ABSTRACT
Hip and pelvis pain is often seen as the “black box” of sports medicine due to the complex anatomy, large differential diagnosis, and overlapping pain patterns that can present in this region (Tables 48.1 and 48.2). Additionally, individuals with chronic hip pain often have multiple simultaneous pathologies accounting for their symptoms. To further complicate matters, injury to surrounding anatomic structures can refer pain to the hip. Yet, despite the perceived difculty in evaluating hip and pelvis disorders, they are fairly common, comprising 5%–6% of musculoskeletal complaints in adults and up to 24% in children.11,35,41 They are frequently seen in sports with cutting activities, quick accelerations and decelerations, and repetitive rotational activity, as well as sports with contact and/or collision. These include soccer, hockey, rugby, dancing, running, and skating sports.8,23,44
The hip is a true ball and socket joint with the femoral head held snuggly within the acetabulum. Its stable design allows for excellent stability while maintaining motion in the frontal, sagittal, and transverse plains. The spherical shape of the femoral head is designed to distribute the forces experienced in activities of daily living, which during walking and running can equal three to ve times body weight.15 The socket is constructed from the ilium, ischium, and pubic bones, which
join together to form the acetabulum. Like the shoulder, there is a brocartilage labrum surrounding the rim of the socket, which serves to deepen the acetabular recess and provides additional stability. It is analogous to the glenoid labrum of the shoulder. On the joint side, it attaches directly to the articular cartilage surface of the hip joint, and this chondrolabral junction is the common site of labral tears. On the exterior side, it attaches to a reection of the joint capsule.
