Evaluation and management of hip pain: an algorithmic approach.

Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, USA.
The Journal of family practice (Impact Factor: 0.89). 09/2003; 52(8):607-17.
Source: PubMed


Start by determining whether pain is located in the anterior, lateral, or posterior hip. As the site varies, so does the etiology. Besides location, consider sudden vs insidious onset, motions and positions that reproduce pain, predisposing activities, and effect of ambulation or weight bearing. 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. Conservative measures and selective use of injection therapy are usually effective.

147 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Musculoskeletal injuries are a frequent consequence of physical activity and sports participation. Many injuries are predictable based on the physical demands of the sport or the inherent risk of the participant. Injuries also tend to follow characteristic patterns because of vulnerabilities dictated by anatomy or skeletal immaturity. Familiarity with injury patterns and injury risks can help correctly diagnose and treat injuries. The patterns and predictabilities of injury also serve as the basis for injury prevention. The clinical approach to acute and overuse injuries varies because the nature of information that is most useful for treatment varies. In acute injuries, the effects of the injury determine treatment. Therefore, the history, physical examination, and imaging studies must be oriented toward assessing what was damaged and how much damage occurred. For overuse injuries, the effects of injury are subtle, nonspecific, and not particularly useful in planning treatment. However, if the extrinsic and intrinsic causes of injury are identified, treatment can address the cause of problem rather than just the symptoms. When the cause of an injury is addressed, the patient has a far greater chance of returning to the activity that prompted the injury - without reurrence of symptoms. Fortunately, most of the sports injuries that affect children and adole scents are not severe, do not require surgery, and do not have adverse long-term consequences. As a result, the majority of injuries do not require consultation or subspecialty care. This creates a responsibility and an opportunity for primary care physicians to care for the majority of injuries that occur. By doing so, physicians can also promote the health benefits of lifelong physical activity.
    Current problems in pediatric and adolescent health care 05/2005; 35(4):110-64. DOI:10.1016/j.cppeds.2004.12.009 · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The hip history involves the standard medical history review components in addition to screening for hip related complaints with emphasis on function and activity. Primary systems of diagnosis have direct correlation of historical relevance, requiring a systematic approach to the history. The patient’s function status can be defined by symptoms reported during rotation with load. Rotation sports commonly have been associated with injuries to the intra-articular structures, including the acetabular labrum and ligamentum teres. The twenty-point examination is a tool to help organize the structure of the physical examination. It will aid in the diagnosis or screening of the osseous, ligamentous, and musculotendonous pathological conditions. The physical exam is performed in three positions: the standing, sitting, lateral and supine examinations. A thorough evaluation takes time and thorough understanding of the anatomy.
    Operative Techniques in Orthopaedics 07/2005; 15(3):177-181. DOI:10.1053/j.oto.2005.07.008
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article provides a succinct and complete method for the clinical evaluation of the hip. Included are descriptions of examination tests as well as their relationships to possible pathology of the hip. The examination is divided into five stages: seated, standing, supine, lateral, and prone; with a total of 11 assessment points. The method for evaluation outlined will assist physicians in determining the location and etiology of presenting hip pathologies. As with any examination, practice and repetition are essential to gain an appreciation of what constitutes a normal as well as an abnormal examination.
    Clinics in sports medicine 05/2006; 25(2):199-210, vii. DOI:10.1016/j.csm.2005.12.001 · 1.22 Impact Factor
Show more


147 Reads
Available from