Christopher Larson MD Twin Cities Orthopedics Edina MN Team Physician Minnesota Wild David Rust MD Orthopedic Sports Medicine Fellow Overview Anatomy What is impingement Affect on hockey playersgoalies ID: 296823
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Hip Impingement in Hockey Players: focus on butterfly style goalies
Christopher Larson, MDTwin Cities Orthopedics, Edina MNTeam Physician: Minnesota WildDavid Rust, MDOrthopedic Sports Medicine FellowSlide2
Overview
AnatomyWhat is impingement?Affect on hockey players/goaliesTreatment optionsOther hip problemsFuture of research and INJURY PREVENTION!!Slide3
Hip = ball and socket joint
Femur = thigh bone, head and neck are involvedAcetabulum
= part of the pelvic ring
Labrum = cartilage ring on rim of acetabulum, mechanical “bumper”, seals the hip joint (gasket)
Articular cartilage = smooth gliding surface, worn out in arthritic jointsSlide4
What is impingement?
FAI = Femoral-Acetabular ImpingementAbnormal contact between the ball and rim/socket during activity Results from a ball that is not perfectly round (CAM) or a socket that is too deep (PINCER)Labral TearRepetitive impingement leads to “pinching” of the labrum between the ball and socketLabral
tears are common and often do not cause pain Important to recognize and treat the underlying impingementSlide5Slide6
Signs and SymptomsDeep sharp groin pain
Worse with quick turnsLimited hip rotation/flexibility/stiffUnable to sit for prolonged periodsGroin / Front of the hip pain after activityImpingement test = pain with hip flexion and internal rotationSlide7
Must rule out other causes of painMuscle and tendon strains
Contusions, fracturesAthletic pubalgia / SPORTS HERNIASlide8
Butterfly Effect
Evolution of styleRules and regulationsIncreased rate of surgeryApproximately 5-10 NHL goalies per year have FAI surgery:•JS Giguere
•Tim Thomas•Niklas Backstrom•Vesa Toskala•Patrick Roy
•Josh Harding•Antero Niitimaki
•Rick DiPietro
•Ray Emery
•Craig AndersonSlide9
Butterfly Effect
Skills that may place hip at riskpad flares recovery pushes T-pushes/One foot stops One knee down on postbutterfly drops Slide10
Treatment OptionsFirst step should be to work with coaches and athletic trainers to identify likely cause of pain
Examination (with experienced provider) and regular x-rays will confirm diagnosisWhen should an MRI be considered?Recent study found positive MRI finding in 77% of asymptomatic professional and NCAA hockey playersSlide11
FAI X-RaysSlide12
Treatment OptionsAnti-inflammatory meds, rest, ice
Modifications in technique and equipment, decreased repetitionsTherapy can work on strengthening core muscles and hip rotatorsNumbing injections can assist in determining the source of pain, but cortisone is usually avoided in young patientsSlide13
Treatment Options
When should surgery be considered?Unable to perform athletics despite non-surgical treatment Pain with daily activitiesIn our experience, athletes that have problems at a younger age are more likely to eventually need surgery and are at risk for more significant hip damageSlide14
Hip Arthroscopy
Dr
Larson has published over 40 articles regarding hip
injuries in athletes & has operated on over 50 US and
European Hockey Goalies from high school to the professional
level in the last 3 years as a result of Impingement and disabling
pain.
We are currently conducting several studies looking
a
t the anatomy of the Hockey Goalie.
Before Surgery
After SurgerySlide15
Can we prevent impingement?
Shape of hip develops over time while the body is growingPrimarily takes shape during adolescent growth spurtAges 10-14 in girls and 12-16 in boysDepends on type of activity and number of repetitionsMay be similar to throwing injuries in youth baseballSlide16
Possible preventive strategies
core fitness program for young goalies to strengthen muscles and/or maintain flexibility Improve upright Posture in butterfly and splits positions skill repetition limits in practice greater “off-season” time, cross-trainingequipment limitations or improvements Slide17
What does the future hold?
Research looking at hockey goalies and players of all ages to find trends and identify who is at riskRules and regulations to help protect athletes from injuryGuidelines and recommendations for youth athletes, parents, and coaches Slide18
Research Study: Cam Impingement in Butterfly Goalies
Goal is to better understand, predict, and prevent hip injuriesHockey goalies, hockey players, non-hockey players, with or without symptoms, ages 10-40No cost to enrollParticipants will complete questionnaire, examination, and x-raysNo personal identifying information
Gain knowledge with respect to the RISK of developing HIP problems based on the Examination and Xrays
Minimal physical riskRadiation from x-ray less than the typical annual exposure for an average Minnesota residentSlide19
Research Study: Cam Impingement in Butterfly Goalies
Participation requires signed consent (adults and parent/guardian) and assent (adolescent)If interested please contact:Becky Stone @ beckystone@tcomn.com or 952-456-7136Dave Rust @ drust1@fairview.org Slide20
Thank You
Twin Cities Orthopedics, Edina