Clinical evaluation of the painful adolescent and young adult hip

Abstract

The history and physical exam are crucial components of the initial assessment of hip pain in adolescents and young adults to identify the cause of the pain, distinguish between common causes of early degeneration such as femoroacetabular impingement (FAI) and acetabular dysplasia (instability), and guide further workup and management. Different aspects of the history and exam are specific to various common causes of hip pain in this patient population. The purpose of this review is to synthesize these components to provide a comprehensive approach to the history and physical exam for adolescents and young adults presenting with hip pain. Key Concepts: (1) Common signs that suggest a mechanical hip problem, but are not specific for the etiology, include symptoms that worsen with activity, discomfort in a seated position, pain on rising from a seated position, or difficulty with ascending or descending stairs. (2) A Trendelenburg gait is caused by insufficient abductors that are unable to maintain a level pelvis and is commonly associated with hip instability due to the biomechanical disadvantage of the dysplastic hip joint. (3) Obligate external rotation of the hip during hip flexion is concerning for slipped capital femoral epiphysis (SCFE) and warrants an AP pelvis and frog leg lateral view for evaluation. (4) The Prone Apprehension Relocation Test (PART) assesses for anterior undercoverage of the acetabulum, and a positive test has been found to be correlated with radiographic markers of instability.

Keywords

• Hip dysplasia
• Femoroacetabular impingement
• Slipped capital femoral epiphysis
• Hip pain
• Physical exam