What are the initial management options for hip pain in women?

Initial Management Options for Hip Pain in Women

For women presenting with hip pain, the initial management should include radiographic imaging with anteroposterior (AP) pelvis and lateral femoral head-neck radiographs, followed by a biopsychosocial assessment and implementation of an individualized non-pharmacological treatment plan. 1

Diagnostic Approach

Initial Imaging

1. First-line imaging:

   • AP pelvis radiograph
   • Lateral femoral head-neck view (such as Dunn view, frog-leg view, or cross-table lateral view) 1
   • These views help identify underlying bony morphology relevant to hip pain

2. When to consider advanced imaging:

   • If radiographs are negative but clinical suspicion for fracture remains high, MRI without contrast is the preferred next study 1
   • For suspected intra-articular pathology (labrum, cartilage, ligamentum teres), MRI/MRA or CT arthrogram 1

Important caveat: Diagnosis should never be made on imaging alone, as incidental findings are common in asymptomatic individuals 1

Physical Assessment

Perform a biopsychosocial assessment that includes 1:

• Physical status evaluation: pain characteristics, fatigue, sleep quality, lower limb joint status, mobility, strength, joint alignment, comorbidities, weight
• Activities of daily living impact
• Participation limitations (work, leisure, social roles)
• Mood assessment
• Health education needs and motivation to self-manage

Pain Location Patterns

Hip pain can be categorized by location to help narrow the differential diagnosis 2, 3:

• Anterior hip/groin pain: Often indicates intra-articular pathology (osteoarthritis, labral tears, femoroacetabular impingement)
• Lateral hip pain: Typically associated with greater trochanteric pain syndrome (gluteus medius tendinopathy, bursitis)
• Posterior hip pain: May indicate lumbar pathology, deep gluteal syndrome, ischiofemoral impingement, or hamstring tendinopathy

Treatment Approach

Non-pharmacological Core Management

Implement an individualized management plan that includes 1:

1. Information and education about the condition
2. Activity maintenance and pacing strategies
3. Regular individualized exercise regimen
4. Weight loss if overweight or obese
5. Reduction of adverse mechanical factors (appropriate footwear)
6. Consideration of walking aids and assistive technology as needed

Pharmacological Management

For pain control, consider:

• NSAIDs such as ibuprofen (400mg every 4-6 hours as needed) 4 or naproxen
• Use the lowest effective dose for the shortest duration to minimize adverse effects
• For osteoarthritis specifically, ibuprofen dosing may range from 1200-3200mg daily (divided doses) 4

Management Based on Likely Etiology

For suspected osteoarthritis:

• Begin with non-pharmacological approaches 1
• Add NSAIDs for pain control as needed 4, 5
• Consider referral if symptoms are severe or unresponsive to initial management

For suspected femoroacetabular impingement or labral tears:

• Consider early referral to orthopedics, especially in younger women 2
• These conditions typically have good surgical outcomes when appropriately diagnosed

For greater trochanteric pain syndrome:

• Activity modification
• Physical therapy focusing on hip abductor strengthening
• NSAIDs for pain control

Clinical Pearls and Pitfalls

• Don't miss fractures: Hip fractures are nearly twice as common in women as in men and are associated with significant morbidity and mortality (22% one-year mortality rate for women) 1
• Consider referred pain: Hip pain may originate from the spine, abdomen, or pelvis 2, 3
• Age matters: In younger women, consider labral tears and femoroacetabular impingement; in older women, osteoarthritis is more common 2
• Avoid diagnostic delay: For suspected fractures, prompt diagnosis is critical as delays increase complications, length of hospital stay, and mortality 1

By following this structured approach to hip pain in women, clinicians can efficiently diagnose the underlying cause and implement appropriate management strategies to improve outcomes and quality of life.