HIP PAIN
TROCHANTERIC BURSITIS
AVASCULAR NECROSIS ( OSTEONECROSIS ) OF THE FEMORAL HEAD
" Hip " refers to a wide area between the upper buttock ,trochanter and groin.It is useful to ask the patient to point to the site of pain and its field of radiation.Pain arising from the hip joint itself is felt in the groin ,lower buttock and anterior thigh and may radiate to the knee .Occasionally and inexplicably ,hip arthritis causes pain only in the knee .
Pain in the hip is not always felt directly on the hip. Instead, you can feel it in the mid-thigh or groin. Similarly, you feel pain in the hip may actually reflect a problem in the back, rather than pain in the hip.
The hip pain is a most common problem and it can be confusing because there are many reason .It is more important to accurately diagnose the cause of your symptoms so that appropriate treatment can be directed to the underlying problem.
If you have pain in the hip, some Common causes include:
PAIN IN THE HIP __ CAUSES .
HIP REGION PROBLEMS _________________ MAIN SITES OF PAIN
Osteoarthritis of hip . ____________________ Groin ,buttock ,front of thigh to knee.
Trochanteric bursitis. ____________________ Lateral thigh to knee.
Meralgia paraesthetica. ___________________ Anterolateral thigh to knee .
Referred from back. ____________________ Buttock.
Facial joint pain . _____________________ Buttock and posterior thigh .
Inflammatory arthritis . ____________________ Groin ,buttock ,front of thigh to knee.
Sacoillitis (AS ). ____________________ Buttock.
Avascular necrosis . ____________________ Groin ,buttock .
Polymyalgia rheumatica . ____________________ Buttocks ,lumbar spine .
OSTEOARTHRITIS ( OA )
Osteo-arthritis is the most common cause of hip joint in a person over the age of 50 years .It causes pain in the buttock and groin on standing and walking .Stiff hip movements cause difficulty in putting on a sock and may produce a limp.
TROCHANTERIC BURSITIS
This may be due to trauma or unaccustomed exercise ,but sometimes has an unknown cause.It occurs in inflammatory arthrithis.the pain over the trochanter is worse going up stairs and when abducting the hip ,and the trochanter is tender to lie on .A local corticosteroid injection onto the surface of the trochanter is helpful.
MERALGIA PARAESTHETICA
This cause numbness and burning dysaesthesia ( increased sensitivity to light touch ) over the anterolateral thigh and may be precipitated by a sudden increase in weight.
FRACTURE OF THE FEMORAL NECK
This usually occurs after a fall ,occasionally spontaneously .There is pain in the groin and thigh ,weight bearing is painful or impossible ,and the leg is shortened and externally rotated .Occasionally a fracture is not displaced and remain undetected .X-rays are diagnostic.Anyone with a hip fracture ,especially after minimal trauma ,should be reviewed for osteoporosis .
AVASCULAR NECROSIS ( OSTEONECROSIS ) OF THE FEMORAL HEAD
This is uncommon but occurs at any agr.There is severe hip pain .X-rays are diagnostic after a few weeks ,when a well -demarcated area of increased bone density is visible .In the femur this lies at the upper pole of the femoral head.The affected bone may collapse.Early ,the X-ray is normal but bone scintigraphy or MRI demonstrate the lesions.Risk factors include treatment with corticosteroids or heparin ,exposure to high barometric pressures ( diverse and tunnellers ) ,excessive alcohol consumption ,and sickle cell disease.
INFLAMMATORY ARTHRITIS OF THE HIP
This produce pain in the groin and stiffness ,which are worse in the morning .Rheumatoid arthritis ( RA) rarely presents with hip pain ,although the hip is involved eventually in severe RA .Ankylosing spondylitis and other seronegative spondarthritides cause inflammatory hip arthritis in younger people.
POLYMYALGIA RHEUMATICA
Bilateral hip ,buttock and thigh pain and stiffness that are worse in the morning in an elderly patient may be attributable to polymyalgia rheumatica .
