From the Guidelines
The next step in managing hip pain with a negative x-ray result is to consider further diagnostic testing, such as MRI, to evaluate soft tissue structures not visible on x-rays, while also trying conservative treatment measures. When a patient presents with hip pain and a negative x-ray result, it is essential to consider the possibility of soft tissue abnormalities, such as tendonitis, bursitis, or labral tears, which may not be visible on x-rays 1.
- Conservative treatment measures, including rest, activity modification, and over-the-counter pain medications like acetaminophen or NSAIDs, should be initiated for 1-2 weeks.
- Applying ice for 15-20 minutes several times daily and considering physical therapy to improve strength and flexibility around the hip joint can also be beneficial. If pain persists beyond 4-6 weeks despite these measures, further imaging such as an MRI may be necessary to evaluate soft tissue structures, including labral tears, muscle strains, or early avascular necrosis 1.
- Conditions like bursitis, tendinitis, or referred pain from the lower back might be causing symptoms despite normal x-rays. For persistent or worsening pain, especially if accompanied by limping, night pain, or difficulty bearing weight, prompt follow-up with your healthcare provider is essential to prevent potential complications and determine the underlying cause. It is also important to note that diagnostic imaging, including MRI or CT scans, should not be used in isolation but combined with the patient's symptoms and clinical signs when making treatment decisions 1.
From the Research
Next Steps in Managing Hip Pain with a Negative X-ray Result
- If the x-ray result is negative, the next step is to consider other diagnostic tests such as ultrasonography or magnetic resonance imaging (MRI) to determine the cause of hip pain 2, 3.
- A thorough history and physical examination are essential in evaluating hip pain, as they can help identify the location and possible causes of pain 2, 3.
- The location of hip pain can be categorized into three regions: anterior, lateral, and posterior, each with different possible causes 2, 3.
- Anterior hip pain may be caused by intra-articular pathology such as osteoarthritis, hip labral tears, or extra-articular etiologies like hip flexor injuries 2, 3.
- Lateral hip pain is commonly associated with greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction 2, 3.
- Posterior hip pain may be caused by referred pain from lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, or hamstring tendinopathy 2, 3.
- Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain 2.
- If the history and plain radiograph results are not diagnostic, MRI should be performed to detect occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head 3.
- Magnetic resonance arthrography is the diagnostic test of choice for labral tears 3.
- Physical therapy may be beneficial in managing hip pain, especially if arthritis has been ruled out 4.
- A comprehensive evaluation of the etiology of hip pain may include laboratory tests and ancillary radiologic tests 5.
- Corticosteroid injections may be considered as part of a comprehensive treatment plan for musculoskeletal diagnoses, but the evidence is limited, and the effectiveness varies depending on the condition 6.