From the Guidelines
A thorough hip pain assessment should begin with a detailed history focusing on pain characteristics, followed by a comprehensive physical examination, and imaging studies may include plain radiographs as first-line, with MRI, CT, or ultrasound reserved for specific indications, as recommended by the most recent study 1.
Key Components of Hip Pain Assessment
- A detailed history focusing on pain characteristics (location, onset, duration, severity, and aggravating/relieving factors)
- A comprehensive physical examination, including:
- Observation of gait and posture
- Palpation of the hip region
- Range of motion testing (flexion, extension, abduction, adduction, and rotations)
- Special tests like the FABER (Flexion, ABduction, External Rotation), FADIR (Flexion, ADduction, Internal Rotation), and Trendelenburg tests
- Assessment for leg length discrepancy and examination of the lumbar spine as referred pain is common
- Neurovascular examination, including motor strength, sensation, and reflexes
Imaging Studies
- Plain radiographs as first-line, with MRI, CT, or ultrasound reserved for specific indications, as recommended by the study 1
- Advanced imaging, such as MRI or CT, may be necessary for further evaluation of intra-articular structures or morphology, as suggested by the study 1
Laboratory Tests
- Laboratory tests, such as ESR, CRP, and rheumatoid factor, may be necessary if inflammatory conditions are suspected, as mentioned in the study 1
Diagnostic Approach
- A comprehensive diagnostic approach, combining patient symptoms, clinical signs, and diagnostic imaging, is recommended, as stated in the study 1
- The diagnostic utility of clinical examination and diagnostic imaging in isolation is limited, and a comprehensive approach is necessary to determine the underlying cause of hip pain, as highlighted in the study 1
From the Research
Hip Pain Assessment
Hip pain assessment is a crucial process in determining the cause of hip pain and prescribing effective therapy. The assessment involves a combination of history, physical examination, and imaging tests.
- The location of hip pain can be anterior, lateral, or posterior, each with different possible causes 2.
- Anterior hip pain can be caused by referred pain from intra-abdominal or intrapelvic causes, extra-articular etiologies such as hip flexor injuries, or intra-articular etiologies like labral tears or femoroacetabular impingement 2.
- Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction 2.
- Posterior hip pain can be caused by referred pain from lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, or hamstring tendinopathy 2.
Imaging Tests
Imaging tests such as radiography, ultrasonography, or magnetic resonance imaging (MRI) may be needed for a definitive diagnosis.
- Radiography of the hip and pelvis should be the initial imaging test 2, 3.
- Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain 2.
- MRI is the imaging modality of choice in diagnosing both intra-articular and extra-articular pathologies if the diagnosis remains uncertain 3.
Physical Examination
A thorough history and an organized physical examination are essential components of hip pain assessment.
- The physical examination of the hip should include a combination of tests, such as flexion range of motion, flexion internal rotation, and flexion external rotation 4, 5.
- The examination should also consider the hip as comprised of four layers: osseous, capsulolabral, musculotendinous, and neurovascular, as well as the kinematic chain 4.
- A clinical evaluation of the hip that incorporates a multifactor thought process will lead to an accurate diagnosis in a timely manner 4.
Treatment
Intraarticular corticosteroid injections have been used to treat hip osteoarthritis, and available randomized controlled trials show that they provide pain relief and functional improvement 6.