Collegiate Wrestler with Bilateral Hip Bone Spurs: A Case Report

1. N o r t h D a k o t a S t a t e U n i v e r s i t y A t h l e t i c T r a i n i n g E d u c a t i o n P r o g r a m s Collegiate Wrestler with Bilateral Hip Bone Spurs: A Case Report Kan Sugiyama, Dr. Pamela Hansen, Dr. Jay Albrecht, Dr. Donna Terbizan North Dakota State University Department of Health, Nutrition and Exercise Sciences, Fargo, ND Abstract Uniqueness Background • 21 year old collegiate male wrestler • Undiagnosed hip pain since high school • Athlete complained of snapping and pain in right hip • Physical findings from the athletic trainers’ examination include snapping hip syndrome and bursitis • Treated with ice, stretching, rest • Referred to clinic where a ultrasonic scan on right hip revealed fluid in the joint and a cortisone injection was prescribed • Left hip pain started a month later • Symptoms continued to be aggravated and he was referred to a hip specialist • X-rays were taken of both hips which noted bone spurs in both right and left hips • Surgeries were performed to remove bone spurs Background: A 21-year-old collegiate wrestler reported snapping and some pain in both hips. A family practice doctor suspected a condition known as snapping hip or bursitis. The athlete was treated with ice, stretching, and limiting activity. However, since treatments showed no results, the athlete was sent to the local clinic for a diagnostic ultrasonic scan. The ultrasonic scan revealed fluid in the right hip joints, and cortisone injection was prescribed. Even though temporary pain relief was reported, subsequent aggravation occurred. After being referred to a hip specialist, surgery was performed and bone spurs were removed. Differential Diagnosis: Snapping hip syndrome, bursitis. Treatment: Initial treatment consisted stretching, limiting activity, and ice. Since a positive result was not achieved, a cortisone injection was prescribed. With no relief, a surgery took place to treat symptoms. Uniqueness: Although the physicians and the athletic trainer evaluated the athlete’s hips, the diagnosis was not adequately provided. The athlete showed no relief from any conservative treatments. The athlete progressively got worse, therefore surgery was chosen. Conclusions: several types of pathology and mechanisms can be cause for hip pain. Athletic trainers need to continue to find a correct diagnosis to help alleviate symptoms for the athlete. • Although the athletic trainer and physicians evaluated the hip, no adequate diagnosis was provided. • Conservative treatments did not show improvements, and symptoms were aggravated in short period of time. Conclusions • Even though bone spurs have a specific mechanism and symptoms, bone spurs around hip joint might be difficult to find out since many structures mimic symptoms around the hip. • For the athletic trainer, it is important to continue to find a correct diagnosis to help alleviate symptoms for athletes. • Diagnostic testing is recommended to rule out possibility of osseous degeneration in hip structures. Surgical Procedures • Right hip surgery was performed first. • Osteophyte on the femur was resected. • Anterior to superior portion of acetabular rim resection was performed. • Labrum was also re-fixed to the acetabulum by suturing. • Calcified and unstable cartilage to the anterior acetabulum was removed. • Left hip surgery was performed six weeks after right hip. • Anterior superior labrum at acetabuli was repaired. • Chondromalacia at acetabuli was debrided. • Osacetabuli was removed. • The acetabular rim was resected. • A large osteophyte on the femur was removed. References Gluen GS, Scioscia TN, Lowenstein JE. The Surgical treatment of internal snapping hip. Am J Sports Med. 2002;30:607-613. Yalcin E Akca AK, Selcuk B, Kurtaran A, Akyuz M. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes. Rheumatol Int. 2010;26:1-5. Thompson CE, Crawford M, Murray GD. The effectiveness of extracorporeal shock wave therapy for plantar heel pain: a systematic review and meta analysis. BMC Musculoskelet Disord. 2005;6:1-11. Tomey EP. Plantar heel pain. Foot Ankle Clin. 2009;14:229-245. Differential Diagnosis • Snapping hip syndrome: Pop or snapping sound when hip is moved through its range of motion (ROM). 1 • Bursitis: Inflammation of bursa, which is a fluid-filled structure that provides cushioning between bones and the soft tissues.