Accurate diagnosis of hip pain can be elusive

July 28th — admin

I saw my primary care physician for hip pain that just won’t go away. Despite a huge amount of time testing me every which way, there’s no known cause for the problem. Should I insist on X-rays or an MRI?

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. The physician’s examination takes into account the possible etiology or cause of the problem. Was there some trauma? The mechanism of acute hip pain caused by injury is often a twisting motion. Overuse, repetitive motion, and diseases or degenerative conditions are other potential causes of hip pain. Pain patterns associated with hip problems start with a deep aching and stiffness in the hip. True hip pain is experienced in the front of the body down into the groin area. Hip pain along the pelvic rim, down the side of the leg, or down the back of the leg is usually a sign that the cause of the pain is extraarticular (outside the hip joint). This could be coming from pinching of the soft tissues, nerve entrapment, or other extraarticular lesions. Loss of motion and/or function can help point to the specific soft tissue structures affected.

It sounds like your physician has been very thorough. Evaluation of hip pain may require imaging studies such as X-rays or MRIs. But unnecessary X-rays and other imaging studies should be avoided. Results are viewed cautiously as many changes in and around the hip may be observed but may not be the cause of the painful symptoms. The most obvious pathologies that must be treated include tumors, fractures, hematoma from bleeding after a fall, and infections.

Often in the face of an unknown cause of joint pain, a short course of physical therapy can be a diagnostic aid for the physician and helpful to the patient. As experts in human movement dysfunction, the therapist can evaluate and treat the soft tissues and postural issues that could be the underlying cause of the problem.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , , , , , , , , , , . No Comments »

What is calcific bursitis of the hip?

July 25th — admin

Have you ever heard of calcific bursitis of the hip? That’s what I have. What can you tell me about it?

Calcific bursitis occurs as a result of tiny calcium deposits in the collagen tissue around the hip. The cause is chronic inflammation of the bursae. The bursa is a normal structure. It is a thin sac of tissue that contains fluid to lubricate areas and reduce friction between muscles, tendons, and bones. The patient reports pain and/or tenderness along the side of the hip. This is the area of the greater trochanter. The greater trochanter is a large bump of bone that juts outward from the top of the femur (thigh bone). Large and important muscles connect to the greater trochanter. Sometimes these muscles are referred to as the rotator cuff of the hip. Chronic tendinitis of the hip rotator cuff can also contribute to this problem. The calcium deposits are called calcification. They can occur as long as there is inflammation of the bursae (or tendons). The deposits don’t always go away after the inflammation has been taken care of, but the symptoms improve.

Treatment can help to prevent further calcification as well as relieve pain and stiffness. Antiinflammatory drugs, cortisone injections into the bursa, and physical therapy have been shown effective. In rare cases, the inflamed bursa is surgically removed.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , , , , , , , , , . No Comments »

Can hip arthritis be diagnosed without an x-ray?

July 20th — admin

My doctor thinks I might have hip arthritis. She would like me to have an X-ray. I’d like to avoid any more exposure to radiation. Can this condition be diagnosed without X-rays?

X-rays are still the number one tool physicians rely on to make an accurate diagnosis of osteoarthritis (OA). The radiograph shows changes that can’t be seen with a clinical exam. For example, narrowing of the joint space and bone spurs associated with OA are easily seen on X-rays.

Other changes common with OA that can be observed with X-rays include changes at the joint margins and subchondral bone. Subchondral bone refers to the first layer of bone underneath cartilage. Once the joint cartilage is destroyed by the OA process, the subchondral bone can be affected, too.

Without X-rays, there are some clinical tests that can be helpful in diagnosing hip OA. Hip range-of-motion (quantity and quality) is a key factor. A quick and easy screening test for the hip is to try assuming a squat position. If this position aggravates the symptoms (or you cannot do it because of hip pain), the hip is involved in some way.

The examiner looks for a specific pattern of motion typical with OA. Loss of hip internal rotation is a positive sign of OA. The examiner also relies on how the joint feels during testing motions. There should be a smooth, easy give through the full arc of motion. The examiner feels for a slight spring at the end of the motion. Any blocks or resistance to movement caused by pain or a bone-on-bone sensation may be an indication of degenerative joint disease.

X-rays may still be needed if all these tests are positive. But if they are negative, it may rule out OA and X-rays can be avoided. It’s likely that your physician found enough suspicious test results to suggest further testing with X-ray imaging. Don’t be afraid to ask your doctor about her findings so far and express your concerns about radiation exposure.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , , , , , , , . No Comments »

Change in hip flexibility is a warning sign for postmenpausal women

July 15th — admin

I’m 56, postmenopausal, and noticing a sudden change in my hip flexibility. My older sister has pretty bad hip arthritis. She started having this same change when she was around my age. Does it sound like I’m going to get arthritis too?

Arthritis is a very common problem for adults 55 and older. In fact, it’s estimated that up to one in four (25 per cent) of older adults will be diagnosed with this condition. Early and accurate diagnosis is the number one key to stay as functional and independent as possible for as long as possible.

For women who are postmenopausal, declining estrogen levels are linked with changes in soft tissue. Decreased blood circulation of estrogen contributes to reduced elasticity of ligaments and joint capsules. In the hip, ligaments surround the joint forming a capsule to support and stabilize the joint. With less estrogen available, these structures tighten up and become less supple or flexible and inflexible. The change in your flexibility could also be caused by a sedentary (inactive) lifestyle. But before you assign blame or cause to your problem, it might be a good idea to see your primary care physician for an accurate diagnosis.

If it turns out that you do have osteoarthritis, in order to prevent disability pay attention to good nutrition, getting enough fluids, and exercise. These four steps in self-care are all equally important. With or without early signs of arthritis, if you are overweight, weight loss is always advised. See a physical therapist for help with an exercise program designed to help you maintain flexibility, joint motion, strength, and endurance.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , , , , , , , , , . No Comments »

Why hip pain is a red flag for total hip replacement patients

July 12th — admin

My right hip has been bugging me off and on for two weeks. I have a hip replacement on that side so I’m a little worried. Could this be caused by a problem with the implant?

For anyone with a total hip replacement (THR), hip pain is a red flag. Medical evaluation is important because of the risk of joint infection. Treatment depends on knowing if there is (or isn’t) an infection. There are many possible causes for the pain you are having. They may or may not be related to the implant. The first thing the orthopedic surgeon will examine is the hip itself. Your history along with the clinical presentation are very helpful. But then the spine (above) and the knee (below) will be tested as possible sources of referred pain. X-rays and lab tests may be needed to rule out a fracture, implant loosening or infection. Other possible causes include bursitis, ossification (bone formation in the muscle or surrounding soft tissue), or synovitis. Cultures of the joint taken directly from the area during surgery are the most accurate way to confirm (or rule out) joint infection. But this type of testing is not practical for the patient who doesn’t have an infection or who doesn’t need surgery. And there is a fair amount of false-positive test results with intraoperative cultures due to errors in sampling technique. Instead, the physician may rely on lab tests that are sensitive, reliable, and accurate with a low false-positive and high true-positive results. The following tests may be needed to evaluate for hip infection: erythrocyte sedimentation (SED rate), C-reactive protein (CRP), and synovial fluid white blood cell count (WBC). Don’t wait to get tested. See your surgeon now. Early diagnosis can prevent a lot of complications from delayed treatment.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , , , , , , , , . No Comments »

Joint pain vs. postoperative pain – which is worse?

July 1st — admin

My adult children are pushing me to have a hip replacement. I don’t really want to have surgery. I think I can put up with the pain. But the kids are worried that I’m not active enough. Would a new hip really make that much difference? Doesn’t having surgery cause pain, too?

Pain can be a big stumbling block to activity and quality of life. Hip replacements have become very common and very successful. Patients are able to perform daily activities, sleep better, and get around better. The implants and techniques for putting them in have improved so they last longer with fewer problems. Relieving pain improves physical function and activity level. This is important in promoting general health and preventing specific diseases such as heart disease and diabetes.

The positive benefit of movement and activity on bone structure is very important for the older adult. Good bone health helps prevent fractures and falls, which can cause serious disability and even death.You may want to just make an appointment with an orthopedic surgeon and find out what are your options. Knowledge and understanding of the process and expectations can help calm your anxious thoughts. Then you’ll be making a decision based on facts, not fears.

You can expect a period of some postoperative pain during recovery. The postoperative plan provides medications to help with the pain. The physical therapist will help you get up and get moving. That always helps alleviate pain and aching from stiffness. Most patients report the postoperative pain is different from the joint pain they had before surgery. They say the new pain is much more tolerable and goes away with time and exercise.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , , , , , , , . No Comments »

Arthritis affecting hip range-of-motion, what can be done?

May 25th — admin

We are really concerned that Dad’s hip range-of-motion is getting worse instead of better. He has fairly severe hip arthritis. Each time a therapist measures him, it seems to slip a few degrees. What can we do to help him at least maintain his motion?

The first thing to be sure is that the testing is accurate. Testing joint motion can be very subjective depending on how it is done and who does it. If the same person measures joint motion each time, intrarater reliability of the test is important. Intrarater reliability refers to the ability of a single individual to complete the test the same each time.

If different people are testing your father’s hip joint motion, then interrater reliability is important. This refers to the test being done the same way from person to person. Interrater reliability is the term used to describe test-retest when performed by different individuals on the same patient. Patient pain levels can vary from day-to-day, too. A measurement on one day may not be the same as on the next if the pain goes up or down.

Assuming there is a true general trend of joint motion loss, the first step is to see his doctor. There may be an adjustment needed in medication that can help make a difference. Or there could be some other explanation for what’s going on. If no medical treatment is warranted, then referral to a physical therapist may be needed. The therapist is well acquainted with ways to help arthritis patients maintain and even regain range of motion. Not only that, but they will pay attention to strength, motor control, and joint proprioception (sense of joint position). Each of these components is important to function and preventing disability.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Arthritis, Hips. Tags: , , , , . No Comments »

What is the hip-spine syndrome?

December 17th — admin

What is the hip-spine syndrome?

Hip pain and loss of motion from osteoarthritis (OA) often causes changes the way people stand and walk. A secondary effect of this is back pain. The condition is known as hip-spine syndrome.

Hip-spine syndrome was first described in 1983. Most orthopedic surgeons are well aware of this phenomenon. Patients who have both hip osteoarthritis and low back pain (LBP) are treated first for the hip problem.

A small study of 25 patients showing the link between hip OA and LBP has been published. The patients reported significant improvement in back pain after a total hip replacement.

The authors took spinal X-rays before and after hip surgery. They hoped to be able to show changes in the spine to account for the improved pain and function after surgery. They were surprised that the X-rays were the same before and after the hip replacement.

More study is needed to fully understand the hip-spine syndrome. For now, we know this is a real condition, and it does get better after hip replacement. That’s good news for many older adults who suffer both hip and back pain.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , , , , . No Comments »

What’s a pistol grip deformity of the hip?

December 9th — admin

What’s a pistol grip deformity of the hip?

Pistol grip deformity describes the abnormal shape of the hip joint. It was first described by Dr. S. D. Stulberg and associates back in 1975. The head and neck of the femur takes on the shape of a pistol grip when viewed on X-ray.

It’s an early sign of osteoarthritis (OA). The edge of the acetabulum (hip socket) is prominent. The head of the femur butts up against the edge of the acetabulum instead of sliding and gliding down smoothly in the socket. It gives the joint the look of a pistol grip shape when seen on X-rays.

The result is that the wrong part of the head of the femur is in contact with the acetabulum. The abnormal part of the head is forced into the socket during hip flexion and internal rotation.

This creates shear forces against the cartilage. This stress produces abrasion and then tearing or shredding of the cartilage. The rim of cartilage around the socket called the labrum is often involved, too.

All of these changes can lead to degenerative joint disease known as osteoarthritis.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , . No Comments »

Pay attention to risk factors when considering hip resurfacing

December 8th — admin

I would like to have that new operation for hip arthritis to resurface the joint instead of a total hip replacement. But my surgeon says I’m not a good candidate for this treatment. Who can have this procedure?

Studies have shown that success rates are much better for hip joint resurfacing when patients are selected carefully. Failure rates are reduced when risks are minimized.

A special risk index called the surface arthroplasty risk index (SARI) can be used to pre-screen patients. This tool identifies the number of risk factors present. It also rank orders them according to the importance of each one.

For example, the presence and number of large cysts on the femoral head has the highest risk. Each cyst gets two points. And a total of three points or more suggests you aren’t a good candidate for this operation. Other risks include obesity, previous hip surgery, and low activity level.

Surgeons know now that doing a hip resurfacing isn’t the same as a total hip replacement. The risk of fracture is much higher with resurfacing. Paying attention to risk factors that might cause problems and implant failure is important.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Posted in Hips. Tags: , , , , , . No Comments »
« Older posts «
Newer posts » »