The approach to evaluating hip pain- Differential Diagnosis
- It's important to obtain a good history in order to formulate a differential diagnosis. This can help differentiate the disease from other conditions, such as referred pain from stenosis.
- In general, different disorders are seen at different age of onset of disease.
- Inflammation of the trochanteric bursae
- Pain increases with hip flexion such as walking, climbing stairs, or getting out of a car or a chair.
- Nocturnal pain while lying on the affected side is common.
- A snap is occasionally felt or heard in the lateral hip with flexion or extension.
Gluteus Medius Syndrome
- Inflammation and pain at the outer hip caused by strain of the gluteus medius muscle and its tendon attachment to the femur.
- Pain and often a limp with walking or running
- Tenderness over the outer hip (lateral side)
- Pain, tenderness, swelling, warmth, or redness over the outer thigh, often worsened by moving the hip
- Often, weakness of the hip (especially when spreading the legs and hips against resistance)
- Patients may present with pain that is transient and worsening over a time period, a Trendelenburg gait, and weakness.
- It can be difficult to distinguish between trochanteric bursitis and gluteus medius tendinitis due to their proximity at the insertion site. Resistance to abduction or internal rotation of the hip may help distinguish these 2 entities, as trochanteric bursitis will not elicit pain with resisted hip abduction, and gluteus medius tendinitis will present with more posterior tenderness to palpation at the insertion site.
Ischiogluteal Bursitis (also known as weaver's bottom)
- Inflammation of the bursa that lies between the ischial tuberosity and the tendon of a hamstring muscle.
- The symptoms of ischiogluteal bursitis are identical to hamstring tendon inflammation and include the following:
- Pain and tenderness at the ischial tuberosity.
- Pain when stretching the hamstring.
- Pain when flexing the knee against resistance.
- A gradually onset of pain following a sprinting session.
- Pain which may be aggravated by sitting.
Iliopsoas tendinitis
- Inflammation of iliopsoas tendon due to acute trauma and overuse resulting from repetitive hip flexion.
- Symptoms:
- Pain with sports-related activities (jogging, running) and pain with simple activities (putting on socks and shoes, rising from a seated position with hips flexed for some time and walking up stairs).
- Pain may radiate down the anterior thigh toward the knee.
- An audible snap or click in the hip or groin.
Iliopsoas bursitis
- Inflammation of the largest bursa in the body- iliopsoas bursa.
- Females tend to be more prone to iliopsoas injuries than men.
- Usually occurs with iliopsoas tendonitis.
- May be caused by rheumatoid arthritis.
- Symptoms :
- Pain radiates down the front and middle areas of the thigh to the knee and is increased when the hip is extended and rotated.
- Extension of the hip during walking causes pain so the person may limit the stride on the affected side and take a shorter step.
- There may be tenderness in the groin area.
- Sometimes a mass may be felt resembling a hernia. The person may also feel numbness or tingling if adjacent nerves are compressed by the inflamed bursa.
- Patients often complain of groin pain, which is worse on walking.
- They often complain of stiffness, first thing in the morning and have symptoms related to stiffness of the hip, such as difficulty in cutting their toenails, difficulty getting in and out of a bath or a car etc.
- Pain at inner thigh, buttocks or knees
Hernia
- Defect of the abdominal wall where part of internal tissue (fat, muscles) protrudes through the inguinal canal.
- Pain in the groin during exercise, also at the anterior part of hip and thigh.
- Pain on increases in abdominal pressure such as when coughing or sneezing.
- A bulge in the groin area which often disappears when lying down.
Just remember..
For most diagnoses all that is needed is an ounce of knowledge, an ounce of intelligence, and a pound of thoroughness. ~Arabic proverb
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