HIP PAIN
When confronted with a case of hip pain in an adult, the clinician is
most likely to think of fracture or joint inflammation such as
osteoarthritis, realizing however that there are many other possibilities
(Table 38). How can the clinician think of them on the spot?
Anatomy is the key. The hip is composed of skin, muscle, bursa, ligament,
joint, and bone. It is also supplied by nerves, arteries, and veins. Looking
at each of these structures in terms of etiology, skin should prompt the
recall of herpes zoster, and muscle should prompt the recall of contusion or
sprain. The bursa should allow one to recall greater trochanter bursitis—a
common and easily treated form of hip pain. Thinking of the ligaments, consider
sprain. Visualizing the joint would prompt consideration of osteoarthritis,
gout, and RA as well as congenital dislocation of the joint, slipped femoral
epiphysis, Legg–Perthes disease, and rheumatic fever. Visualizing the bone
should prompt recall of fracture and primary and metastatic tumors.
Visualizing the nerves, one should think of the sciatic nerve and consider a
herniated lumbar disc, cauda equina tumor, or sciatic neuritis (which is
rare). Considering the arteries and veins may prompt one to think of
avascular necrosis.
Approach to the Diagnosis
The history and physical examination will allow differentiation of many
of the conditions listed above. For example, the history of trauma suggests
sprain, fracture, or contusion. Remember that fractures of the hip can occur
in elderly persons without a history of trauma. A positive
straight-leg-raise (SLR) test suggests a herniated disc or other cauda
equina pathology. X-ray of hip and lumbosacral spine will help rule out
fracture or osteoarthritis, but CT scan, bone scan, or MRI may be necessary.
If x-rays and laboratory examinations are negative, a trial of lidocaine
injections into the greater trochanter bursa or other trigger points may be
diagnostic.
Other Useful Tests
-
CBC (infection)
- Chemistry panel (metastatic neoplasm)
- Urinalysis (multiple myeloma, gout)
- Sedimentation rate (osteomyelitis, arteritis)
- RA tests
- ANA analysis (collagen disease)
- Joint fluid analysis (all types of arthritis)
- Tuberculin test (TB of the joint)
- Bone biopsy (neoplasm)
HIP PAIN
|
| M | I | N | T |
|
| Malformation | Inflammation | Neoplasm | Trauma |
|
|
Skin |
|
Herpes zoster |
|
Contusion |
|
Muscle |
|
Myositis |
|
Contusion |
|
Bursa |
|
Greater trochanter bursitis |
|
Contusion |
|
Ligaments |
|
|
|
Sprain |
|
Joint |
Congenital dislocation |
Rheumatoid arthritis Osteoarthritis Gout |
|
Contusion Hemorrhage |
|
Bone |
|
Osteomyelitis |
Primary or metastatic neoplasm |
Fracture Avascular necrosis |
|
Nerves |
|
Neuritis |
Cauda equina tumor |
Herniated disc |
|
- Exploratory surgery
CASE PRESENTATION #46
A 56-year-old white woman complained of increasing left hip pain which
began 3 months ago and had gradually gotten worse. There is no history of
trauma, fever or chills, and no numbness or tingling of the extremities. She
had a mastectomy for breast cancer 5 years previously.
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Hip symptoms
Read excerpts from these other book chapters related to Hip symptoms:
Medical Books Excerpts
- HIP PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Hip Pain
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- HIP PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Hip Pain
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- HIP PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Hip symptoms
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