GP Management of Hip Pain

Question 1

How do patients present to their GP?

Answer 1

Pain/discomfort, referred/exercise-related pain, night pain/insomnia, stiffness, not able to do things they used to do

Question 2

What are some features of the examination?

Answer 2

Look = deformity, asymmetry, scars
Feel = swelling, bony landmarks, tenderness, heat
Move = ROM, stiffness, pain

Question 3

What are some investigations that may be done?

Answer 3

X-ray = only if it will affect management
ESR/PV
FBC
Calcium and alkaline phosphatase

Question 4

What features may be seen on imaging?

Answer 4

Loss of joint space, osteophytes, sclerosis, subarticular cysts

Question 5

What are some treatments patients may be offered?

Answer 5

Education, weight reduction, physio, complementary medicine
Walking stick, home adaptations (occ. therapy)
Analgesia, NSAIDs
Mobility allowance, disability badge for car

Question 6

What factors affect referral?

Answer 6

Pain (especially night pain), support at home, loss of function, patient expectations, age of patient, physical and mental fitness, uncertain about diagnosis

Question 7

What are common causes of hip pain?

Answer 7

Osteoarthritis, rheumatoid arthritis and other arthritides, fracture, referred from back, malignancy

Question 8

What are some less common causes of hip pain?

Answer 8

Soft tissue = trochanteric bursitis, snapping ilio-psoas tendon
Paget’s disease, avascular necrosis
Infection = sepsis, TB