Child Orthopedics


Frequently Asked Questions

Our 15-year-old daughter is well on her way to having a career in the golf world. But she's having a problem we just can't seem to figure out -- left buttock pain. It seems to start along the back of her hip and go down to the middle of her buttock. We are going to see a specialist next week to have some tests done. What are some of the possible causes of a problem like this in someone so young?

Pain along the back of the hip is a fairly rare problem and affects athletes involved in golf, dance, or soccer most often. The most likely causes of posterior hip pain in athletes include: 1) pain coming from the lumbar spine, 2) problems in the sacroiliac joint, 3) muscle pain, 4) piriformis syndrome, 5) hamstring rupture, and 6) femoroacetabular impingement. Let's take a quick look at each one of these problems. Herniated discs that put pressure on the sciatic nerve are the most common cause of referred pain from the lumbar spine. Hip pain occurs in this instance because the L3 lumbar nerve root that can be pinched by a bulging or herniated disc also supplies sensation in the hip. A problem at L3 can produce symptoms in both places: the low back and the hip. The tip off is that with sciatica, there is back, buttock, and often leg pain. Next is the sacroiliac joint. This is where the triangular-shaped sacrum is wedged between the two pelvic bones. Any problem with ligament strains, infection, fractures, or alignment in this area can cause what is felt as posterior hip pain. This problem can also send pain down the back of the leg, so further testing is often needed to tell the difference between pain coming from lumbar spine versus the sacroiliac joint. Strain, overuse, or tear of any of the muscles that insert into the hip, low back, or sacroiliac area can cause posterior hip pain. Palpating for tenderness and testing hip muscle strength are the key diagnostic tests here. One muscle in particular to check for is the piriformis. The piriformis rotates the leg outward, a movement referred to as external rotation. For some people, contraction of the piriformis muscle presses on the sciatic nerve. This is another problem that can refer pain down the leg. But it's one problem that doesn't show up well on X-rays, MRIs, CT scans, or other imaging studies. The physician may try treating the symptoms conservatively with antiinflammatories and physical therapy. If the symptoms don't go away, then it might be necessary to perform electrodiagnostic tests to confirm the diagnosis. Ruptured hamstring muscles are much easier to diagnose. First of all, there is usually a history of trauma or specific injury the athlete can remember as the starting point of the problem. Muscle weakness is common with partial or complete tears. Surgery (as early as possible) is the most effective treatment for this problem. And finally, there's femoroacetabular impingement. This refers to pinching of the soft tissues somewhere around the hip joint -- usually along the backside of the joint when the symptoms present in the buttock area. Certain hip motions will reproduce the pain and that's the main test for the problem. MRIs or CT scans are helpful in looking at the anatomy and seeing what might be contributing to the impingement problem. Today's improved testing methods, updated technology, and better understanding of anatomy have made it possible to identify differences between and among these six possible causes of posterior hip pain. Your specialist will perform a systematic examination and evaluation. The clinical workup will lead to an accurate diagnosis. The most appropriate treatment will follow based on identification of the underlying cause of the problem.

Rachel M. Frank, BS, et al. Posterior Hip Pain in an Athletic Population: Differential Diagnosis and Treatment Options. In Sports Health. May/June 2010. Vol. 2. No. 3. Pp. 237-246.

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