Hip Pain - Evaluation

--localization of the pain can really help in the ddx (see attached diagram):

• Posterior/gluteal pain tends to be referred from the lumbosacral region (often radiating down the posterior thigh)
• Lateral hip pain is more c/w trochanteric bursitis
• Lateral hip pain with paresthesias/hyperesthesia is suggestive of lateral femoral cutaneous nerve entrapment (meralgia paresthetica)  
• Sacroiliac pain and ishiogluteal bursitis localize to specific bony locations in the posterior aspect of the hip
• Anterior/groin pain is more reflective of true “hip joint” pain, but can also be caused by iliopsoas bursitis

--Hip pain is best assessed by the patient’s gait (stance vs. swing phase)

• Most problems appear during the weight-bearing “stance” phase
• Hip dislocation, arthritis or abductor weakness can cause the pelvis to drop on the opposite side, causing a waddling gait
• An antalgic gait is defined by a shortened stance phase on the affected side, to decrease weight-bearing
• Trendelenburg gait- seen with lumbosacral nerve root injury or gluteal weakness. Weight is shifted to the affected hip, while the contralateral hip does all the work

--physical exam pearls”

• Look for warmth, redness, muscle atrophy
• Palpation (particularly over the trochanteric and ischiogluteal bursa)
• ROM: extension, flexion, ab/adduction, int and ext rotation-**limitation of internal rotation is a sensitive indicator of an intrinsic hip process
• Listen for femoral bruits or decreased pulses in the appropriate pt population--can be 2/2 vascular insufficiency (aortoiliac occlusive disease)

 

 

(Victoria Kelly MD, 8/26/10)