Hip Pain

INTRODUCTION

KEY FEATURES: HIP AND BUTTOCK PAIN

Key history Pain analysis, especially exact site and pain radiation. Associated symptoms such as limp, stiffness, night pain, fever. Past history, family history, obstetric history, drug history.

Key examination

• Use the traditional method of look, feel, move, measure, test function and look elsewhere.

• The patient should be stripped to the underwear to allow maximal exposure.

• Also examine lumbosacral spine, sacroiliac joints, groin and knee.

Key investigations

• Serological tests: RA factor

• FBE, ESR/CRP

• Radiological tests: plain X-ray (AP) of pelvis to show both hip joints; lateral X-ray (‘frog’ lateral best in children)

• CT or MRI of hip joint

• Needle aspiration of joint if septic arthritis suspected

HIP PAIN IN CHILDREN

Children can suffer from a variety of serious disorders of the hip, e.g. developmental dysplasia (DDH), Perthes disease, tuberculosis, septic arthritis and slipped capital femoral epiphysis (SCFE), all of which demand early recognition and management.

DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)

Previously known as congenital dislocation of the hip.

Clinical features

• Females:males = 6:1

• Asymmetry in 40%; deep thigh crease or extra crease; and short leg

• Diagnosed early by Ortolani (IN TEST) and Barlow (OUT TEST) tests (abnormal thud or clunk on abduction); test usually –ve after 2 mths

• US excellent (esp. up to 3–4 mths, ideally 6 wks) and more sensitive than clinical examination

• Plain X-ray difficult to interpret up to 3 mths, then helpful

Treatment (guidelines)

• DDH must be referred to a specialist.

• Placed in an abduction splint or pelvic harness, or other methods if older.

PERTHES DISEASE

A juvenile osteochondritis leading to avascular necrosis of the femoral head.

Clinical features

• Males:females = 4:1

• Usual age 4–8 (rarely 2–18)

• Sometimes bilateral

• Presents as a limp and aching (hip or groin pain)

• Characteristic X-ray changes Requires urgent referral: provide crutches.