrasma. Tinea pedis is common in athletes and probably originates in swimming pools, gymnasium floors and locker rooms. Interdigital, dry-moccasin and pustular-midsole forms can be distinguished. The latter two forms respond to topical antifungal agents, while the interdigital form, a mixed fungal/bacterial infection, is treated with debridement, antibiotics and drying routine similar to the therapy of otitis externa. Nail infections by a variety of organisms may appear as onycholysis with or without paronychia and should be treated with the appropriate antibiotics. Tinea versicolor occurs in heat and humidity. Since Pityrosporum orbiculare is part of the normal flora it often recurs, necessitating regular treatment. Acute trauma injuries include contusions, black heel or petichiae of the heel, black toe (bleeding under the nail), 'jogger's nipple' caused by chafing, and foot blisters. Chronic trauma may result in calluses, corns and paronychia. Plantar corns can be disabling and may be caused by overly tight shoes or abnormalities in biomechanics; treatment includes restoring normal foot function and minimal surgical procedures. Paronychia is treated best by wedge resection.(ABSTRACT TRUNCATED AT 400 WORDS)     

Achilles tendon disorders in athletes

Achilles tendon disorders are among the more common maladies seen by sports medicine physicians. Understanding the anatomy and biomechanics of the Achilles tendon and contiguous structures is essential to the diagnosis and treatment of Achilles tendon overuse injuries. Posterior heel pain is multifactorial and includes paratenonitis, tendinosis, tendinosis with partial rupture, insertional tendinitis, retrocalcaneal bursitis, and subcutaneous tendo-Achilles bursitis. Each of these entities is distinct, but they often occur in combination. Although most cases of this disorder are successfully treated nonoperatively, a small subgroup of recalcitrant cases may benefit from surgical intervention. Complete ruptures in active, athletic persons should be treated operatively in most cases and result in predictably good outcomes. There may be some cases that escape early recognition and require a reconstructive procedure to salvage a potentially severe functional deficit.     

Intra-articular membranous interposition detected by MRI in developmental dysplasia of the hip

Intra-articular membranous interposition was detected by MRI in the hip joint with residual subluxation of a girl aged 5 years 10 months. This structure, which had low signal intensity on both T1- and T2-weighted images, separated the femoral head from the acetabulum. Histological examination revealed chondrometaplasia, which suggested that this interposition might be transformed to a surface cartilaginous tissue of the secondary acetabulum often observed in residual subluxation of the hip. Received: 20 July 2000 Revision requested: 18 August 2000 Revision received: 8 September 2000 Accepted: 8 September 2000     

Eating disorders in Spanish female athletes

The objective of the study was to determine the prevalence of eating disorders and risk factors for their development in female athletes. Two hundred and eighty-three elite sportswomen, competing in 20 different sports, were administered the EAT, the CETCA (the Eating Disorders Assessment Questionnaire, based on DSM-III-R diagnostic criteria), and two other inventories which evaluated 1) the possible influence on eating disorders of exposure of the body in public and 2) pressure from coaches regarding eating habits, weight, physical appearance and performance. More than 11% of subjects had scores above the cut-off point (>30) on the EAT questionnaire, a proportion similar to that found in a general female population in Spain. On the basis of the CETCA score, AN was putatively diagnosed in 2.5% of the sample, and BN in 20.1%. Though some of these cases may have been EDNOS (eating disorders not otherwise specified), the proportion of athletes suffering from some kind of eating disorder was five times higher than in the general population (22.6% vs. 4.1%). No differences were found between the sportswomen and the general population in terms of specific risk behaviours and attitudes, but a substantial subgroup of athletes presented two or more of these risk behaviours. Exposure of the body in public seems to be a risk factor for eating disorders in general, and pressure from coaches seems to be a risk factor for bulimia.     

Eating disorders in athletes: managing the risks

Athletes risk injuries and make personal sacrifices in their education, careers, and personal relationships in pursuit of excellence. Well-prepared athletes and their support teams take steps to minimize these risks. Since the 1980s, it has been apparent that development of an eating disorder is a risk associated with considerable morbidity and significant mortality, and with shorter careers characterized by inconsistency and recurrent injury. How likely is it that an athlete will develop an eating disorder? Who is at risk? Can eating disorders be prevented? How can eating disorders be identified? What are the consequences of developing an eating disorder? What can be done to help an athlete who has an eating disorder? This article attempts to answer these questions.     

Imaging of hip and groin injuries in athletes

Proper function of the hip joint is imperative for athletes who participate in sporting activities that rely on utilization of the lower extremity; these primarily include kicking, running, and jumping activities. Sports-related injuries of the hip and groin are not frequent sources of disability in athletes; however, they may present a significant diagnostic dilemma, both from a clinical and radiological standpoint. Delay in diagnosis and treatment may result in undesired complications, such as premature degenerative disease, as well as time lost from athletic activities. Magnetic resonance (MR) imaging of the hip, particularly following the intra-articular administration of gadolinium, has proven to be extremely valuable in the diagnosis of radiographically occult osseous abnormalities as well as soft-tissue injuries, such as pubalgia, musculotendinous abnormalities, and bursitis. This article will review several pathological conditions of the hip and groin in both recreational and professional athletes, with an emphasis on MR imaging as the modality of choice in the diagnosis of these injuries.     

Eating disorders in athletes: A review of the literature

Over the last two decades an increasing amount of research has begun to examine the issue of eating disorders in athletes. While a number of studies in this area have been published, the results have not been able to clarify the nature of the relationship between athletic involvement and eating problems. This review critically evaluates existing studies of eating disorders in athletes, highlighting various methodological limitations. Studies are grouped under three main headings: uncontrolled studies; controlled studies; and studies comparing athletes with different body type requirements. A fourth section of the paper evaluates studies which have addressed the issue of gender differences in eating disorders among athletes. Suggestions are made for guidelines that will improve future research in this area.     

Imaging of hip disorders

Many different imaging modalities are available to assist in the evaluation of hip disease. One must choose the image or series of images that not only provide the most diagnostic and clinical information, but also remain the simplest and most cost effective for the patient. The initial examination should be the conventional radiograph. This will provide, in most instances, the most diagnostic information for arthritic disease, stress and insufficiency fractures, infection, and bone tumors. If the conventional radiograph is normal, or if more information is needed, bone scintigraphy should be done next. Bone scintigraphy will confirm the presence of disease, demonstrate its anatomic location, and give some information as to its physiologic state. Computed tomography does not play an important role in the evaluation of hip disease except in acute fractures involving the acetabulum. MR imaging is the modality of choice for diagnosing and staging osteonecrosis, searching for marrow disease, assessing cartilage abnormality, and evaluating the extent of soft-tissue disease.     

Intra-articular adhesions following hip arthroscopy: a risk factor analysis

Purpose

The purpose of this study was to evaluate possible risk factors for symptomatic adhesions after hip arthroscopy.

Methods

Data were analysed from hip arthroscopies performed between 2005 and 2009. Only primary hip arthroscopies were included. Data collected included demographics, primary treatment, rehabilitation, revision surgery, and presence of adhesions at revision.

Results

One thousand two hundred and sixty-four hips in patients 18 years or older underwent primary hip arthroscopy during the defined period. Eight underwent revision hip arthroscopy by a different surgeon. Patients under 30 years of age were 5.9 times more likely to be in the adhesion group [95 % CI 3.1–11.5]. Patients who underwent microfracture were 3.1 times less likely to have adhesions compared to patients who did not [95 % CI 1.1–8.2]. Patients who did not receive circumduction therapy were 4.1 times more likely to have adhesions compared to those who performed circumduction exercises [95 % CI 1.25–11.0].

Conclusion

Risk factors for adhesions following hip arthroscopy identified were age under 30, modified Harris Hip score under 50, no microfracture performed, and rehabilitation without circumduction.

Level of evidence

IV.     

Sonography in pediatric hip disorders

Real-time ultrasonography of the infant hip has proven to be a reliable and safe method of evaluating the joint for dislocation or instability. A number of techniques for diagnosing and quantifying these disorders have been developed. Several other applications of ultrasound in pediatric hip disorders have also been described, most notably the detection of joint fluid.