Hip and buttock pain Flashcards
Probability diagnosis
Traumatic muscular strains
Referred pain from spine
Greater trochanteric pain syndrome
Osteoarthritis of hip
Serious disorders not to be missed
Cardiovascular:
- buttock claudication
Neoplasia:
- metastatic cancer
- osteoid osteoma
Infection:
- septic arthritis
- osteomyelitis
- tuberculosis
- pelvic abscess
- pelvic inflammatory disease
- prostatitis
Childhood disorders:
- DDH
- Perthes’ disease
- slipped femoral epiphysis
- transient synovitis (irritable hip)
- juvenile chronic arthritis
Pitfalls (often missed)
- Risk of leomysacroma is 1:400 Polymyalgia rheumatica
- Fractures:
- stress fractures femoral neck
- subcapital fractures
- sacrum
- pubic rami
- Avascular necrosis femoral head
- Femoroacetabular impingement (e.g. exostoses)
- Torn acetabular labrum
- Sacroiliac joint disorders
- Inguinal or femoral hernia
- Bursitis or tendonitis:
- greater trochanteric pain syndrome
- ischial bursitis
- iliopsoas bursitis
- Osteitis pubis
- Neurogenic claudication
- Chilblains
- Rarities:
- haemarthrosis (e.g. haemophilia)
- Paget disease
- nerve entrapments: sciatica ‘hip pocket nerve’, obturator, lateral cutaneous nerve thigh
Masquerades checklist
Depression
Spinal dysfunction incl. spinal stenosis
Is the patient trying to tell me something?
Non-organic pain may be present.
Pt with arthritis may be fearful of being crippled.
Key history
Pain analysis, especially exact site and pain radiation.
Associated symptoms such as limp, stiffness, night pain, fever.
PMHx, FHx, obstetric history, drug history.
Key examination
The traditional method of;
- look
- feel
- move
- measure
- test function
- look elsewhere
Pt should be stripped to the underwear to allow maximal exposure
Exam lumbosacral spine, sacroiliac joints, groin and knee
Key investigations
Serological tests: RA factor
FBE, ESR/CRP
Radiological tests:
- X-ray (AP) of pelvis to show both hip jts
- lat X-ray (‘frog’ lateral best in children)
CT or MRI of hip joint
Needle aspiration of jt if septic arthritis suspected
Diagnostic tips
True hip pain is felt in the groin, thigh and medial aspect of the knee.
Disorders of the hip joint commonly refer pain to the knee and thigh.
Limp has an inseparable relationship with painful hip and buttock conditions.
Keep in mind the greater trochanteric pain syndrome, especially when middle-aged women complain of hip pain.
