Hip Dislocation Clinical Presentation

  • Author: Matthew Gammons, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Feb 1, 2012
 

History

  • The typical history of a hip dislocation during an athletic event involves 1 of 2 mechanisms.
    • Most commonly, an athlete is running and lands on the feet or flexed knees, striking the ground while the hip is flexed, adducted, and internally rotated. This type of injury has been well documented in contact sports in which participants are tackled at high speeds and land out of control with other players piling on top of them (eg, football, rugby). A similar injury may occur during high-speed racecar driving accidents.
    • The second mechanism involves an athlete landing in the splits, with the hip flexed, abducted, and externally rotated. This type of injury is more likely to be seen during sports involving jumping and landing (eg, basketball, gymnastics).
    • The mechanism in skiing and snowboarding injuries is not well described and complex, due to high speeds and additional equipment, but it is likely similar to the aforementioned mechanisms.
  • Patients often present in obvious severe pain in the hip region and upper leg. They may also complain of knee, lower leg, or even back pain.
  • Patients usually complain of the inability to walk or move their leg about the hip joint.
  • Patients may complain of numbness and/or tingling in the legs in cases involving neurovascular damage.
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Physical

  • Hip dislocations usually present with the athlete complaining of severe pain around the hip and proximal thigh.
  • Anterior hip dislocations may present in 2 different ways.
    • Superiorly displaced dislocations present with the affected hip extended and externally rotated.
    • The inferior type of anterior dislocations presents with the affected hip flexed, abducted, and externally rotated.
  • However, the affected limb of a posterior hip dislocation most commonly appears shortened, internally rotated, and adducted.
  • In those patients whose mechanism of injury suggests a posterior hip dislocation but who have no evidence of a dislocation on examination, a traumatic posterior hip subluxation should be considered. This injury carries many of the risks of a true dislocation and may be overlooked.[13]
  • Assessing the neurovascular status of the injured leg is extremely important. Nerve injury, particularly neurapraxia, is not uncommon. The sciatic nerve and the common peroneal division of the sciatic nerve are most often injured in posterior dislocations. Simple observation and palpation for bony deformity, skin color, and temperature provides clues to the vascular status of the leg. Test reflexes, strength, and sensation in the affected leg, and palpate for femoral and distal pulses.
  • The physician should also examine the patient carefully for other bony injuries. A significant amount of force is required to dislocate a hip. Studies of motor vehicle accidents have shown hip dislocations are commonly associated with knee injuries such as fractures, dislocations, and ligamentous damage. Whether or not sport-related hip dislocations have the same rates of associated knee injuries is not known; however, a careful knee examination should be performed on all patients with hip dislocations.

Related eMedicine topics:

Fracture, Knee

Knee Injury, Soft Tissue

Peripheral Nerve Injuries

Traumatic Peripheral Nerve Lesions

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Causes

  • High-speed, high-impact sports are the most common setting for hip dislocations.
    • Unsafe and poorly maintained playing surfaces may add to the risk of participating in high-impact sports. For instance, wet surfaces provide an environment where athletes are more prone to lose control of their bodies while running and jumping. However, no evidence exists to link these factors with an increased incidence of hip dislocations.
    • One case report describes a basketball player who slipped on a wet court and dislocated his hip.[5]
  • Although warming up before an activity and stretching on a regular basis may help prevent some sporting injuries, no evidence suggests that this decreases the risk of hip dislocation.
  • No correlation exists between athletic experience and hip dislocations.
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Contributor Information and Disclosures
Author

Matthew Gammons, MD  Assistant Clinical Professor, Department of Family and Community Medicine, Medical College of Wisconsin; Medical Director, Castleton State College; Consulting Staff, Vermont Orthopaedic Clinic and Killington Medical Clinic

Matthew Gammons, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and American Society of Mechanical Engineers

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Alexander Zlidenny, MD, and Federico E Vaca, MD, FACEP, to the development and writing of this article.

References

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