Abstract
Hip pain in adults is a common complaint. Secondary processes can often mask underlying conditions, prolonging the course to diagnosis and definitive treatment. In this case, a 74-year-old man presented to an outpatient clinic after 6 weeks of right hip pain that began upon initiation of a rehabilitation program following coronary artery bypass graft surgery. Various imaging and treatment modalities (including radiography, osteopathic manipulative treatment, injection of the greater trochanteric bursa, L2-3 paravertebral block, magnetic resonance imaging, and intra-articular hip injection with 1% lidocaine) ultimately led to the definitive diagnosis of a labral tear. This case report highlights how a comprehensive osteopathic approach was used to evaluate and treat a patient with persistent unilateral hip pain because of an acetabular labral tear, associated psoas syndrome, and trochanteric bursitis, all within 2 months and with a positive clinical outcome.
Physicians often see patients with hip pain, yet because of the broad differential diagnoses, discovering a primary cause can be challenging. Secondary processes, such as inflammation, impaired biomechanics, and referred pain, can create confounding symptoms and mask underlying issues. Common causes include osteoarthritis, fracture, bursitis, labral tear, femoroacetabular impingement, referred lumbar or knee pain, and muscle spasm.
1,2 Because of overlapping symptoms, acetabular labral tears often go undiagnosed for prolonged periods, with some studies suggesting a mean of more than 2 years before definitive diagnosis. This extended time to diagnosis can affect a patient's quality of life through limitations in physical function and persistent pain.
3 Two studies
4,5 have suggested that a labral lesion doubles the relative risk of significant chondral erosion and that the labrum has a low potential for self-repair because of a limited blood supply. With an estimated prevalence of 22% to 55% in patients with hip or groin pain, labral tears are a relevant concern for both primary care providers and orthopedic surgeons.
3 This case report demonstrates how a comprehensive osteopathic approach was used to efficiently diagnose a labral tear in 2 months, as well as manage commonly associated sources of hip pain in an adult.