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Hip Pain in Ski Jumping - Extraordinary Pitfall: 1180May 30 4:55 PM - 5:15 PM

Wicker, Anton FACSM

Medicine & Science in Sports & Exercise: May 2008 - Volume 40 - Issue 5 - p S150-S151
doi: 10.1249/01.mss.0000322115.06027.7c
F-52 Clinical Case Slide - Hip and Groin: MAY 30, 2008 3:15 PM - 5:15 PM ROOM: 122

Paracelsus Medical University Salzburg, Salzburg, Austria.

Email: wicker@aon.at

(No relationships reported)

HISTORY: Ski jumper (12 a) - pain in back and left leg during training sessions. First pain only after hard training units. Next day pain free. Later pain during every training session, pain free intervals decreased, pain level increased. Unable to participate in training, few pain free intervals, even walking painful. Sent to doctor after 4 months.

PHYSICAL EXAMINATION: Asymmetric gait, limping. Range of movement reduced. Ext. 0-5-80 Flex with pain in end position of flex and ext. Outside rot 25-0-30 Inside rot. - pain in end posit of both ways. Abduct 20-0-10 Adduct, pain in end posit of Adduct. Mennel: left ileosacral joint pos. Lasegue neg. Tender points: spina iliaca anterior superior, inferior, crista iliaca, trochanter maior area. Load free - no pain. Limping, by walking faster, pain increased. No signs of herniation in groin and testis. No neurolog signs or signs of inflammation. Musc gluteus med weaker on left side.

DIFFERENTIAL DIAGNOSIS:

  1. Coxitis
  2. Sacroileitis
  3. Lesion of musc rectus fem
  4. Femur necrosis (Mb. Perthes)

TEST AND RESULTS:

Ileosacral joint-and hip radiographs anterior-posterior 3 months before: no patholog signs Lab (Blood, CRP, Westergreen, Rheumat Serology, Kreatinin, HLA-B27, SGOT, SGPT, Antibodies, Serology, Electrophoresis): No pathol signs MRI: Pathol mark oedema (bone bruises) of metaphyse, passing over to proximal diaphyse of femur left side. Joint effusion

FINAL WORKING DIAGNOSIS: Femur Head Necrosis (Mb. Perthes)

TREATMENT AND OUTCOMES:

  1. Stop training activities with loading left leg
  2. Walking with crutches - no weight bearing - pain free unrolling foot for 6 months
  3. Mobilisation of hip - pain free - by therapist 2x week
  4. Hydrotherapy - 3× week
  5. Medical Training Therapy: stabilis of trunk, balance training right leg
  6. Coord training of upper extremities
  7. Cycling ergometer min resistance: 20′ a day
  8. MRI after 6 months
  9. Walking with crutches - weight bearing - daily activities - no sports
  10. Trunk stabilisation, coordinat training, cycling
  11. MRI after 1 year
  12. No crutches - normal weight bearing - daily school and playing activities - pain free; no running, jumping
  13. MRI after 2 years (no pathol signs)
  14. Intensifying of training and playing activities pain free all over the year
  15. MRI after 3 years (normal femur head)
  16. Ski jumping. End of 3. year after diagnosis back in sport
©2008The American College of Sports Medicine