For personal injury victims, hip pain is an often-encountered complaint. The problem with hip pain is that it is not necessarily indicative of a hip injury. Lower back injuries are an overwhelmingly often-encountered injury in a personal injury setting and it is well known that lower back injuries, such as a herniated disc or a sciatic nerve injury, can cause referred pain to the hip.
Referred pain is pain the body perceives or experiences at a location other than the site of the actual injury or abnormality. Therefore, hip pain is not always specifically addressed on a timely basis and sometimes can become a more difficult part of the claim.
By way of background, it is important to understand the anatomy of the hip and the terminology used by specialists. First, the hip bone and the hip joint are two different parts of the anatomy. Each person has two hip bones, the left hip and the right hip. Each hip bone is formed by three bones: the ilium, the ischium and the pubis. The hip joint is a joint formed where the head of the femur meets the pelvis.
In a personal injury setting, victims will experience hip fractures, hip dislocations and hip strains and sprains, among other hip injuries. A hip fracture is a fracture to the part of the femur nearest the hip joint. A hip dislocation occurs when the head of the femur slips out of its socket in the pelvis. Just like all strains and sprains, a hip strain and sprain is an injury to the soft tissue of the area surrounding the hip.
From a personal injury standpoint, hip strains and sprains can also be closely associated with something called a labral tear. Those of us who practice in this area frequently encounter labral tears in the shoulder. However, the labrum actually refers to a type of cartilage that surrounds the socket of ball-and-socket joints. Therefore, there is a labrum found bilaterally in both the shoulder and the hip joints. The labrum forms a ring around the edge of the bony socket of the joint. It helps to provide stability to the joint by deepening the socket, yet, unlike bone, it also allows flexibility and motion. The labrum is extremely important to function and a labral tear can be a debilitating injury.
On cross-examination, most defense medical examiners will concede that injuries to the labrum have long been recognized as a possible source of pain and discomfort. It is important for the plaintiff’s attorney to understand that a labral tear in the hip can be a difficult diagnosis.
Generally speaking, a labral tear is something that can be found on both clinical examination and something that can be detected on diagnostic testing. However, on diagnostic testing, a labral tear will not always be apparent. For instance, it wasn’t until the recent development of arthroscopic techniques to surgically manage the hip joint that there has been increased recognition and awareness of hip labral tears. Those of us who follow sports have probably noticed the increase in the characterization of athletes’ injuries as labral tears and to hear of athletes having their “hip scoped” to have their labral tear treated.
Short of arthroscopic surgery, a labral tear can many times be detected on an MRI study. However, even a standard MRI study is not always sufficient. On those occasions when a standard MRI study is not sufficient, the treating physician may order something called an MR Arthrogram. An MR Arthrogram is an MRI with an injection of contrast fluid into the hip joint at the time of the MRI, which can help show labral tears much more clearly.
When trying to prove disability from a labral tear, the plaintiff’s attorney should be aware that complete rest is many times the best treatment for a labral tear. Therefore, it is necessarily true that labral tears will carry some period of disability. Aside from rest, labral tears are typically treated with anti-inflammatory medication, physical therapy and cortisone injections. Cortisone injections serve the dual purpose of being a form of treatment and a diagnostic tool. For instance, if the cortisone injections provide temporary relief, it serves to confirm to the treating physician that he or she has isolated the cause of the problem.
If these treatments fail to alleviate the pain associated with a hip labral tear, a surgical procedure called a hip arthroscopy may be considered, wherein the surgeon will shave out the torn portion of the labrum or, in some larger tears, an actual repair of the damaged labrum may be attempted.
Obviously, this article is not exhaustive to the issue of hip injuries but was meant to highlight the unique nature of the hip and that it is important for the plaintiff’s attorney to understand the difficulties of diagnosing and treating hip abnormalities. •
Brandon Swartz is a founding partner ofSwartz Culleton. His practice focuses on all types of personal injury cases, includingwrongful death, medical malpractice, civilrights violations, motor vehicle, premisesliability, products liability, trucking accidentsand workers’ compensation.