Complex Hip Spine Syndrome in Young Athlete: A Diagnosis Dilemma

Hip spine syndrome is often associated with hip arthrosis and degenerative spine disease affecting the older generation. However, it can also present in young athlete as well. This is a case of 32-years-old male, active body builder with herniated disc L3, L4 and L5 for 5 years presented with acute onset excruciating pain over the anterior portion of his left hip that was affecting his daily living. His clinical examination revealed a classical positive finding of Femoral Acetabular Impingement (FAI) with positive hip provocation tests and MRI confirmed the diagnosis of acute left labral tear of the hip. Patient was offered intra-articular anesthetic hip injection while planning for surgical intervention. The pain did not resolve despite intra-articular injection. This led to the surgeon with the high index of suspicion that the pain was not arising from the left hip but from the spine. Patient was then counselled for laminectomy. Post-operatively, there was a big improvement is seen in pain and disability outcome. A systematic approach is discussed in this report to guide physicians who manage cases of complex Hip Spine Syndrome.