Knowledge
Medical Insight: Polodoc
Dr.med. Andreas Krüger is a Swiss board orthopaedic and trauma surgeon in Zurich, who specialises in knee and shoulder surgery. Andi is a second generation of tournament doctors for equine sports, known as Polodoc since 2013
Unhappy Hip
Sudden pain & no idea about the trigger?
Grain of rice shaped calcification as a sign of inflammation of the gluteus mdius tendon
Anatomy Photograph courtesy by MTR Spa
Shockwave application with Swiss DolorClast® EVO Blue on the point of pain where the tendons insert on the bone to trigger regeneration
Introduction
In the evening you go to bed and in the morning you stand up and walking feels like you slept on a bed of needles. Immense pain in the gluteal area and thigh with no idea what the reason is for it. Mostly pain in the joints results from overuse or wear over time, with a constant increase of impairment. Nevertheless subclinical inflammation of the insertion of hip muscle can result in a calcification of the intersection between these two materials (bone – tendon interface). The inflammatory pain can be immense with massive reduction in mobility and loading. Tendinitis is most often caused by 38
Polo Times, June 2021
repetitive, minor impact on the affected area, or from a sudden, more serious injury. Pain can be so limiting that riding is not possible at all.
Symptoms
In the intimal phase, a sore muscle feeling can be present. Secondly a sharp, disabling pain can limit the free range of motion with very localized area of discomfort. Mostly rotational movements trigger these sensations. Patients usually try resting in a comfortable position in slight elevation and external rotation.
The hip is built by the femur bone with its ball like head and the acetabulum, which is a cup shape. The cup is surrounded by a soft sealing tissue, which forms a capsule and joint lip. Muscle around the hip bone is in a circumferential position forming a cuff so that movement in all directions is possible. In between the tendon and bone intersection, soft tissue in the form of a bursa, is positioned to minimize friction in this area.
Diagnostics
Clinical signs A clinical examination will highlight joint pain through passively moving the hip. The outer side of the hip, where the soft tissue of the bursa is placed above the insertion of hip muscles, is a typical spot where pain is localised. Local reddening and pseudo infection signs like reddening or swelling and pressure tenderness can be present. Elevated infection parameter like CRP and white blood count is possible but can also be misleading. www.polotimes.co.uk
