ANKLE PAIN
CARPAL TUNNEL SYNDROME
CHRONIC PAIN
ELBOW PAIN
HIP PAIN
IMPAIRMENT & DISABILITY
KNEE PAIN
MUSCLE WEAKNESS
MYOFASCIAL PAIN
NECK & LOW BACK PAIN
NUMBNESS
SHOULDER PAIN
WRIST PAIN
BIOGRAPHY
REFERALS
Spence Rehabilitation Center
1650 45th Ave. Suite 2C
Munster, IN 46321
Visit our Porter County location!
1620 Country Club Rd. Ste E
Valparaiso, IN 46383
Phone : (219) 513-2267
 
     
 
What symptoms are common with hip problems and
how are they important?
 
1. Groin Pain that Increases with weight-bearing:
Usually associated with osteoarthritis which is a
structural deformity of the joint.
2. Constant hip pain, especially at night:
Can mean an infection, joint inflammation, or cancer.
3. Outer hip pain aggravated by direct pressure:
Is commonly associated with trochanteric bursitis which
is a fluid filled sac that sits on the outer hip bone.
4. Outer hip pain that is aggravated by both direct
pressure and weight bearing which has been
getting progressively worse:
Can hint at a possible cancer. Other warning signs
include a previous history of cancer and unintentional
weight loss particularly in older individuals.
5. Outer hip pain associated with numbness:
Is common in a condition called meralgia
paresthetica which is irritation of the lateral femoral
cutaneous nerve. The pain is usually a burning sensation
on the outer thigh that is not influenced by direct
pressure, hip movement, or lower back movement.
6. Hip pain that shoots down below the knee:
Can be associated with a lumbar radiculopathy which is
a pinched nerve at the back particularly at the L4-5
level. Patients can also complain of numbness in the
foot.
7. Pain in front of the hip that is not aggravated by
direct pressure or repetitive movement:
May be due to an inguinal hernia, lower abdominal
problem, or even a pinched nerve in the lumbar spine
at L2-3.
8. Pain in the buttocks or back of the hip:
Is most often a sign of sacroiliac joint disease, lumbar
radiculopathy, herpes zoster, or an unusual
presentation of the hip joint.
9. Thigh pain:
Can be caused by a variety of problems including stress
fracture of the femor, pinched nerves at the lumbar
spine.
 
 
What are some potential causes of hip pain?
 
1. Trochanteric bursitis:
Inflammation of a fluid filled sac that sits on a bony
prominence of the femor . It can be brought out by
uneven leg length, overuse or tightness of the hip
muscle, etc.
2. Hip osteoarthritis:
Bony structural deformities of the hip joint that
develops with trauma and aging. It is most common
in people over age 40, is usually aggravated with
walking and relieved with rest, and can be
accompanied by limited joint range of motion as well
as morning stiffness that is usually less than 30
minutes long.
3. Meralgia paresthetica:
Irritation of the lateral femoral cutaneous nerve which
is located on the outer thigh.
4. Osteonecrosis:
Bone death due to loss of blood flow which leads to
bony degeneration.
5. Occult hip fracture:
Usually results in severe pain and tenderness that
results in difficulty bearing weight on the joint.
6. Aortoiliac vascular occlusive disease:
Clogged arteries of the vessels that go to the legs.
Pain is usually aching in nature and aggrevated with
walking.
7. Lumbar Radiculopathy:
Pinched nerves in the low back can cause pain to
shoot down the extremities and mimic hip pain.
8. Sacroiliac Joint Dysfunction:
Arthritis and stiffness can develop in the joint that
attaches the tailbone to the hip.
   
   
   
   
 
 
What Tests are useful when evaluating hip pain?
 
1. Xrays:
To rule out fracture particularly for moderate to severe
chronic hip pain. A lateral and Weight bearing AP pelvis
x-ray assesses the joint space, bone density, and
sacroiliac joints for narrowing and irregularity.
2. Magnetic resonance imaging:
Most sensitive at detecting fracture and should be
ordered if the Xray is negative and a stress fracture
is still suspected. It can also look for soft tissue
abnormalities caused by infections, persistant tendinitis,
bursitis and tumors.
3. Radionuclide bone scan:
Usually ordered to double check for fracture when the
Xray is negative and there is no MRI available. It can
also show activity with arthritis and tumors.
4. Ultrasound:
Is used to look for excess fluid in the joint called an
effusion particularly in children. The ultrasound can help
guide a needle to drain the extra fluid out of the joint.
5. Local anesthetic block:
Injecting a numbing medicine near the affected area to
determine if it is the source of pain. One example is
injecting the sacroiliac joint to determine if it is the pain
source.
6. Hip aspiration:
Draining fluid out of the hip joint. The fluid is then
checked for the presence of infection or cancer cells.
This test is usually ordered when sudden severe pain
develops in the hip without a history of trauma.
7. Sensory Nerve Conduction Study:
This test is used to see if the lateral femoral cutaneous
nerve is irritated.
8. Inflammatory labs:
Blood tests used to look for inflammation in the body.
Common labs checked are a Complete blood count,
erythrocyte sedimentation rate, or C-reactive protein.
 
 
What are some treatment options for hip pain?
A physician’s choice of treatment will depend on the
diagnosis and disease severity as well as other medical
conditions present.
 
1. activity modification:
Avoid activities that aggravate the pain.
2. Acetaminophen: also known as Tylenol.
3. Nonsteroidal anti-inflammatory drugs (NSAIDs):
Commonly used medications include ibuprofen and
naprosyn.
4. Physical therapy:
Hip range of motion exercises and stretching.
Therapists can also use modalities such as ultrasound
and administer techniques to mobilize the Sacroilliac
joint.
5. Walking support:
A cane can be used to improve base of support and
help to limit weight bearing.
6. Corticosteroid Hip injections:
7. Sensory Nerve Conduction Study:
This test is used to see if the lateral femoral cutaneous
nerve is irritated.
8. Inflammatory labs:
Blood tests used to look for inflammation in the body.
Common labs checked are a Complete blood count,
erythrocyte sedimentation rate, or C-reactive protein
 
     
 
What are the different types of Hip injections?
The technique and site will vary depending on the diagnosis.
 
1. fluoroscopically (Xray) guided Intraarticular Hip
injection:
A corticosteroid or a joint buffer consisting of hyaluronic
acid is injected into the hip joint itself. This procedure is
performed for significant Hip Osteoarthritis that has not
responded to conservative treatments.
2. Greater Trochanteric Bursa injection:
A steroid is injected into the fluid filled sac that sits on
the bony prominence which makes up the hip bone.
3. Iliopsoas Bursa Injection:
Administered for persistant inflammation of the
Iliopsoas Bursa that has not responded to therapy.
Typically, patients are first sent to physical therapy to
work on hip rotation strengthening exercises.
 
 
 
4. Lateral Femoral Cutaneous Nerve injection:
Administered next to the anterior superior iliac where
the lateral femoral cutaneous nerve emerges. This
injection is administered for Meralgia Peresthetica.
5. Sacroiliac joint Injection:
Is typically performed for persistent inflammation of
the SI joint that attaches the tailbone to the hip.
Typically, physical therapies are first tried to work on
range of motion of the hips and mobilization of the SI
joint before proceeding with this injection. An SI joint
injection can also be used by your doctor to help
diagnose Sacroilliitis when the etiology of the pain is
unclear. This injection is also typically done with X-ray
guidance.
 
     
 
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