Management of Hip Pain

Question 1

Symptoms of hip problems?

Answer 1

• Pain/discomfort
• Referred pain
• Night pain/insomnia (marker of severity)
• Exercise-related pain
• Stiffness
• Loss of function and impact on ADLs

Question 2

Physical examination of a patient with hip pain?

Answer 2

Look:
• Deformity 
• Asymmetry 
• Scars 
• Assess gait 

Feel:
• Swelling
• Bony landmarks
• Tenderness 
• Heat

Move:
• Range of movement
• Stiffness
• Pain on movement

Question 3

Ix of hip pain?

Answer 3

• X-ray (only if it will affect management)
• ESR/PV
• FBC (infection)
• Ca/Alk phos (bone destruction, e.g: from tumours)

Question 4

X-ray signs of OA?

Answer 4

LOSS

Question 5

Management of hip OA?

Answer 5

Education and weight reduction

Home adaptations (occupational therapy input)

Walking stick, analgesia, NSAIDs

Physiotherapy

Some patients may want to try complementary medicines

Mobility allowance, disability car badge

Surgery

Question 6

Signs that a patient with hip pain should be referred?

Answer 6

• Pain, esp. at night
• Loss of function
• Physical and mental fitness
• Support at home
• Patient expectations
• Age of patient
• Uncertain about diagnosis

Question 7

Common causes of hip pain?

Answer 7

OA

RA and other arthritides, e,g: ankylosing spondylitis

Fracture

Referred from back

Malignancy

Question 8

Rarer causes of hip pain?

Answer 8

Soft tissue problems, e.g: trochanteric bursitis, snapping iliopsoas tendon

Paget’s disease

Infection, e.g: septic, TB

Avascular necrosis