Hip and buttock pain in the elderly

Question 1

The following conditions are highly significant in the elderly:

Answer 1

osteoarthritis of the hip

aortoiliac arterial occlusion → vascular claudication

spinal dysfunction with nerve root or referred pain

degenerative spondylosis of lumbosacral spine → neurogenic claudication

polymyalgia rheumatica

trochanteric bursalgia (greater trochanteric pain syndrome)

fractured neck of femur

•secondary tumours

Question 2

Osteoarthritis of the hip

Answer 2

The most common form of hip disease.

Clinical features

Usually >50 yrs, increases with age

May be bilateral: starts in one, other follows

At first pain worse with activity, relieved by rest, then nocturnal pain and pain after resting

Stiffness, esp. after rising

Stiffness, deformity and limp may dominate (pain mild)

May present with knee pain.

Abnormal gait

First movements lost are IR and extension

Question 3

Treatment

Answer 3

Careful explanation: patients often fear OA of hip

Weight loss if overweight

Relative rest

Complete RIB for acute pain

Analgesics and NSAIDs (judicious use)

Aids and supports (e.g. walking stick)

Physical therapy, including isometric exercises

Hydrotherapy is useful

Surgery is very effective for continuing severe pain or disability

Question 4

Greater trochanteric pain syndrome

Answer 4

Also known as trochanteric bursalgia,

it is very common in mid-age to elderly females presenting with pain over lateral surface of the greater trochanter.

Features are:

• female >45–50 years but all ages and sexes, esp. older person
• pain on outside hip referred to as far as foot
• pain climbing stairs, getting in and out of vehicle
• pain on lying on hip at night
• limp
• localised tenderness on the outer border of thigh

Treat with:

1. trial of physiotherapy and exercises.
2. Trial of NSAIDs
3. and local steroid plus lignocaine injection into area of maximal tenderness (consider under US)