Materiały źródłowe

• #1 Hip Pain in Adults: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p81.html

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. […] In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. […] If imaging is performed in the evaluation of a patient with undifferentiated chronic hip pain, standing anteroposterior hip and pelvic radiographs should be the first choice. […] For patients with anterior hip pain and history suggestive of a labral tear, stress fracture of the femoral neck, or early avascular necrosis, magnetic resonance imaging should be performed for accurate diagnosis. […] For intra-articular pain, ultrasound-guided anesthetic injection of the hip may be diagnostic, and corticosteroid injection may be therapeutic.

• #1 Evaluation of the Patient with Hip Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0101/p27.html

  Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. […] A history and physical examination are essential to accurately diagnose the cause of hip pain. […] Initial plain radiography of the hip should include an anteroposterior view of the pelvis and a frog-leg lateral view of the symptomatic hip. […] Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. […] Magnetic resonance arthrography is the diagnostic test of choice for labral tears. […] MRI is useful for the detection of occult traumatic fractures and stress fractures not seen on plain radiographs. […] MRI is useful for differentiating septic arthritis from transient synovitis. […] Magnetic resonance arthrography provides added sensitivity of 90% and accuracy of 91% for the detection of labral tears.

• #1 Hip Pain in Adults: Evaluation and Differential Diagnosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33448767/

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy.

• #1 Imaging evaluation of the painful hip in adults – UpToDate

  https://www.uptodate.com/contents/imaging-evaluation-of-the-painful-hip-in-adults

  Imaging evaluation of the painful hip in adults […] Imaging modalities used to evaluate adults with hip pain and the appropriateness of particular exams in different clinical scenarios will be reviewed here. […] The modalities available for evaluation of the hip include: […] Plain film radiography of the hip is used in the initial evaluation of any cause of hip pain, including trauma and sports injuries, suspected avascular necrosis (AVN), arthritis, hip arthroplasty, infection, dysplasia, tumor, and microinstability. […] Computerized tomography (CT) of the hip without contrast is most useful in the setting of trauma, for preoperative planning, and for evaluation and guiding percutaneous biopsy of tumors.

• #1 Hip Pain in Adults: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p81.html

  For patients with greater trochanteric pain syndrome not responding to conservative therapy, ultrasonography or magnetic resonance imaging should be considered to evaluate for gluteus medius tendon tears. […] A standing radiograph should be the initial imaging test. […] However, with recent advances to 3-tesla MRI and specialized hip protocols, noncontrast 3-tesla MRI is as sensitive and specific as magnetic resonance arthrography and does not require a procedure for contrast injection. […] Standing anteroposterior radiography of the pelvis is the radiologic test of choice and will show joint space narrowing and osteophyte formation. […] Most hip fractures are visible on a radiograph and require surgical fixation.

• #1 Diagnosis – International Hip Dysplasia Institute

  https://hipdysplasia.org/adults/diagnosis/

  Hip Dysplasia is usually diagnosed by an experienced physician using the combination of symptoms, hip examination, and x-ray findings. […] One study showed that adult patients with hip dysplasia may see more than three healthcare providers and have symptoms for five years before a correct diagnosis is made. […] However, a second opinion may be worthwhile if you have continuing hip pain. […] An x-ray can identify hip dysplasia by the shallow socket (acetabulum), and by displacement of the ball (femoral head) from the socket. […] X-rays can determine the severity of dysplasia, which helps to establish the need for surgery. […] A common measurement for the depth of the socket is the center-edge angle (C-E angle). […] An MRI may also be helpful to diagnose hip dysplasia and give the physician information on any damage to the cartilage and labrum. […] Treatment decisions for adults generally depend on the age of the person, the extent of deterioration of the joint surface and the amount of displacement of the hip from the socket. […] Both of these classifications are helpful to plan total hip replacement.

• #1 Imaging for Hip Pain | Radiology Techniques for Diagnosis

  https://www.hss.edu/conditions_imaging-for-hip-pain.asp

  Ultrasound can also be used to guide procedures such as injections, allowing the doctor doing the procedure to guide a needle exactly where it should go, whether it is a cyst to aspirate, a tendon sheath to inject, or the hip joint itself. […] If the patient responds to a hip injection, it indicates that the pain arises from the hip, explains Dr. Mintz.

• #1 Diagnosis and Management of Hip Pain | OrthoVirginiaSearch

  https://www.orthovirginia.com/blog/diagnosis-and-management-of-hip-pain/

  Rheumatoid arthritis is an inflammatory arthritis where the body’s immune system will attack the hip joint, which can result in an inflamed or swollen joint. […] Post-traumatic arthritis is where somebody has had a broken bone or an injury to their hip, the injury is fixed, and then arthritis develops later. […] Femoroacetabular impingement (FAI) is less known but is very common in the United States. […] Muscle and tendon injuries are often after an acute injury like a fall or after exercise. […] If you have a back condition like lumbar arthritis, nerve impingement or sciatica, these conditions can refer pain to the hip. […] My assessment in the office always starts with a really simple question: where does it hurt? […] Based on those answers, we get x-rays, we may get ultrasound, we may get an MRI. These investigation studies then lead us further towards diagnosing correctly what the problem is so that we can give you the correct treatment plan.

• #1 Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018 | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/54/11/631

  There is no agreement on how to classify, define or diagnose hip-related pain a common cause of hip and groin pain in young and middle-aged active adults. […] The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. […] Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. […] Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential.

• #1 Hip pain – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hip-pain/

  Imaging (e.g., x-ray, MRI): fracture. […] MRI hip: labral tear. […] X-ray hip: narrowing of joint space. […] MRI pelvis: detachment or tear of adductor longus or rectus abdominis. […] X-ray hip: cystic and sclerotic changes in the femoral head. […] MRI hip: visualization of the interface between necrotic and viable bone. […] Targeted antimicrobial therapy for adults with septic arthritis.

• #1 5 Common Causes of Hip Pain in Women | Everyday Health

  https://www.everydayhealth.com/hip-pain/five-common-causes-of-hip-pain-in-women.aspx

  When you tell your doctor your hip hurts, they should first confirm that your hip is actually the problem. […] Chronic hip pain in women is often due to arthritis, particularly osteoarthritis, the wear-and-tear kind that affects many people as they age. […] Hip pain in women can have gynecological causes, Siegrist says. […] Your healthcare provider will determine treatment options based on the cause and your medical history.

• #1 Hip Pain in Adults: Evaluation and Differential Diagnosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33448767/

  In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.

• #1 Approach to the adult with unspecified hip pain – UpToDate

  https://www.uptodate.com/contents/approach-to-the-adult-with-unspecified-hip-pain

  Approach to the adult with unspecified hip pain […] Hip pain is common in adults and often causes functional disability. Among adults who play sports, the incidence of chronic hip pain is 30 to 40 percent; among all adults over 60, the incidence of hip pain is 12 to 15 percent. Hip joint labral injuries and synovitis are common causes of hip pain in younger adults, while trochanteric pain syndrome and osteoarthritis become more common with aging. Important medical causes include referred pain from lumbosacral radiculopathy and aortoiliac arterial insufficiency. […] This topic will provide a general approach to the adult with a chief complaint of hip pain. Evaluation of the athlete and active adult with a likely musculoskeletal cause of hip pain, the diagnosis and treatment of specific disorders of the hip, and evaluation of hip pain in children are all discussed separately. […] Pain is the most common complaint among adults with hip problems. Identifying the location of the hip pain can help narrow the differential diagnoses and direct the history and examination. […] A pain history should be obtained, including: […]

• #1 Mastering the Hip Exam: Top Tests for Hip Pain — ChiroUp

  https://chiroup.com/blog/mastering-the-hip-exam-top-tests-for-hip-pain

  Providers must consider various other potential diagnoses that can affect the region’s bones, joints, cartilage, ligaments, tendons, muscles, and nerves. […] Like most other musculoskeletal complaints, a comprehensive patient history is the primary source of diagnostic information for hip-related issues. […] Key history questions during a hip pain physical exam include: Onset – Traumatic onsets can indicate sprains, labral tears, or fractures. Conversely, non-traumatic hip pain emerges slowly and often signals myofascial, degenerative, or systemic conditions. […] Significant stiffness – Hip osteoarthritis patients commonly report morning stiffness. However, if this stiffness exceeds 30 minutes, it may raise suspicion of inflammatory arthropathy. […] Health history – Conditions such as diabetes, thyroid disorders, vitamin D deficiency, psoriasis, and osteoporosis can increase the risk or serve as potential catalysts for various hip-related issues.

• #1 Mastering the Hip Exam: Top Tests for Hip Pain — ChiroUp

  https://chiroup.com/blog/mastering-the-hip-exam-top-tests-for-hip-pain

  Age – Clinicians must be especially aware of a slipped capital femoral epiphysis in children and early adolescents. Femoroacetabular impingement frequently affects young adults. Avascular necrosis often occurs in middle-aged individuals, whereas conditions such as osteoarthritis and insufficiency fractures are more prevalent among seniors. […] The essential components of a physical exam for hip pain include: Inspection – swelling, deformity, atrophy, Range of motion – active, passive, and resisted movements, General palpation – tenderness, swelling, warmth, muscle wasting, Joint palpation – stability testing, motion palpation, Orthopedic assessment – specific to the differential diagnoses, Functional assessment – hip abductor weakness, lower crossed syndrome, foot hyperpronation, etc. […] A positive C-sign hip pain test strongly suggests a hip-related diagnosis.

• #1 Mastering the Hip Exam: Top Tests for Hip Pain — ChiroUp

  https://chiroup.com/blog/mastering-the-hip-exam-top-tests-for-hip-pain

  The FABER hip test is another generalized screening test that is routinely positive (88%) for most causes of hip pathology. […] Gluteal tendinopathy is among the leading causes of hip pain, yet it is frequently overlooked. […] The Hip Lag Sign demonstrates high sensitivity (89.5%) and specificity (96.6%) for detecting gluteal tendon injury. […] Likewise, the resisted external de-rotation test claims good sensitivity (88%) and specificity (97%) for gluteal tendon pathology. […] Femoroacetabular impingement, an increasingly recognized diagnosis, is particularly prevalent among young, active individuals. […] The FADIR test will typically provoke cam-type FAI. A negative FADIR test is thought to be most useful for ruling out FAI. […] Hip extension and external rotation often provoke pincer-type FAI during the Posterior Impingement FAI test.

• #1 Hip Region Exam, Approach to | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/HipRegionExam.html

  If your patient complains of anterior (sometimes anterior and lateral) thigh pain, the diagnoses may be meralgia paresthetica. This diagnosis is usually caused by entrapment of the lateral femoral cutaneous nerve as it passes under the inguinal ligament and supplies the sensory distribution of the anterior/lateral thigh. […] The diagnosis of greater trochanteric bursitis is diagnosed by asking the patient to lay on the side (painful side up) and palpating over the burse of the greater trochanter. Tenderness should be appreciated. […] Pain in the sacroiliac joint can be elicited with the FAbER Test. FAbER stands for Flexion, Abduction and External Rotation. Once the leg is flexed, abducted and externally rotated, you will apply a downward pressure at the knee. The presence of pain in the posterior (or buttocks) region suggests pain from the sacroiliac joint. […] Tests for piriformis syndrome are attempting to move the leg so that the piriformis muscle pushes against the sciatic nerve leading to pain and thus a positive test.

• #1 Hip Pain Diagnosis Chart

  https://www.kneepaincentersofamerica.com/blog/hip-pain-diagnosis-chart

  Identifying the exact source of hip pain is paramount, as conditions can often mimic one another. Patients may experience pain due to various bone or soft tissue conditions, such as arthritis or tendon injuries, with symptoms frequently leading to misdiagnosis. […] Imaging techniques like X-rays and MRIs play a vital role in revealing underlying problems. While X-rays provide insight into bone structure, MRIs excel in detailing soft tissue damages. Accurate imaging is essential, particularly because abnormalities on an image might not correlate directly with reported pain, highlighting the need for comprehensive evaluations. […] To effectively diagnose hip pain, physical examinations are crucial. These exams typically begin with a detailed history, focusing on the patient’s symptoms, prior injuries, and activity levels. Specific tests, such as the Stinchfield test, evaluate pain during resisted hip flexion, while the Trendelenburg sign assesses gait stability. Additionally, tests like the log rolling and compression techniques help identify possible hip fractures or muscle injuries.

• #1 Assessing Adult Hip Problems

  https://ganapathihipkneesurgeon.com/assessing-adult-hip-problems/

  The three main symptoms which can arise from a hip problem are pain, mechanical symptoms and stiffness. […] Vast majority of the hip problems present as pain. However, it can be quite difficult to be sure that the hip is the source of pain as the hip joint is deep seated and pain around the hip joint can be produced from a multitude of sources apart from the hip joint itself. Moreover two problems can co-exist (for example back pain and hip pain). […] Pain from the hip joint is usually felt in the groin area. However, the pain from the hip joint may also be felt as pain over the anterior thigh and also to the front of the knee. […] Hence the important for examining the hip joint in all cases of knee pain. […] As the hip joint is deep seated, it is difficult for the patient to point to the area of pain. One of the common ways a hip joint pain is described by the patient is by the C sign (the patient places the fingers in front of the hip and the thumb over the lateral aspect).

• #1 Differential Diagnosis Of Hip Pain — Physio Network

  https://www.physio-network.com/blog/differential-diagnosis-hip-pain/

  The evidence-based assessment consists of four parts: […] The following is not an exhaustive assessment, but will give the clinician some guidance about key components specific to younger adults presenting with hip and groin pain. […] Pain location can greatly assist in diagnosing the clinical entity involved. […] Red flag screening is critical for people with hip pain. […] The lumbar spine and pelvis can often refer pain to the hip and groin region. […] Components of an objective assessment and imaging can aid the physiotherapist in coming to a diagnosis, but cannot do so in isolation. […] Most diagnostic tests assist in ruling out a specific diagnosis than ruling in a condition. […] The Flexion-Adduction-Internal Rotation test (FADIR) test has high sensitivity and low specificity. […] A positive test does not assist in diagnosis. […] Hopefully this blog has provided you with some useful insights into how to differentially diagnose hip pain in young adults, allowing you to be more confident and accurate in your clinical assessment.

• #1 Osteoarthritis: Symptoms, Diagnosis, and Treatment | Arthritis Foundation

  https://www.arthritis.org/diseases/osteoarthritis

  Medical history, a physical examination and lab tests help to make up the OA diagnosis. […] A primary care doctor may be the first person you talk to about joint pain. The doctor will review your medical history, symptoms, how the pain affects activities, as well as your medical problems and medication use. He or she will also look at and move your joints, and may order imaging. These tests help to make the diagnosis: […] Joint aspiration. After numbing the area, a needle is inserted into the joint to pull out fluid. This test will look for infection or crystals in the fluid to help rule out other medical conditions or other forms of arthritis. […] X-ray. X-rays can show joint or bone damage or changes related to osteoarthritis. […] MRI. Magnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint.

• #1 Hip pain | Causes, exercises, treatments | Versus Arthritis

  https://versusarthritis.org/about-arthritis/conditions/hip-pain/

  If your hip pain hasn’t improved after two weeks you should see your doctor. […] Your doctor will ask about your pain and what movements make it feel worse. […] They’ll examine your hip to find out how well it moves, and this will usually give them enough information to plan your treatment. But you may need other tests to diagnose some conditions. […] X-rays are often the best way of finding out what’s wrong with your hip as they show the condition of the bones. […] A CT (computerised tomography) scan can often be very helpful to work out if the hip joint has an unusual shape. […] MRI (magnetic resonance imaging) scans use radio waves to build a picture to show what’s happening to the soft tissue, such as the muscles and tendons, inside your hip. […] If your doctor thinks your pain is caused by an infection or rheumatoid arthritis, blood tests can often help.

• #1 Hip pain in adults

  https://www.nhs.uk/conditions/hip-pain/

  Hip pain is common, especially as you get older. There are things you can do to ease the pain, but get medical help if your hip is very painful or the pain does not get better. […] Your symptoms might give you an idea what could be causing the pain. But do not self-diagnose, see a GP if you’re worried. […] Non-urgent advice: See a GP if: hip pain is stopping you doing normal activities or affecting your sleep; the pain is getting worse or keeps coming back; the pain has not improved after treating it at home for 2 weeks; you have hip stiffness for more than 30 minutes after waking up. […] Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if: you have severe hip pain that started suddenly but you’ve not had a fall or injured your hip; your hip is swollen and feels hot; the skin around your hip has changed colour; you have hip pain and feel generally unwell and have a high temperature or feel hot and shivery.

• #1 Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018 | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/54/11/631

  A negative flexion adduction internal rotation test helps rule out hip-related pain although its clinical utility is limited. […] Anteroposterior pelvis and lateral femoral head neck radiographs are the initial diagnostic imaging of choice advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). […] The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice.

• #1 Common Hip Injuries – Weiss Memorial Hospital

  https://www.weisshospital.com/our-services/orthopedics/hip-care/common-hip-injuries/

  Hip injuries are extremely common in people of all ages. […] The specialists at the Chicago Center for Orthopedics administer thorough tests and examinations to properly identify and diagnose the source of the pain and follow up with the appropriate plan of action. […] Symptoms of a labral tear include sharp pain in the groin, thigh or leg, stiffness, “popping,” and decrease in range of motion. […] If untreated, AVN may eventually result in collapse of the bone. […] Treatment options include cortisone injections, PRP injections, physical therapy or stretching. […] If bursitis does not resolve with these measures, arthroscopic surgery may be used to remove the painful bursa. […] If undetected and/or untreated, gluteus medius tears may cause severe persistent pain. […] Chronic instability may arise from overuse of the hip joint.

• #1 Hip pain in adults

  https://www.nhs.uk/conditions/hip-pain/

  Treatment for hip pain depends on what’s causing it. […] A GP might: prescribe stronger painkillers; give you some simple exercises to try; refer you for physiotherapy for more help with exercises and stretches to ease the pain; refer you for occupational therapy an occupational therapist can help with things to make your life easier, such as walking sticks or walking aids; refer you to a specialist the specialist may do a scan and discuss treatments such as steroid injections or surgery. […] Some people with pain caused by a damaged hip joint may eventually need a hip replacement if other treatments do not help.

• #1 Hip Pain In Young Adults – New York Bone & Joint Specialists

  https://nyboneandjoint.com/hip-pain-in-young-adults/

  Hip pain in young adults (16-50 years of age) is a very common condition in sports-active individuals. Any persistent hip pain in young adults is not normal and should be evaluated by a doctor. […] A diagnosis can be made by physical exam, X-rays and MRI of hip (arthrogram/regular MRI). […] Early diagnosis and treatment is very important to prevent cartilage damage, joint deterioration and arthritis in future. […] Non-surgical treatment involves targeted physical therapy and activity modification which may show some improvement in mild FAI (femoroacetabular impingement) patients or patients with trochanteric bursitis or milder type of muscular or tendon strain. […] Surgical treatment involves arthroscopy and repair for labral tears, osteotomy for hip dysplasia, core decompressions for AVN, tendon repair, if torn, and replacement for patients with advanced arthritis. […] Rehab and physical therapy after surgery is very important to return full strength and range of motion of the joint to return to preinjury level of sports activities.

• #1 Hip Pain: Causes, Diagnosis, and Treatment Options – Orthopedic Centers of Colorado

  https://occ-ortho.com/hip-pain-causes-diagnosis-and-treatment-options/

  Hip pain can be both frustrating and limiting, impacting your ability to perform daily activities and enjoy life to the fullest. […] Understanding the causes of hip pain, how it is diagnosed, and the treatment options available can make a significant difference in managing symptoms and improving quality of life. […] Accurate diagnosis is essential to developing an effective treatment plan for hip pain. […] The diagnostic process often begins with a thorough medical history, including questions about the onset, duration, and nature of your pain. […] To get a clearer picture of what’s happening inside the hip joint, imaging studies are commonly used, including X-rays, MRI scans, CT scans, and ultrasound. […] In cases where hip pain may be due to an inflammatory condition like rheumatoid arthritis, lab tests can be helpful. […] If there is suspected infection or inflammation in the hip joint, your physician may perform joint aspiration, a procedure where fluid is drawn from the joint for testing.

• #1 Diagnosis – Hip Dysplasia Life

  https://www.hipdysplasialife.org/diagnosis

  Some people are diagnosed with hip dysplasia as an infant and have a series of interventions as children and young adults. […] For others, hip dysplasia isnt diagnosed until symptoms occur much later, in their twenties, thirties or beyond. […] For those not diagnosed as children, the journey to a diagnosis as an adult can be lengthy and at times, very frustrating. […] People with hip dysplasia can have many consultations with different health care professionals before a diagnosis of hip dysplasia is eventually given. […] In a study with 97 people diagnosed with hip dysplasia in adulthood, 22 had received a diagnosis and began some form of treatment within 12 months, while the majority (75) had experienced a late/delayed diagnosis and thus delayed treatment. […] Although the aim of the study was not to identify the reasons for delayed diagnosis, the authors conclude that hip dysplasia is an under-recognised condition – in both the general public and among doctors.

• #1 Navigating Hip and Low Back Pain With Differential Diagnosis

  https://www.chicagostemcells.com/blog/navigating-hip-and-low-back-pain-with-differential-diagnosis/?bp=39040

  Hip pain and lower back pain affect a significant portion of the population. […] Diagnosing the cause of hip or lower back pain can be challenging because various conditions and injuries can cause it. Differential diagnosis helps doctors more accurately pinpoint the underlying condition causing hip or lower back pain. […] Hip pain and low back pain often share similar symptoms. Both can cause discomfort in the hip region, and the pain might radiate to the lower back or vice versa. This overlap makes it difficult for patients and doctors alike to identify the source of the problem. […] To accurately diagnose the cause of hip and lower back pain, doctors use a method called differential diagnosis. This approach involves systematically ruling out other conditions that share your symptoms until they can be sure which disease or injury is causing your hip or lower back pain. […] Through differential diagnosis, doctors can accurately diagnose the source of pain. This approach ensures that the treatment plan is tailored to the actual problem, improving patients’ chances of finding lasting relief from hip pain, low back pain or a combination of both.

• #1 Evaluation and management of hip pain: An algorithmic approach | MDedge

  https://ma1.mdedge.com/content/evaluation-and-management-hip-pain-algorithmic-approach

  Lateral hip pain is usually associated with greater trochanteric pain syndrome, iliotibial band syndrome, or meralgia paresthetica. […] Posterior hip pain is the least common pain pattern, and it usually suggests a source outside the hip joint. […] The American Academy of Orthopaedic Surgeons created a clinical guideline on the evaluation of hip pain. […] In general, osteoarthritis and trochanteric bursitis are more common in older, less active patients, whereas stress fractures, iliopsoas strain or bursitis, and iliotibial band syndrome are more common in athletes. […] With any adult who has acute hip pain, be alert for red flags that may indicate a more serious medical condition as the source of pain. […] When hip pain is refractory to conventional treatment, consider referral to a specialist, such as a sports medicine specialist, physiatrist, rheumatologist, or orthopedic surgeon.

• #1 Hip Pain Diagnosis | Memorial Hermann

  https://memorialhermann.org/services/conditions/hip-pain-and-injuries/hip-pain-diagnosis

  Memorial Hermann orthopedic specialists use a combination of questions, tests and imaging tools to determine the reason for your current pain and the root cause of the problem. […] As with most conditions, early diagnosis and treatment of hip pain usually equates to a better outcome. […] If you have severe pain following an injury or have chronic hip joint pain, it is time for Plan B: see a board-certified specialist who has specific experience in hip joint treatment. […] To isolate the cause of your hip pain, your orthopedist will ask you questions about your relevant personal and family medical history, and questions about your current pain, to learn: […] Your orthopedist will check your range of motion and assess what movements give you discomfort or pain. […] Vital to most diagnoses is a visual image inside the joint. X-rays, CT scans and MRI’s may be used to check for hip alignment, space between bones, bone structure abnormalities and the presence of bone spurs.

• #2 Hip Pain in Adults: Evaluation and Differential Diagnosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33448767/

  In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.

• #2 Hip Pain in Adults: Evaluation and Differential Diagnosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33448767/

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy.

• #2 Differential Diagnosis Of Hip Pain — Physio Network

  https://www.physio-network.com/blog/differential-diagnosis-hip-pain/

  Hip pain is complicated, with many possible and sometimes overlapping sources of pain making diagnosis a challenge. […] This blog will provide a guide for physiotherapists to perform an evidence-based assessment for the diagnosis of the source of hip pain in younger adults. […] Three recent consensus agreements have provided clear advice on how to classify hip or groin pain. […] The Zurich agreement then described hip-related pain as having three likely sources: 1. Femoroacetabular Impingement (FAI) Syndrome; 2. Acetabular dysplasia/hip instability; and 3. Other sources of pain without abnormal bony shape (e.g. cartilage or labral tears). […] The Warwick agreement on FAI syndrome stated that a diagnosis of FAI syndrome required the presence of symptoms, signs and positive imaging findings.

• #2 Evaluation and management of hip pain: An algorithmic approach | MDedge

  https://ma1.mdedge.com/content/evaluation-and-management-hip-pain-algorithmic-approach

  Lateral hip pain is usually associated with greater trochanteric pain syndrome, iliotibial band syndrome, or meralgia paresthetica. […] Posterior hip pain is the least common pain pattern, and it usually suggests a source outside the hip joint. […] The American Academy of Orthopaedic Surgeons created a clinical guideline on the evaluation of hip pain. […] In general, osteoarthritis and trochanteric bursitis are more common in older, less active patients, whereas stress fractures, iliopsoas strain or bursitis, and iliotibial band syndrome are more common in athletes. […] With any adult who has acute hip pain, be alert for red flags that may indicate a more serious medical condition as the source of pain. […] When hip pain is refractory to conventional treatment, consider referral to a specialist, such as a sports medicine specialist, physiatrist, rheumatologist, or orthopedic surgeon.

• #2 Differential Diagnosis Of Hip Pain — Physio Network

  https://www.physio-network.com/blog/differential-diagnosis-hip-pain/

  The evidence-based assessment consists of four parts: […] The following is not an exhaustive assessment, but will give the clinician some guidance about key components specific to younger adults presenting with hip and groin pain. […] Pain location can greatly assist in diagnosing the clinical entity involved. […] Red flag screening is critical for people with hip pain. […] The lumbar spine and pelvis can often refer pain to the hip and groin region. […] Components of an objective assessment and imaging can aid the physiotherapist in coming to a diagnosis, but cannot do so in isolation. […] Most diagnostic tests assist in ruling out a specific diagnosis than ruling in a condition. […] The Flexion-Adduction-Internal Rotation test (FADIR) test has high sensitivity and low specificity. […] A positive test does not assist in diagnosis. […] Hopefully this blog has provided you with some useful insights into how to differentially diagnose hip pain in young adults, allowing you to be more confident and accurate in your clinical assessment.

• #2 Evaluation of the Patient with Hip Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0101/p27.html

  Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. […] A history and physical examination are essential to accurately diagnose the cause of hip pain. […] Initial plain radiography of the hip should include an anteroposterior view of the pelvis and a frog-leg lateral view of the symptomatic hip. […] Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. […] Magnetic resonance arthrography is the diagnostic test of choice for labral tears. […] MRI is useful for the detection of occult traumatic fractures and stress fractures not seen on plain radiographs. […] MRI is useful for differentiating septic arthritis from transient synovitis. […] Magnetic resonance arthrography provides added sensitivity of 90% and accuracy of 91% for the detection of labral tears.

• #2 Diagnosis – International Hip Dysplasia Institute

  https://hipdysplasia.org/adults/diagnosis/

  Hip Dysplasia is usually diagnosed by an experienced physician using the combination of symptoms, hip examination, and x-ray findings. […] One study showed that adult patients with hip dysplasia may see more than three healthcare providers and have symptoms for five years before a correct diagnosis is made. […] However, a second opinion may be worthwhile if you have continuing hip pain. […] An x-ray can identify hip dysplasia by the shallow socket (acetabulum), and by displacement of the ball (femoral head) from the socket. […] X-rays can determine the severity of dysplasia, which helps to establish the need for surgery. […] A common measurement for the depth of the socket is the center-edge angle (C-E angle). […] An MRI may also be helpful to diagnose hip dysplasia and give the physician information on any damage to the cartilage and labrum. […] Treatment decisions for adults generally depend on the age of the person, the extent of deterioration of the joint surface and the amount of displacement of the hip from the socket. […] Both of these classifications are helpful to plan total hip replacement.

• #2 Hip pain – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hip-pain/

  Imaging (e.g., x-ray, MRI): fracture. […] MRI hip: labral tear. […] X-ray hip: narrowing of joint space. […] MRI pelvis: detachment or tear of adductor longus or rectus abdominis. […] X-ray hip: cystic and sclerotic changes in the femoral head. […] MRI hip: visualization of the interface between necrotic and viable bone. […] Targeted antimicrobial therapy for adults with septic arthritis.

• #2 Diagnosing Hip Pain: From the HSS Hip Preservation Service

  https://www.hss.edu/hip-pain-center-diagnosis.asp

  The right hip pain diagnosis is essential to obtaining the right care. […] Both a physical examination and radiological examinations are conducted to diagnose hip joint pain. […] Medical imaging, including X-rays and magnetic resonance imaging (MRI), is crucial in diagnosing hip pain. […] If the pain is coming from the hip joint, the injection provides the patient with pain relief and confirms the diagnosis of hip pain. […] Although patients may have undergone tests prior to arriving at HSS, additional tests using the our advanced equipment may reveal conditions or problems previously unseen. […] X-rays (radiographs) are the most universal and often used diagnostic imaging technique. […] MRI is a diagnostic test that depicts both soft tissue and bone. […] CT stands for Computed Tomography, a type of X-ray examination that obtains digital images of the body using a thin X-ray beam to produce a more detailed, cross-sectional image of the body.

• #2 Hip pain | Causes, exercises, treatments | Versus Arthritis

  https://versusarthritis.org/about-arthritis/conditions/hip-pain/

  If your hip pain hasn’t improved after two weeks you should see your doctor. […] Your doctor will ask about your pain and what movements make it feel worse. […] They’ll examine your hip to find out how well it moves, and this will usually give them enough information to plan your treatment. But you may need other tests to diagnose some conditions. […] X-rays are often the best way of finding out what’s wrong with your hip as they show the condition of the bones. […] A CT (computerised tomography) scan can often be very helpful to work out if the hip joint has an unusual shape. […] MRI (magnetic resonance imaging) scans use radio waves to build a picture to show what’s happening to the soft tissue, such as the muscles and tendons, inside your hip. […] If your doctor thinks your pain is caused by an infection or rheumatoid arthritis, blood tests can often help.

• #2

  https://www.aurorahealthcare.org/services/orthopedics/conditions/hip-bursitis

  Bursitis symptoms include pain that may radiate throughout the hip, thigh and buttock. To confirm that the cause of the pain is bursitis, your doctor will do a complete physical exam and ask you about how and when the pain began. […] Sometimes, your doctor will order an X-ray or MRI (magnetic resonance imaging) scan, too, to verify that the pain is due to bursitis and not a fracture or other problem.

• #2 Imaging for Hip Pain | Radiology Techniques for Diagnosis

  https://www.hss.edu/conditions_imaging-for-hip-pain.asp

  Ultrasound can also be used to guide procedures such as injections, allowing the doctor doing the procedure to guide a needle exactly where it should go, whether it is a cyst to aspirate, a tendon sheath to inject, or the hip joint itself. […] If the patient responds to a hip injection, it indicates that the pain arises from the hip, explains Dr. Mintz.

• #2 Hip pain – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hip-pain/

  Hip pain can be a diagnostic challenge due to its diverse etiologies and potential for significant morbidity. […] Clinical assessment should include details of the hip pain (e.g., onset, duration, and exacerbating symptoms) and a focused examination of the hip. Most patients presenting with hip pain should be initially evaluated with x-rays of both hip and pelvis, with additional testing based on clinical suspicion. Management is based on the underlying cause. […] Studies are based on clinical suspicion and may include the following: […] Imaging may not be required for patients with acute hip pain and a clear clinical diagnosis based on history and physical examination. […] CBC and ESR: assessment for inflammation or infection. […] Provide immediate inpatient care to patients with fractures or infection.

• #2 Evaluation and management of hip pain: An algorithmic approach | MDedge

  https://ma1.mdedge.com/content/evaluation-and-management-hip-pain-algorithmic-approach

  Start by determining whether pain is located in the anterior, lateral, or posterior hip. As the site varies, so does the etiology. […] Physical examination tests that elucidate range of motion, muscle strength, and pain replication will narrow the diagnostic search. […] Magnetic resonance imaging is usually diagnostic if plain x-rays and conservative therapy are ineffective. […] In the work-up of hip pain, the first fact to establish is whether pain is felt in the anterior, lateral, or posterior part of the hip. Each location suggests a distinctive set of possible underlying causes. […] Anterior hip pain, which is the most common, usually indicates pathology of the hip joint (ie, degenerative arthritis), hip flexor muscle strains or tendonitis, and iliopsoas bursitis. […] In a study of subjects older than 40 years who experienced a new episode of hip pain, 44% had evidence of osteoarthritis.

• #2 Diagnosing Hip Impingement

  https://www.sports-health.com/sports-injuries/hip-injuries/diagnosing-hip-impingement

  Only a medical professional can diagnose hip impingement. A doctor can make this diagnosis after conducting a physical exam, ordering medical imaging (such as x-rays), and ruling out other problems. […] A case of hip impingement cannot be definitively diagnosed without medical imaging, such as x-rays and/or an MRI. […] An x-ray or MRI may show bone abnormalities that are indicative of hip impingement but, for reasons that are not well understood, those changes do not cause impingement during movement. […] A physician will consider all possible diagnoses.

• #2 Common Hip Injuries – Weiss Memorial Hospital

  https://www.weisshospital.com/our-services/orthopedics/hip-care/common-hip-injuries/

  Hip injuries are extremely common in people of all ages. […] The specialists at the Chicago Center for Orthopedics administer thorough tests and examinations to properly identify and diagnose the source of the pain and follow up with the appropriate plan of action. […] Symptoms of a labral tear include sharp pain in the groin, thigh or leg, stiffness, “popping,” and decrease in range of motion. […] If untreated, AVN may eventually result in collapse of the bone. […] Treatment options include cortisone injections, PRP injections, physical therapy or stretching. […] If bursitis does not resolve with these measures, arthroscopic surgery may be used to remove the painful bursa. […] If undetected and/or untreated, gluteus medius tears may cause severe persistent pain. […] Chronic instability may arise from overuse of the hip joint.

• #2 Hip Dysplasia in Adults | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/hip-dysplasia-in-adults.php

  Usually, hip dysplasia presents in adolescents or adults with pain and possibly a limp. Most often, deep pain is experienced in the groin or the side or back of the hip. […] Definitive diagnosis of hip dysplasia requires X-rays and sometimes an MRI. The condition is identified by a shallow hip socket. On some occasions, hip dysplasia is diagnosed accidentally during an imaging examination administered for another reason.

• #2 Hip Pain in Adults: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p81.html

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. […] In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. […] If imaging is performed in the evaluation of a patient with undifferentiated chronic hip pain, standing anteroposterior hip and pelvic radiographs should be the first choice. […] For patients with anterior hip pain and history suggestive of a labral tear, stress fracture of the femoral neck, or early avascular necrosis, magnetic resonance imaging should be performed for accurate diagnosis. […] For intra-articular pain, ultrasound-guided anesthetic injection of the hip may be diagnostic, and corticosteroid injection may be therapeutic.

• #2 Think that hip pain is bursitis? Think again. – Harvard Health

  https://www.health.harvard.edu/pain/think-that-hip-pain-is-bursitis-think-again

  Hip bursitis an inflammation between your thighbone and nearby tendons is commonly diagnosed when patients have pain on the outer side of the hip. However, several other conditions can cause similar pain, and require different treatments. „Doctors often assume that pain on the outer side of the hip is due to bursitis. But 90% of the time, it’s not bursitis,” says Dr. Lauren Elson, a physiatrist with Harvard-affiliated Massachusetts General Hospital. […] You may need to seek treatment from a primary care physician or specialist (such as a physiatrist, sports medicine specialist, or physical therapist) who can interpret your symptoms and imaging tests to determine the cause of pain on the side of your hip. […] „Pain almost always goes away with targeted exercise and stretching,” says Dr. Elson. […] „Pain comes on because of an imbalance from tight or weak muscles,” Dr. Elson says. „If you can restore balance, you can help the body function better and eliminate pain.”

• #2 Mastering the Hip Exam: Top Tests for Hip Pain — ChiroUp

  https://chiroup.com/blog/mastering-the-hip-exam-top-tests-for-hip-pain

  The FABER hip test is another generalized screening test that is routinely positive (88%) for most causes of hip pathology. […] Gluteal tendinopathy is among the leading causes of hip pain, yet it is frequently overlooked. […] The Hip Lag Sign demonstrates high sensitivity (89.5%) and specificity (96.6%) for detecting gluteal tendon injury. […] Likewise, the resisted external de-rotation test claims good sensitivity (88%) and specificity (97%) for gluteal tendon pathology. […] Femoroacetabular impingement, an increasingly recognized diagnosis, is particularly prevalent among young, active individuals. […] The FADIR test will typically provoke cam-type FAI. A negative FADIR test is thought to be most useful for ruling out FAI. […] Hip extension and external rotation often provoke pincer-type FAI during the Posterior Impingement FAI test.

• #2 Diagnosis and Management of Hip Pain | OrthoVirginiaSearch

  https://www.orthovirginia.com/blog/diagnosis-and-management-of-hip-pain/

  Rheumatoid arthritis is an inflammatory arthritis where the body’s immune system will attack the hip joint, which can result in an inflamed or swollen joint. […] Post-traumatic arthritis is where somebody has had a broken bone or an injury to their hip, the injury is fixed, and then arthritis develops later. […] Femoroacetabular impingement (FAI) is less known but is very common in the United States. […] Muscle and tendon injuries are often after an acute injury like a fall or after exercise. […] If you have a back condition like lumbar arthritis, nerve impingement or sciatica, these conditions can refer pain to the hip. […] My assessment in the office always starts with a really simple question: where does it hurt? […] Based on those answers, we get x-rays, we may get ultrasound, we may get an MRI. These investigation studies then lead us further towards diagnosing correctly what the problem is so that we can give you the correct treatment plan.

• #2 5 Common Causes of Hip Pain in Women – Michigan Spine & Pain

  https://michiganspineandpain.com/5-common-causes-of-hip-pain-in-women/

  When you tell your doctor your hip hurts, the first thing he should do is confirm that your hip is actually the problem. […] Hip pain in women can have gynecological causes and its important not to just assume the pain is caused by arthritis, bursitis or tendinitis. […] Treatment for hip pain depends on the diagnosis, but pain caused by overuse or sports injury is often treated with heat, rest and over-the-counter anti-inflammatory medication. […] If your hip pain persists, come in and lets discuss the possible causes and treatment options.

• #2 Hip Pain in Adults: Evaluation and Differential Diagnosis – Minuti

  https://www.fondazionemenarini-minuti.com/scienza/numero-248-en/la-coxalgia-negli-adulti-valutazione-e-diagnosi-differenziale/?lang=en

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. […] In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. […] Radiography of the hip and pelvis should be the initial imaging test. […] Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. […] Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.

• #2 Diagnosis – Hip Dysplasia Life

  https://www.hipdysplasialife.org/diagnosis

  Some people are diagnosed with hip dysplasia as an infant and have a series of interventions as children and young adults. […] For others, hip dysplasia isnt diagnosed until symptoms occur much later, in their twenties, thirties or beyond. […] For those not diagnosed as children, the journey to a diagnosis as an adult can be lengthy and at times, very frustrating. […] People with hip dysplasia can have many consultations with different health care professionals before a diagnosis of hip dysplasia is eventually given. […] In a study with 97 people diagnosed with hip dysplasia in adulthood, 22 had received a diagnosis and began some form of treatment within 12 months, while the majority (75) had experienced a late/delayed diagnosis and thus delayed treatment. […] Although the aim of the study was not to identify the reasons for delayed diagnosis, the authors conclude that hip dysplasia is an under-recognised condition – in both the general public and among doctors.

• #2 Hip pain in adults

  https://www.nhs.uk/conditions/hip-pain/

  Treatment for hip pain depends on what’s causing it. […] A GP might: prescribe stronger painkillers; give you some simple exercises to try; refer you for physiotherapy for more help with exercises and stretches to ease the pain; refer you for occupational therapy an occupational therapist can help with things to make your life easier, such as walking sticks or walking aids; refer you to a specialist the specialist may do a scan and discuss treatments such as steroid injections or surgery. […] Some people with pain caused by a damaged hip joint may eventually need a hip replacement if other treatments do not help.

• #2 Mastering the Hip Exam: Top Tests for Hip Pain — ChiroUp

  https://chiroup.com/blog/mastering-the-hip-exam-top-tests-for-hip-pain

  Providers must consider various other potential diagnoses that can affect the region’s bones, joints, cartilage, ligaments, tendons, muscles, and nerves. […] Like most other musculoskeletal complaints, a comprehensive patient history is the primary source of diagnostic information for hip-related issues. […] Key history questions during a hip pain physical exam include: Onset – Traumatic onsets can indicate sprains, labral tears, or fractures. Conversely, non-traumatic hip pain emerges slowly and often signals myofascial, degenerative, or systemic conditions. […] Significant stiffness – Hip osteoarthritis patients commonly report morning stiffness. However, if this stiffness exceeds 30 minutes, it may raise suspicion of inflammatory arthropathy. […] Health history – Conditions such as diabetes, thyroid disorders, vitamin D deficiency, psoriasis, and osteoporosis can increase the risk or serve as potential catalysts for various hip-related issues.

• #2 Hip Pain Diagnosis | Memorial Hermann

  https://memorialhermann.org/services/conditions/hip-pain-and-injuries/hip-pain-diagnosis

  Memorial Hermann orthopedic specialists use a combination of questions, tests and imaging tools to determine the reason for your current pain and the root cause of the problem. […] As with most conditions, early diagnosis and treatment of hip pain usually equates to a better outcome. […] If you have severe pain following an injury or have chronic hip joint pain, it is time for Plan B: see a board-certified specialist who has specific experience in hip joint treatment. […] To isolate the cause of your hip pain, your orthopedist will ask you questions about your relevant personal and family medical history, and questions about your current pain, to learn: […] Your orthopedist will check your range of motion and assess what movements give you discomfort or pain. […] Vital to most diagnoses is a visual image inside the joint. X-rays, CT scans and MRI’s may be used to check for hip alignment, space between bones, bone structure abnormalities and the presence of bone spurs.

• #2 Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018 | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/54/11/631

  A negative flexion adduction internal rotation test helps rule out hip-related pain although its clinical utility is limited. […] Anteroposterior pelvis and lateral femoral head neck radiographs are the initial diagnostic imaging of choice advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). […] The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice.

• #2 Mastering the Hip Exam: Top Tests for Hip Pain — ChiroUp

  https://chiroup.com/blog/mastering-the-hip-exam-top-tests-for-hip-pain

  Age – Clinicians must be especially aware of a slipped capital femoral epiphysis in children and early adolescents. Femoroacetabular impingement frequently affects young adults. Avascular necrosis often occurs in middle-aged individuals, whereas conditions such as osteoarthritis and insufficiency fractures are more prevalent among seniors. […] The essential components of a physical exam for hip pain include: Inspection – swelling, deformity, atrophy, Range of motion – active, passive, and resisted movements, General palpation – tenderness, swelling, warmth, muscle wasting, Joint palpation – stability testing, motion palpation, Orthopedic assessment – specific to the differential diagnoses, Functional assessment – hip abductor weakness, lower crossed syndrome, foot hyperpronation, etc. […] A positive C-sign hip pain test strongly suggests a hip-related diagnosis.

• #2 Imaging evaluation of the painful hip in adults – UpToDate

  https://www.uptodate.com/contents/imaging-evaluation-of-the-painful-hip-in-adults

  Imaging evaluation of the painful hip in adults […] Imaging modalities used to evaluate adults with hip pain and the appropriateness of particular exams in different clinical scenarios will be reviewed here. […] The modalities available for evaluation of the hip include: […] Plain film radiography of the hip is used in the initial evaluation of any cause of hip pain, including trauma and sports injuries, suspected avascular necrosis (AVN), arthritis, hip arthroplasty, infection, dysplasia, tumor, and microinstability. […] Computerized tomography (CT) of the hip without contrast is most useful in the setting of trauma, for preoperative planning, and for evaluation and guiding percutaneous biopsy of tumors.

• #2 Hip Pain: Causes, Diagnosis, and Treatment Options – Orthopedic Centers of Colorado

  https://occ-ortho.com/hip-pain-causes-diagnosis-and-treatment-options/

  Hip pain can be both frustrating and limiting, impacting your ability to perform daily activities and enjoy life to the fullest. […] Understanding the causes of hip pain, how it is diagnosed, and the treatment options available can make a significant difference in managing symptoms and improving quality of life. […] Accurate diagnosis is essential to developing an effective treatment plan for hip pain. […] The diagnostic process often begins with a thorough medical history, including questions about the onset, duration, and nature of your pain. […] To get a clearer picture of what’s happening inside the hip joint, imaging studies are commonly used, including X-rays, MRI scans, CT scans, and ultrasound. […] In cases where hip pain may be due to an inflammatory condition like rheumatoid arthritis, lab tests can be helpful. […] If there is suspected infection or inflammation in the hip joint, your physician may perform joint aspiration, a procedure where fluid is drawn from the joint for testing.

• #2 HIP PAIN IN THE ACTIVE ADULT: WHAT CAN BE DONE? – Orthopedic One

  https://www.orthopedicone.com/news-events/hip-pain-in-the-active-adult-what-can-be-done/

  Hip pain can vary from an occasional annoyance to a debilitating problem. […] This article focuses on the nagging hip pain that plagues so many young (teens to early fifties) active individuals. […] Patients usually seek medical attention at some point and to the untrained eye, will have a relatively normal looking x-ray. […] An orthopaedic hip preservation specialist should evaluate this type of patient. To diagnose the exact problem will consist of scrutinizing the x-rays (bone evaluation) and sometimes MRI of the hip to evaluate cartilage and soft tissue inside and around the hip. […] The two most common diagnoses are femoroacetabular impingement (FAI) with or without a labral tear, and hip dysplasia. […] FAI is a condition in which the hip joints have malformations causing the femoral head (ball) and the acetabulum (socket) to rub or come into abnormal contact with each other at extremes of motion causing damage to the cartilage or the labrum (a spongy bumper-like tissue).

• #2 Hip Arthritis: Causes, Symptoms & Treatment Options

  https://my.clevelandclinic.org/health/diseases/hip-arthritis

  Diagnosing hip arthritis begins with a survey of your symptoms and a physical examination of your hip joint. A healthcare provider will test your range of motion and your pain levels and observe how you walk. Then, theyll take X-rays to look for signs of swelling, erosion or other degenerative changes in your joint. If they suspect inflammatory arthritis, you might have blood tests to check for certain indicators. […] The best treatment for hip arthritis depends on the type and how severe it is. Regardless of the type, healthcare providers usually start by recommending conservative therapies and lifestyle changes. […] When conservative treatments fail, hip replacement surgery can reliably eliminate the symptoms of hip osteoarthritis.

• #2 HIP PAIN IN THE ACTIVE ADULT: WHAT CAN BE DONE? – Orthopedic One

  https://www.orthopedicone.com/news-events/hip-pain-in-the-active-adult-what-can-be-done/

  The other diagnosis that can cause hip pain in younger patients is hip dysplasia. […] A dysplastic hip can function for many years without symptoms and the timing of ones symptoms can vary from patient to patient. […] As in FAI, the longer this process is left untreated the higher likelihood that early arthritis will develop and ultimately need a total hip replacement. […] Treatment for acetabular dysplasia is a surgical procedure called a periacetabular osteotomy or PAO. […] If you feel as though you experience these hip symptoms, please contact an orthopaedic surgeon to discuss your options and further details.

• #2 Hip Dysplasia | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hip-dysplasia

  Hip dysplasia is a treatable condition. However, if left untreated, it can cause irreversible damage that will cause pain and loss of function later in life. […] Therefore, monitoring and early intervention are both important to reduce a child’s risk of pain and disability in adulthood. […] The condition ranges from a mild abnormality of the hip socket to a complete dislocation of the hip. As children become more active and demand more of their legs, the ill-fitting hip joint becomes unstable. The instability damages cartilage inside the joint that becomes increasingly painful over time. […] It is important not to ignore hip pain. Hip dysplasia is a treatable condition but early diagnosis and treatment are critical to preventing irreversible damage. […] Doctors typically use a variety of tests to determine if dysplasia is the source of hip pain in adolescents and young adults.

• #2 Differential diagnosis and early management of rapidly progressing hip pain in a 59-year-old male

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3360490/

  This case highlights the ability of the clinician to recognize a non-typical hip pain pattern with thought being given to the possible need for further medical consultation. […] The evaluation of the patients examination and systems review lead to a differential diagnosis of bilateral avascular necrosis (AVN) of the femoral heads or hip OA. […] The generated working hypothesis driving the clinical decision making process in determining a differential diagnosis was report of insidious onset, bilateral groin and anterior thigh pain with rapid progression of restricted ADLs combined with multiple medical comorbidities. […] This case highlights the need for clinicians to consider competing diagnoses when treatment intervention fails to improve patient symptoms. […] By identifying progression of functional decline using regular outcome measures, the physical therapist is better equipped to manage patients and identify the need for outside referral to optimize best patient care.

• #2 Reddit – The heart of the internet

  https://www.reddit.com/r/HipImpingement/comments/1cd76ij/the_pain_is_so_unbearable_and_ive_gotten_nowhere/

  I’ve had hip pain for coming up to 3 years (I’m 31F) that’s gotten progressively worse and massively ramped up in the last couple months, to the point where I’m on crutches as I can barely walk, and I hardly ever leave my flat because I can’t walk far enough to really go anywhere. […] I’ve just had the last of my scan results through, which mention slight dysplasia, and I’m frustrated because the last consultant I spoke to was looking directly at my CT results and said there was nothing wrong with my hip. […] The Hip Preservation guy said he thinks the pain is coming from my back and that 'hip impingement is often asymptomatic’, which makes me feel insane because obviously I have symptoms so how is that relevant??? […] I’m in severe pain 24/7 that painkillers barely touch (I’m prescribed cocodamol), crying all the time because of how limited my life has become, and I don’t believe even with physio at this point that it can ever get better without intervention. […] The fact that I deteriorated so quickly in the last couple weeks makes me incredibly depressed and worried about how much worse it will be soon.

• #2 Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018 | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/54/11/631

  Diagnostic utility of imaging for hip disease in young and middle-aged active adults presenting with hip-related pain is limited; we recommend that imaging should never be used in isolation but combined with the patients symptoms and clinical signs (when making treatment and other relevant decisions). […] We recommend anteroposterior (AP) pelvis and lateral femoral head neck radiographs to assist in diagnosing the hip conditions characterised by hip-related pain, and MRI/magnetic resonance arthrogram (MRA) or CT scan where three-dimensional morphological assessment is indicated. […] Hip-related pain may be further categorised after imaging into: (1) FAI syndrome; (2) acetabular dysplasia and/or hip instability and (3) other conditions causing hip-related pain. […] Research studies reporting bony morphology should provide clear definitions and detailed imaging and reporting methods. […] We recommend large-scale, prospective and interdisciplinary research on aetiology and prognosis of hip-related pain where the overlapping nature of the various conditions is considered.

• #2

  https://www.aurorahealthcare.org/services/orthopedics/conditions/hip-bursitis

  Hip bursitis is inflammation of one of the hips bursa, cushions that protect tendons and muscles from rubbing against bone. Hip bursitis is the most common cause of hip pain. […] Whether you know you have hip bursitis or aren’t sure what’s causing your hip pain, we can help. Our orthopedic team can identify the source of your pain and offer personalized bursitis treatments that will help you find relief. […] If you have bursitis of the hip, Aurora Health Care’s orthopedic team can help you find a bursitis treatment plan to ease the pain. […] Our orthopedic team handles hip care for everyone from active adults to athletes to people with arthritis pain. Because we treat so many people from different backgrounds, we have the experience to accurately diagnose bursitis and recommend the most effective treatment option for you often without surgery.

• #3 Hip Pain in Adults: Evaluation and Differential Diagnosis – Minuti

  https://www.fondazionemenarini-minuti.com/scienza/numero-248-en/la-coxalgia-negli-adulti-valutazione-e-diagnosi-differenziale/?lang=en

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. […] In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. […] Radiography of the hip and pelvis should be the initial imaging test. […] Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. […] Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.

• #3 Mastering the Hip Exam: Top Tests for Hip Pain — ChiroUp

  https://chiroup.com/blog/mastering-the-hip-exam-top-tests-for-hip-pain

  The FABER hip test is another generalized screening test that is routinely positive (88%) for most causes of hip pathology. […] Gluteal tendinopathy is among the leading causes of hip pain, yet it is frequently overlooked. […] The Hip Lag Sign demonstrates high sensitivity (89.5%) and specificity (96.6%) for detecting gluteal tendon injury. […] Likewise, the resisted external de-rotation test claims good sensitivity (88%) and specificity (97%) for gluteal tendon pathology. […] Femoroacetabular impingement, an increasingly recognized diagnosis, is particularly prevalent among young, active individuals. […] The FADIR test will typically provoke cam-type FAI. A negative FADIR test is thought to be most useful for ruling out FAI. […] Hip extension and external rotation often provoke pincer-type FAI during the Posterior Impingement FAI test.

• #3 Imaging evaluation of the painful hip in adults – UpToDate

  https://www.uptodate.com/contents/imaging-evaluation-of-the-painful-hip-in-adults

  Imaging evaluation of the painful hip in adults […] Imaging modalities used to evaluate adults with hip pain and the appropriateness of particular exams in different clinical scenarios will be reviewed here. […] The modalities available for evaluation of the hip include: […] Plain film radiography of the hip is used in the initial evaluation of any cause of hip pain, including trauma and sports injuries, suspected avascular necrosis (AVN), arthritis, hip arthroplasty, infection, dysplasia, tumor, and microinstability. […] Computerized tomography (CT) of the hip without contrast is most useful in the setting of trauma, for preoperative planning, and for evaluation and guiding percutaneous biopsy of tumors.

• #3 Hip pain | Causes, exercises, treatments | Versus Arthritis

  https://versusarthritis.org/about-arthritis/conditions/hip-pain/

  If your hip pain hasn’t improved after two weeks you should see your doctor. […] Your doctor will ask about your pain and what movements make it feel worse. […] They’ll examine your hip to find out how well it moves, and this will usually give them enough information to plan your treatment. But you may need other tests to diagnose some conditions. […] X-rays are often the best way of finding out what’s wrong with your hip as they show the condition of the bones. […] A CT (computerised tomography) scan can often be very helpful to work out if the hip joint has an unusual shape. […] MRI (magnetic resonance imaging) scans use radio waves to build a picture to show what’s happening to the soft tissue, such as the muscles and tendons, inside your hip. […] If your doctor thinks your pain is caused by an infection or rheumatoid arthritis, blood tests can often help.

• #3 Mastering the Hip Exam: Top Tests for Hip Pain — ChiroUp

  https://chiroup.com/blog/mastering-the-hip-exam-top-tests-for-hip-pain

  Guidelines, including the American College of Radiology (ACR) Appropriateness Criteria for Acute and Chronic Hip Pain, suggest which imaging tests are most suitable for diagnosing acute and chronic hip pain. […] X-rays of the hip and pelvis are prioritized to rule out fractures, especially after a fall or minor injury. […] If X-rays are unclear but a fracture remains a concern, a non-contrast MRI or CT scan of the pelvis and hip should be considered. […] X-rays are often the starting point, but they mainly help identify osteoarthritis, a frequent culprit. […] Depending on the patient’s specific situation and the provider’s clinical suspicion, other imaging techniques like MRI may be warranted to delve deeper into less common causes of chronic hip pain. […] Magnetic resonance imaging (MRI) is more sensitive to detect joint effusion/synovitis, cartilage, labral, and bone marrow lesions.

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