J Orthop Sports Phys Ther. 2019 Aug;49(8):611-619. doi: 10.2519/jospt.2019.8309. Epub 2019 Jul 10.
In patients presenting with hip and groin symptoms, evaluation and treatment of the thoracolumbar junction (TLJ) may be underutilized. The TLJ is less recognized as a source of pain referral in these regions. The purpose of this case series was to describe the management of 3 patients with primary hip and groin pain who were treated with interventions targeting the TLJ.
The 3 patients in this case series presented with subacute or chronic complaints of hip and groin pain that had failed to resolve with typical treatments. They had undergone several inconclusive clinical testing procedures. Each patient underwent a detailed physical therapy evaluation and was found to have pain and mobility deficits at the TLJ. Once the therapist had determined that the patients' symptoms were likely of musculoskeletal origin, treatment commenced. Joint mobilization and exercise directed at the TLJ were used in each case. Marked improvements in pain, thoracic range of motion, and functional deficits were observed within 3 to 4 weeks, after an average of 6 treatment sessions. All patients returned to prior activity levels. Patients in cases 1 and 3 had improvements in hip mobility and strength without direct treatment to the hip.
This case series describes the management of 3 patients with hip and groin symptoms who were successfully treated with interventions targeting the TLJ. In patients reporting primary hip or groin pain, physical therapists should consider the TLJ as a potential source of symptoms and include treatment strategies directed at the TLJ, as warranted, after a careful examination and clinical-reasoning process.
Differential diagnosis, level 4. .
在出现髋部和腹股沟症状的患者中，可能会低估对胸腰椎连接（TLJ）的评估和治疗。TLJ 作为这些区域疼痛牵涉源的认识度较低。本病例系列的目的是描述对 3 名患有原发性髋部和腹股沟疼痛的患者的治疗方法，这些患者接受了针对 TLJ 的干预措施。
本病例系列中的 3 名患者出现亚急性或慢性髋部和腹股沟疼痛，这些疼痛经典型治疗后仍未缓解。他们已经接受了多次无定论的临床检查程序。每位患者都接受了详细的物理治疗评估，发现 TLJ 存在疼痛和活动度受限。一旦治疗师确定患者的症状可能是肌肉骨骼来源，治疗就开始了。在每个病例中，都使用了针对 TLJ 的关节松动术和运动治疗。在 3 到 4 周内（平均 6 次治疗后），观察到疼痛、胸椎活动度和功能缺陷有明显改善。所有患者都恢复了之前的活动水平。病例 1 和 3 的患者髋部活动度和力量有所改善，而无需直接治疗髋部。
本病例系列描述了对 3 名患有髋部和腹股沟症状的患者的治疗方法，他们通过针对 TLJ 的干预措施成功治疗。在报告原发性髋部或腹股沟疼痛的患者中，物理治疗师应考虑 TLJ 作为症状的潜在来源，并在仔细检查和临床推理过程后，如有必要，包括针对 TLJ 的治疗策略。
鉴别诊断，4 级。
