From the Guidelines
If you're experiencing hip pain while walking or standing, I recommend scheduling an evaluation with a healthcare provider, preferably your primary care physician or an orthopedic specialist, to determine the exact cause of your pain, as hip pain can result from various conditions including arthritis, bursitis, tendinitis, labral tears, or referred pain from back issues, and prompt evaluation is crucial for proper diagnosis and treatment. This evaluation should include a physical examination, medical history review, and possibly imaging tests such as X-rays, MRI, or ultrasound. According to the American College of Radiology Appropriateness Criteria 1, radiographs of the pelvis and hip should be the first test ordered for the evaluation of patients with chronic hip pain. Some key points to consider in the evaluation of hip pain include:
- Radiographs are an excellent screening tool and can provide specific information for common disorders such as arthritis or less common disorders such as primary bone tumors 1.
- MRI is frequently performed after initial radiographs to detect osseous and soft tissue abnormalities, and is highly sensitive and specific for detecting many abnormalities involving the surrounding soft tissues 1.
- Diagnostic joint injections are safe and useful tools for confirming the etiology of pain, such as labral tear 1. While waiting for your appointment, you can manage discomfort with over-the-counter pain relievers like acetaminophen (Tylenol) at 500-1000mg every 6 hours (not exceeding 3000mg daily) or NSAIDs like ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours with food (if not contraindicated by other medical conditions). Applying ice for 15-20 minutes several times daily and avoiding activities that worsen pain can help reduce inflammation. Rest is important, but gentle stretching and low-impact exercises like swimming may maintain mobility without aggravating symptoms. The International Hip-related Pain Research Network recommends a comprehensive diagnostic approach of patient symptoms, clinical signs, and diagnostic imaging, and that imaging should never be used in isolation but combined with the patient’s symptoms and clinical signs 1.
From the Research
Evaluation of Hip Pain
The evaluation of hip pain experienced during ambulation (walking) or orthostasis (standing) involves a combination of physical examination, patient history, and imaging tests.
- The location of the pain is an important factor in determining the cause, with anterior, lateral, and posterior hip pain having different potential etiologies 2, 3.
- A thorough physical examination, including tests to assess range of motion, muscle strength, and pain replication, can help narrow down the diagnostic possibilities 2, 4.
- Imaging tests, such as radiography, ultrasonography, or magnetic resonance imaging (MRI), may be necessary to confirm a diagnosis or rule out other potential causes 2, 3, 4.
- The initial imaging test should be radiography of the hip and pelvis, with MRI reserved for cases where the diagnosis is unclear or where more detailed imaging is needed 2, 3.
Diagnostic Approach
A rational approach to the hip examination can be used to evaluate hip pain, taking into account the patient's history, physical examination findings, and results of imaging tests.
- The diagnostic approach should consider the potential causes of hip pain, including intra-articular and extra-articular etiologies, as well as referred pain from other sources 2, 3.
- The use of algorithms, such as the one proposed by 4, can help guide the evaluation and management of hip pain.
- Interdisciplinary evaluation, involving a physical therapist and surgeon, may also be beneficial in informing treatment decisions and reducing decisional conflict 5.
Imaging Tests
Imaging tests play a crucial role in the evaluation of hip pain, particularly in cases where the diagnosis is unclear or where more detailed imaging is needed.
- Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected, and should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip 2.
- MRI should be performed if the history and plain radiograph results are not diagnostic, and is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head 2.
- Ultrasonography may also be used to aid in the diagnosis of hip pain, particularly in cases where intra-articular pathology is suspected 3.