Hip Pain in Adults

Question 1

Describe the features of transient idiopathic osteoporosis?

Answer 1

• An uncommon condition sometimes seen in the third trimester of pregnancy
• Groin pain associated with a limited range of movement in the hip
• Patients may be unable to weight bear
• ESR may be elevated

Question 2

What are the features of pubic symphysis dysfunction?

Answer 2

• Common in pregnancy
• Ligament laxity increases in response to hormonal changes of pregnancy
• Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs.
• A waddling gait may be seen

Question 3

Describe the features of avascular necrosis (of femoral head)?

Answer 3

• Symptoms may be of gradual or sudden onset
• May follow high dose steroid therapy or previous hip fracture of dislocation

Question 4

Describe the features of meralgia paraesthetica.

Answer 4

• Caused by compression of lateral cutaneous nerve of thigh
• Typically burning sensation over antero-lateral aspect of thigh

Question 5

Describe the features of trochanteric pain syndrome (Trochanteric bursitis).

Answer 5

• Due to repeated movement of the fibroelastic iliotibial band
• Pain and tenderness over the lateral side of thigh
• Most common in women aged 50-70 years

Question 6

Describe the features of referred lumbar spine pain.

Answer 6

• Femoral nerve compression may cause referred pain in the hip
• Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped

Question 7

Describe the difference between OA of the hip and inflammatory arthritis of the hip.

Answer 7

• OA of the hip -
  
  • Pain exacerbated by exercise and relieved by rest
  • Reduction in internal rotation is often the first sign
  • Age, obesity and previous joint problems are risk factors
• Inflammatory arthritis of the hip
  
  • Pain in the morning
  • Systemic features
  • Raised inflammatory markers