Hip and Pelvis
Core concepts
Understand femoroacetabular impingement, labral tears, hip dysplasia, proximal hamstring injuries, sports hernia/athletic pubalgia, slipped capital femoral epiphysis, Perthes disease, pelvic ring injuries, and hip dislocation. Know cam and pincer morphology, the acetabular labrum, and the concept of chondrolabral junction injury. Examination includes FADIR, FABER, log roll, and internal rotation at 90 degrees of flexion. Differentiate intra-articular hip pain from lumbar spine, sacroiliac, and pubic symphysis pathology. In skeletally immature patients, thigh or knee pain can be the presenting complaint of hip disease.
Traps
Referred thigh or knee pain is a classic trap in hip pathology; always examine the hip in a limping child. FAI is not simply a labral tear-address morphology if surgery is considered. Hip dysplasia is a contraindication to routine arthroscopy without addressing instability. Proximal hamstring avulsion with retraction and sciatic symptoms warrants early surgical evaluation. In pelvic ring injuries, hemodynamic instability may require sheet wrapping or external fixation before definitive imaging.
Worked example
A 19-year-old soccer player has deep groin pain, positive FADIR, and a cam lesion on radiographs. Rule of thumb: confirm that the pain is intra-articular with a fluoroscopically guided anesthetic injection before recommending arthroscopy; a positive injection response supports the diagnosis, while persistent extra-articular pain suggests athletic pubalgia or spine pathology.