Approach To The Patient With Hip Pain
February 21, 2008 by Dr Arun Pal Singh
Filed under Clinical Evaluation
Hip pain is quite a cause for concern when it occurs. A systematic approach to the hip would help to delineate the plausible causes.
The first thing that is done for examining the hip is observation of the gait. This is done the moment patient comes in without making him cautious.
A careful clinical history would narrow the possibilities of diagnoses which are then furthe r narrowed in examination in usual sequence.
The vast majority of patients reporting “hip pain” localize their pain unilaterally to the posterior or gluteal musculature. Such pain may or may not be associated with low back pain and tends to radiate down the posterolateral aspect of the thigh.
Range of movement may be limited by pain.
This presentation frequently results from degenerative arthritis of the lumbosacral spine and commonly follows a dermatomal distribution with involvement of nerve roots between L2 and S1.
Some individuals instead localize their “hip pain” laterally to the area overlying the trochanteric bursa. Because of the depth of this bursa, swelling and warmth are usually absent. Diagnosis of trochanteric bursitis can be confirmed by inducing point tenderness over the trochanteric bursa.
Pain in the hip joint is less common and tends to be located anteriorly, over the inguinal ligament; it may radiate medially to the groin or along the anteromedial thigh.
Iliopsoas bursitis may mimic true hip joint pain.
Diagnosis of iliopsoas bursitis may be suggested by a history of trauma or inflammatory arthritis. Pain associated with an iliopsoas bursitis tends to worsen with hyperextension of the hip, and may patients prefer to flex and externally rotate the hip to reduce the pain from a distended bursa.
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Thank you for this information. Many individuals no doubt like myself go to the computer for further understand or get a better idea of pain which they experience.
This article was good, very good but perhaps a diagram might have helped someone like myself. Also the terms used are a challenge.
My research was basic, I have a pain on the outside of my thigh. Very acute at times, more so with some movements. The pain goes to my lumbar region. Standing, kneeling, lying down is ok. but I have to take care sitting, getting in and out of the car.Sometimes going upstairs is painful. A sharp pain and soreness there after is a challenge. this all started recently. Yes, I do have curvature in my spine. It helps to know what the long term prognosis could be.
Many thanks . B Thomson
Hi B Thompson,
You forgot to mention your age. From your symptoms it seems that cause of the pain might be in the spine and the pain radiates to the thigh.
Please see a physician to reach at a diagnosis.
Thanks for your reply. Will see the doctor.
I would like your suggestion on the fact that every time I rotate my hip in my marital arts training like roundhouse or reverse fan kick, I seem to get inflammation of my bursa which is so painful. This time it even hurt when I was lying down. I have been xrayed and it seems to be inflammation. It takes me several weeks to get back to being painless. it especially hurts when I rotate my hip to the right. The pain is in my left hip. I can walk pretty well, just rotating is tough. I am 58 years strong.
Dr Arun Pal Singh Reply:
June 18th, 2009 at 1:41 pm
@Estella Ramirez,
Inflammation is a sign, not a disease in itself. It gets produced from variety of causes.
Sometimes they respond to overuse/repeated injuries by inflammation.
In my office I also like to rule out infection as a cause.
If no specific cause can be found, it could be due to repeated strains on bursa.
I think you should discuss it with your doctor who can examine yo physically and would be able to gauge better.
Im a 19 year old girl, with hip pain on and off for the last 5-6 years. Mainly in my right hip, on the outside of the pelvis/hip joint, deep inside the joint and on the inside towards my groin.
5 years ago I was send for x-rays and saw a orthopeadic surgeon who sent me for physio. I moved not long after treatment, and sort of accepted that my pain was just going to be one of those things. in the past year the pain has been worse than ever, now i also get pain in my lower back, and down my leg. It hurts even when lying down, and more often than not there is a dull ache which gets worse periodically, sometimes due to increased activity and sometimes it just seems to be bad. My doctor sent me for xrays again, but nothing has shown up. Im now waiting to see another Orthopeadic surgeon at the hospital. The joint clicks or pops in different places, the outside (like over the whole joint) deep in the joint, and now, which seems to be more recent than the other clicking is around the top of my groin. I am also hypermobile. I was wondering if you would have any idea as to what it could be, or just things to talk to the doctor about?
Thanks
Dr Arun Pal Singh Reply:
July 29th, 2009 at 6:09 pm
@Claire Short,
Hypermobile patients are more prone to joint pains. Another problem that you might want to rule out is spondyloarthropathy which is a group of diseases the cause joint and back pains.
your doctor can investigate you if it is suspected from your clinical profile
Claire,
I have the SAME symptoms as you. I starting to think it has something to do with the Iliopsoas Muscle.
PLEASE let me know if you find out anything!
I saw the consultant about a month ago, and he says he thinks i have labral tears in both of my hips.. he’s sent me for artrhrograms and MRIs of both hips, and they also scanned my knees at my first appointment. I find out on tuesday whether he was right or not. the scan was looking for any cartilage damage or if my bones were grinding together.. but i’ll let you know the diagnoses after I’ve seen him!
Good luck!!
three years ago I was diagnosed with moderate to severe spinal stenosis by neuro surgeon after a mri.
Now have pain in groin, etc. quite like july 29 comment of Claire Short. Have had two knee replacements, one shoulder replacement; was told l have no cartilage in the hands. Have a fusion of the lower lumbar which is 30 years old. I am going on 70 and this pain is starting to wear me down. Now have moved and have no access to the neuro surgeon l saw before for the stenosis. Was helped by water therapy so we decided to hold off on the surgery , Have osteoarthritis. Walk a mile at the gym and ride a bike at the gym for l mile about 4 times a week.