THU0503\u2005ICONOGRAPHIC STUDY OF ACUTE MECHANICAL HIP PAIN IN YOUNG PATIENTS: CLINICAL-ULTRASONOGRAPHIC CORRELATE AND PROPOSAL OF DIAGNOSTIC-THERAPEUTIC ALGORITHM

Abstract

Background: Coxarthrosis is the first cause of mechanical pain and functional limitation of the hip joint, however its prevalence in subjects over 65 years is much higher than the incidence of these symptoms so its causal link is not complete. In a young population, mechanical groin pain of acute origin is usually linked to periarticular processes mainly related to adductor muscles, psoas and tendons with pertrocanteric entheses. In the routine approaches of these patients, when they consult, the simple radiological study is included and it is usually treated with NSAIDs, assuming tendinopathy as a diagnostic process. Objectives: The purpose of this study is to determine the ultrasound characteristics of the coxofemoral joint of patients who consult for acute inguinal pain, correlate it with its clinical presentation and propose a reasoned strategy for its management. Methods: We reviewed the clinical records of patients under the age of 50 who consulted for direct non-traumatic hip joint pain. Only cases with less than one week of evolution were included. Patients who consulted on weekends or in the afternoon were not included in this register because of the lack of immediate ultrasound study during these periods of time. We excluded those patients who, during the consultation, acknowledged having used anti-inflammatory drugs in the last 24 hours and those whose records are incomplete. The ultrasounds were performed with a portable Logiq e ultrasound machine, equipped with a linear probe of up to 12MHz. Results: Between 2014 and 2017, 211 patients under 50 years of age consulted for non-traumatic mechanical groin pain. Excluding patients who consulted outside of the immediate ultrasound study access hours, who had recently taken NSAIDs and whose clinical records were incomplete, we reviewed 116 clinical and image records. The mean age of the patients whose records were included was 37.8 SD 8.5. The mean time, in days, between the consultation and the onset of symptoms according to history constancy was 4 SD 2. 59 subjects were male (50.9%). In the physical examinations described in the reports, 29 patients (25%) presented painful passive manoeuvres, 38 (32.8%) presented painful active manoeuvres, and 22 (19%) could not maintain standing due to the impossibility of loading due to coxofemoral pain. Regarding the ultrasound findings, 5 patients presented unequivocal capsular distension at the level of the upper anterior labrum (4.3%) and 32 (27.6%) presented distension of the anterior recess. One patient with capsular distension was finally diagnosed with ONA and another with APso.Abstract THU0503 – Table 1 summarizes the prevalence of clinical findings depending on the existence or not of distension of the anterosuperior labrum or of the previous recess in the ultrasound scan performed. Conclusion: Our results show that in the studied population (<50 years old, non-traumatic coxofemoral pain of sufficient intensity to be consulted in the emergency department in less than 7 days of evolution) synovitis is a finding present in a quarter of patients and that it is severe in approximately 4%. Its strong association with incapacity for load and passive joint dysfunction would condition the incorporation of these findings in therapeutic decision making, including -in these cases- rest in unloading. On the other hand, the absence of synovitis in ¾ parts of the patients strongly suggests a muscular etiology that with high probability will respond positively only to NSAIDs. The incorporation of ultrasound, in our opinion, plays a role of diagnostic clearance when the semiological exploration is doubtful. \nDisclosure of Interests:\xa0: None declared