Hip Pain in Athletes - When It is Not the Labrum

Area of Science:

• Sports Medicine
• Orthopedics
• Diagnostic Imaging

Background:

• Hip pain is a frequent complaint among athletes, often leading to an initial focus on labral pathology.
• A significant prevalence of asymptomatic labral disease exists, challenging the direct correlation between labral tears and symptomatic hip pain.
• Accurate diagnosis requires considering a broad differential, extending beyond musculoskeletal origins to include nonmusculoskeletal pathology.

Purpose of the Study:

• To review and classify nonlabral causes of hip pain in athletic populations.
• To emphasize the importance of a comprehensive differential diagnosis for hip and pelvic pain in athletes.
• To guide clinicians in identifying alternative pain generators beyond labral tears.

Main Methods:

• Systematic review of literature on nonlabral hip pain in athletes.
• Classification of hip pain causes based on anatomical region: anterior, lateral, and posterior.
• Analysis of diagnostic criteria and clinical presentations for various nonlabral pathologies.

Main Results:

• Labral tears are frequently found incidentally in asymptomatic athletes, complicating diagnosis.
• Nonlabral pathologies represent a substantial portion of hip pain etiologies in athletes.
• Differential diagnosis includes conditions affecting nerves, vascular structures, and referred pain patterns.

Conclusions:

• Clinicians must broaden their diagnostic considerations beyond labral pathology for athletes presenting with hip pain.
• A thorough evaluation encompassing nonmusculoskeletal causes is crucial for effective management of athletic hip pain.
• Understanding the regional presentation of hip pain aids in differentiating between labral and nonlabral sources.