hip pain
Jump to navigation
Jump to search
Introduction
Hip pain is the most common symptom of hip disease.
Etiology
- groin, anterior thigh & medial thigh pain
- osteoarthritis of the hip (most common in adults)
- connective tissue diseases (next most common)
- transient synovitis
- osteomyelitis
- septic arthritis
- idiopathic avascular osteonecrosis
- hip fracture
- pigmented villonodular synovitis
- referred pain
- adductor/quadriceps muscle strain
- iliopectineal or iliopsoas bursitis
- acetabular labrum tear
- lateral hip & thigh pain
- trochanteric bursitis
- fascia lata syndrome
- abductor, gluteus muscle strain, gluteal tendinopathy[10]
- meralgia paresthetica[3][4]
- posterior hip (buttocks) & thigh pain
- children & adolescents
- bone metastases[3]
Clinical manifestations
- generally manifests as groin pain & less commonly
- pain in the thigh or buttocks
- pain in the pelvis
- pain in the proximal femur
- referred pain: knee pain
- groin pain increased by weight bearing[3]
- pain when first getting out of a chair or bed
- difficulty ascending stairs
- patient may walk with a limp
- decreased hip range of motion
- hip stiffness may improve with activity in connective tissue disease, but worsen with osteoarthritis
- bilateral pain that occurs when walking & is relieved by rest suggests vascular or neurogenic claudication
- fever may be associated with septic joint
- gait abnormalities, i.e. Trendelenberg gait
- muscle atrophy in quadriceps indicated severe disease in hip joint
- positive Trendelenberg sign
- presence of ecchymoses or abrasions suggests trauma
- tenderness to palpation along lateral aspect of hip & greater trochanter suggests trochanteric bursitis
- abnormalities in range of motion, mainly limitation of abduction & internal rotation are common with intra-articular hip disease (FADIR test)
- The FABER test may cause posterior hip pain with sacroiliitis, groin pain with intra-articular joint disease & lateral hip pain with greater trochanteric pain syndrome
- pain on hip extension suggests sacroiliac pain, lumbar spine disease, or articular hip pain
- sensory & motor abnormalities are suggestive of radiculopathy
Laboratory
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- serologic tests for rheumatologic diseases
- complete blood count (CBC)
- serum uric acid
- joint aspiration for Gram stain & culture if septic joint is suspected
Radiology
- plain radiographs of both hips with weight-bearing films
- suspected intra-articular pathology, bone fracture, hip dislocation
- anteroposterior (AP) & frog-leg lateral views in child to rule out:
- pelvic films for comparison of symmetry
- magnetic resonance imaging for suspected avascular necrosis
Differential diagnosis
- bursitis
- pain located laterally (trochanteric bursitis) or posteriorly
- pain worsend by lying on affected bursa[3]
- referred pain, from abdomen, groin, back, knee[3]
Management
- pharmacologic agents
- physical modalities
- heat, ice, ultrasound
- physical therapy to maintain range of motion & strengthen target muscle groups when pain is adequately controlled
- weight loss
- exercise*[10]
- surgery
- patient education*[10]
* most effective modalities for gluteal tendinopathy[10]
Notes
- management of hip pain secondary to septic arthritis or osteomyelitis differs from that described above
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 745
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 4.0 4.1 Plante M, Wallace R, Busconi BD. Clinical diagnosis of hip pain. Clin Sports Med. 2011 Apr;30(2):225-38. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21419954
- ↑ Byrd JW. Evaluation of the hip: history and physical examination. N Am J Sports Phys Ther. 2007 Nov;2(4):231-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21509142 Free PMC Article
- ↑ Brown MD, Gomez-Marin O, Brookfield KF, Li PS. Differential diagnosis of hip disease versus spine disease. Clin Orthop Relat Res. 2004 Feb;(419):280-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15021166
- ↑ Lesher JM, Dreyfuss P, Hager N, Kaplan M, Furman M. Hip joint pain referral patterns: a descriptive study. Pain Med. 2008 Jan-Feb;9(1):22-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18254763 Free Article
- ↑ NEJM Knowledge+ Question of the Week. Oct 25, 2016 http://knowledgeplus.nejm.org/question-of-week/4532
- ↑ Houghton KM. Review for the generalist: evaluation of pediatric hip pain. Pediatr Rheumatol Online J. 2009 May 18;7:10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19450281 Free PMC Article
- ↑ 10.0 10.1 10.2 10.3 10.4 Mellor R, Bennell K, Barry R Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ 2018;361:k1662 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29720374 https://www.bmj.com/content/361/bmj.k1662