Hip and Pelvic Injuries in the Young Athlete

Hip pain in the young athlete can be a diagnostic and treatment dilemma for the clinician. In the past decade, progress in imaging and operative techniques have provided tools to better outfit the orthopedist involved in the care of these patients. Hip pain can be intra-articular or extra-articular, and it is important to distinguish between the two. The differential diagnosis for extra-articular hip pain includes apophyseal avulsion fractures, snapping iliotibial band over the greater trochanter, snapping hamstring over the ischial tuberosity, psoas snapping, psoas tendonitis, hip pointer, and even inguinal hernia. Intra-articular pathology includes all intracapsular sources of pain, including femoral neck stress fracture, ligamentum teres pathology, labral tears, chondral injuries, loose bodies, and slipped capital femoral epiphysis. The treating physician should be aware of pediatric conditions such as hip dysplasia and Legg–Calve Perthes disease, which can predispose the patient to hip pain as adolescents. Although many young patients may be treated with nonoperative means for their hip pain, the physician should be aware of new hip arthroscopic techniques that may be appropriate for their patients.