Hip and groin region conditions: introduction
| Hip and groin region conditions: introduction |
It is important to distinguish the lay and medical uses of the term ‘hip’. Pain originating in the hip joint is felt in the groin and may extend down the anterior thigh to the knee or present with knee pain only. Pain elsewhere in the ‘hindquarter’ or colloquial ‘hip’ region (buttock, lateral thigh, posterior thigh) is commonly referred from proximal structures such as the lumbar spine and sacroiliac joint. Such pain is dull or aching in character, difficult for the patient (and examiner) to localise and not associated with neurological signs. It may be reproduced by movements of the lumbar spine, sacroiliac joint, or local muscles.
True hip joint disease should be suspected when passive movements of the joint are painfully limited. A positive Trendelenburg’s sign (inability to maintain a level pelvis when standing on the painful leg only) is a good indicator of hip joint pathology.
Imaging studies to aid diagnosis may be necessary. Plain X-ray may reveal characteristic changes of osteoarthrosis or less common disorders such as osteonecrosis of the femoral head. Suspected osteonecrosis is best confirmed by magnetic resonance imaging (MRI) scanning. A plain X-ray examination that is normal does not exclude osteoarthritis.
The clinical features outlined in Box 12.10 indicate potentially serious pathology that must not be missed in assessment of any joint pain.
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