HIP PAIN
HIP PAIN: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is there a positive straight-leg raising test or other neurologic signs? The presence of positive straight-leg raising tests or other neurologic signs would suggest a herniated disk, a cauda equina tumor, or other neurologic disorders of the lumbar spine. Meralgia paresthetica will cause characteristic loss of sensation in the distribution of the lateral femoral cutaneous nerve.
- Is there a positive Patrick's test or limitation of the range of motion of the hip? These findings suggest a greater trochanter bursitis or hip joint pathology such as fracture, osteoarthritis, rheumatoid arthritis, metastasis, slipped femoral epiphysis, Legg-Perthes disease, rheumatic fever, or transient synovitis.
- Is there tenderness of the greater trochanter bursa? Tenderness of the greater trochanter bursa will help differentiate greater trochanter bursitis. It is also seen in hysteria.
- Is the patient a child or an adult? If the patient is a child, transient synovitis, slipped femoral epiphysis, Legg-Perthes disease, and rheumatic fever should be considered. If the patient is an adult, it is more likely that the problem is osteoarthritis, a fracture, rheumatoid arthritis, metastasis, or avascular necrosis.
- Is there a history of trauma? A history of trauma would suggest that there is a fracture or a sprain of the hip joint, but the clinician should remember that a fracture in the elderly often occurs with no history of trauma.
DIAGNOSTIC WORKUP
A CBC, sedimentation rate, chemistry panel, arthritis panel, tuberculin test, and x-rays of the lumbosacral spine and hip will diagnose 90% of the cases. These are relatively expensive in comparison to MRI. A bone scan may be necessary to diagnose occult fractures. A serum protein electrophoresis will help diagnose multiple myeloma. A trigger point injection of the greater trochanter bursa or ischiogluteal bursa will assist in the diagnosis of these conditions. An orthopedic surgeon should be consulted before ordering MRI of the lumbar spine or hip. However, MRI is especially important if the diagnosis of avascular necrosis is suspected.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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