HIP PAIN

Crucial functions of the hip joint are weight bearing and locomotion. Because of its location and range of movement it is subjected to many type of stress, arthritis, diseases (collagen vascular disease, infection, Lyme disease) and trauma, all of which can cause pain.

DIFFERENTIAL DIAGNOSIS:

	Fractured hip
	Avascular necrosis
	Osteoarthritis and Rheumatoid arthritis
	Septic arthritis/ostomyelitis
	Synovitis
	Tendinitis
	Bursitis
	Polymyalgia rheumatica
	Referred pain (from structures outside the hip joint)
	Children and adolescents
	Slipped epiphysis
	Juvenile rheumatoid arthritis
	Legg-Perthes’ disease Various systemic diseases

Hip pain in adults is mostly due to degenerative joint disease, osteoarthritis and fractures. Children may have acute septic arthritis, osteomyelitis of the femur/greater trochanter. systemic disease or trauma.

HISTORY:

• Where is the pain? (point to the area)
• Did the pain start suddenly or gradually?
• Does the pain radiate from its primary location?
• Is there pain in any other joint or joints?
• What was the cause of pain? (trauma, other activity)
• What makes the pain better? Worse?
• Joint stiffness. Where? When? How long?
• What type medication are you taking? Is alcohol a problem?
• Fever or other signs of systemic disease?

CLINICAL FINDINGS:

• Gait abnormalities (antalgic gate, Trendelenburg gait, adductor lurch)
• Trauma (ecchmosis, bruising, abrasions)
• Range-of -motion (limitation of internal, external rotation, abduction, adduction, flexion)
• Tenderness to palpation
• Muscle atrophy
• Pain on hip extension (lumbar spine disease, articular pain, sacroiliac pain)
• Sensory and motor abnormalities

TESTS:

• Radiographs (weight bearing films both hips)
• Laboratory work as indicated (CBC, sedimentation. rate, serum uric acid level)
• Other special tests (hip aspiration etc.,)

MANAGEMENT:
Management includes patient education, medications, physical therapy and surgery

• Nonsteroidal ant-inflammatory drugs (taken regularly for limited time)
• Acetaminophen (taken regularly)
• Antidepressants (Amitriptyline etc.)
• Topical medications
• Corticosteroid injections (intra-articular, tendons, and bursa)
• Narcotics may be necessary short term

OTHER THERAPY:

• Physical therapy (range-of -motion, muscle strengthening and pain control, ultrasound, moist heat)
• Weight loss if over weight
• Surgery (femoral osteotomy or hip replacement, other)

PATIENT EDUCATION and ACTIVITY:

• Weight reduction should be encouraged for those who are obese
• Weight bearing should be restricted during acute phase only, with gradual increase in activity and weight bearing as soon as possible.
• Assertive devices as indicated (cane or crutches)