Clinical Diagnosis of Hip Pain
Section snippets
History
The first step in evaluating the hip is to obtain a thorough history from the patient. The presence or absence of trauma, as well as the duration and severity of symptoms, should be determined. The examiner should inquire about prior hip consultations, past surgeries, and old injuries. Exacerbating and alleviating factors should be identified. Specific activities of daily living that are limited should be documented. Information regarding prior treatments including activity modifications, oral
Physical examination
Because hip pain may be a result of intra-articular hip pathology as well as a myriad of extra-articular and referred sources of pain, it is crucial to perform a consistent, comprehensive physical examination to best identify the underlying diagnosis. An appropriate physical examination should begin with documentation of vital signs including patient temperature. Although rare, hip pyathrosis should be considered in any febrile patient with hip pain. Other conditions that may produce fever and
Diagnostic studies
Laboratory studies have a limited role in the evaluation of hip pathology, and no studies are routinely ordered in this setting. If there is concern for a possible infectious etiology, a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) may be helpful to establish a diagnosis. In certain areas, Lyme infection should be added. Occasional gout can produce hip pain and can be diagnosed by a joint aspiration tested for crystals. For patients with
Summary
It is vitally important to elucidate intra-articular versus extra-articular pathology of hip pain in every step of the patient encounter: history, physical examination, and imaging. The role of imaging studies will be discussed in another article.
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