Treatment Options
Acute
| Patient group |
Treatment line
| Treatmentshow all |
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x-ray findings consistent with congenital or anatomical deformity
| 1st |
- referral to orthopaedic surgeon
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femoral neck stress fracture
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superior femoral neck stress fracture (tension-side fracture)
| 1st |
- immediate internal fixation
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Superior femoral neck fractures (tension-side) must be identified and treated promptly with internal fixation to prevent complications of fracture propagation and displacement including osteonecrosis, non-union, mal-union, and post-traumatic arthritis.
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Displacement of a femoral neck stress fracture is fortunately rare with timely recognition. Among stress fractures that do displace, rates of osteonecrosis have been reported to be between 24% and 33%.
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inferior femoral neck stress fracture (compression-side fracture)
| 1st |
- cessation of high-impact activities and protected weight-bearing for 6 to 8 weeks
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Inferior femoral neck stress fractures are mechanically stable and can be treated non-operatively, with excellent healing rates in compliant patients.
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The mainstay of successful treatment is immediate cessation of high-impact activities and protected weight-bearing (using a walking stick or crutches) for 6 to 8 weeks.
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Follow-up imaging to ensure proper healing is advisable.
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traumatic or overuse injury: initial presentation
| 1st |
- conservative management
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Appropriate initial management includes rest, activity modification, ice or heat, and protected weight-bearing (using a walking stick or crutches).
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Physiotherapy with a gradual return to activities should be commenced once symptoms have abated, usually within 4 to 6 weeks of initiating treatment.
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Addressing the specific structure (often muscle/tendon) that is injured with specific exercise is very important, but the delicate balance that exists around the pelvis involving balance, coordination, and strength should also be restored before return to sport.
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- non-steroidal anti-inflammatory drugs (NSAIDs)
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Primary Options
diclofenac
:
100-150 mg/day orally given in divided doses every 8-12 hours when required
OR
ibuprofen
:
200-400 mg orally every 4-6 hours when required, maximum 2400 mg/day
OR
naproxen
:
250-500 mg orally twice daily when required, maximum 1250 mg/day
|
Ongoing
| Patient group |
Treatment line
| Treatmentshow all |
|
traumatic or overuse injury: not responding to initial management
| 1st |
- advanced imaging studies ± orthopaedic referral
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In patients who do not respond to initial conservative management, ultrasound or MRI imaging studies are helpful for arriving at a more definitive diagnosis.
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In some cases, referral to an orthopaedic surgeon may be warranted.
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In all cases, patient compliance with initial conservative management should be checked.
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long-standing adductor-related groin pain
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- functional physiotherapy and strengthening
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For patients with long-standing adductor-related groin pain, a specific exercise therapy programme aimed at improving strength and coordination of the muscles acting on the pelvis is significantly better than a conventional physiotherapy programme. In one prospective, randomised trial, 79% of patients involved in an active sport training programme for 8 to 12 weeks returned to their previous level of activity with no residual pain, compared with 14% of patients in the conventional therapy group.
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Cessation of aggravating exercises/sport activity is a mainstay in treatment.
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- adductor longus tenotomy
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Adductor longus tenotomy may be performed in cases of chronic, debilitating groin pain due to adductor injury that has failed to respond after 6 months of non-operative treatment, but should be used with great care.
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Good long-term results can be achieved, with 75% of patients returning to their previous sport within 3 to 4 months of surgery. About one third of patients may perform at a reduced level. A decrease in muscle strength is commonly observed but does not seem to influence sport participation.
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osteitis pubis
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- physiotherapy
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inguinal-related groin pain
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- functional physiotherapy and strengthening
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- surgical exploration and repair
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iliopsoas-related groin pain
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- strengthening exercises + pelvic muscle coordination programme
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Exercises to strengthen the iliopsoas muscle should be tried, especially if the muscle is tight.
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If doing the exercise therapy is too painful, ultrasound-guided injections can be helpful in order to lower the pain and enable the exercises to continue.
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A pelvic muscle coordination programme should accompany the exercise therapy.
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Last updated: Sep 17, 2012
