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.

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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.

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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.

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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.

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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.

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How to diagnose hip bursitis

May 20th — admin

I have a very tender and painful point along the side of my hip. My doctor thinks I have hip bursitis but nothing showed up on the X-ray or MRI. Is there some other way to figure out what’s going on?

Hip bursitis can be difficult to diagnose accurately in some patients. Often there is really more than one problem going on. Osteoarthritis, bursitis, and tendon pathology can all occur at the same time with overlapping signs and symptoms. Some experts say that bursitis never occurs alone. They believe bursitis is just one of several problems that occur together. In fact, they suggest that bursitis is a sign that tendon and joint degeneration are occurring. And to make matters even more confusing, many people with bursitis don’t have any symptoms. So finding reliable test measures and symptoms to confirm a diagnosis of hip bursitis can be a challenge.

As you have discovered, sometimes bursitis shows up on an MRI, but not always. Pain with palpation over the greater trochanter may be the most reliable clinical sign of bursitis. The greater trochanter is a large bump that can be felt along the side of your hip. Large and important muscles connect to the greater trochanter. The bursa is designed to provide a buffer or cushion between the tendons of muscles and the attachment of the tendons to the bones. Overuse or misalignment of the gluteal muscles can cause irritation and inflammation of the bursa. The end-result may be painful and persistent bursitis.

Sometimes a trial and error process is required to figure out exactly what soft tissue structures are getting pinched or pushed. When tests aren’t clear as to the problem, then treatment may be started. The diagnosis is made after a specific treatment is successful.

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.

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Lateral hip pain can have many causes

May 17th — admin

I’m having some trouble with pain along the outside of my leg up by the hip. It the worst when I lie down on side. My sister is a nurse and says this is common in women my age (63 years old). She has it too and says not to worry about it. I’d really like to know what’s causing it.

You may be suffering from a condition called lateral hip pain or greater trochanter pain syndrome. This is a fairly common problem. And, as you and your sister have discovered, it’s especially common in postmenopausal women. Besides lying on the already painful side, activities that make the pain worse include standing or sitting for more than a few minutes, walking up or down stairs, or walking for more than a few minutes. Sitting, resting, and pain relieving medications seem to make it feel better. The cause of lateral hip pain could be an inflamed bursa (bursitis), tendinitis of the gluteal (buttock) muscles, or tendinosis (degeneration) of the same muscles. Diagnosis of the problem can take some time. We have a few reliable clinical tests to use when sorting out hip pain. Sometimes MRIs offer useful information. But many times nothing unusual shows up on MRIs for patients with lateral hip pain. And there are just as many patients with pathologic changes on MRIs who have no symptoms. It may take a period of trial and error with treatment (medications, physical therapy, exercise) before symptoms improve. Don’t assume this is just a problem of aging. Pain of any kind can reduce your quality of life. It’s best to get a diagnosis and then decide on the best course of action.

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.

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I didn’t fall or hurt myself that I can remember. How can I find out what’s causing my pain?

April 21st — admin

How can I find out what’s causing my hip pain? I don’t notice it so much during the day but at night it aches like a son of a gun. I didn’t fall or hurt myself that I can remember. It just started bothering me all of a sudden.

There are many possible causes of hip pain. Often what patients call hip pain isn’t coming from the hip at all. Pain along the outside or back of the hip may not indicate a problem with the hip. True hip pain tends to cause pain along the inside of the leg near the groin.

There are many structures in and around the hip that can be causing painful symptoms. These include the joint itself, the rim of cartilage around the joint (called the labrum), the bursa, ligaments, muscles, and tendons.

Sometimes pain coming from the sacroiliac joint or low back can be referred to the hip. Most of the time, pain in the general region of the hip is caused by the soft tissue structures around the hip. There may be tightness, laxity, impingement, weakness, or poor alignment resulting in hip pain. Less often, fracture, infection, or tumor may be the source of symptoms.

A medical examination may be needed to find out exactly what’s causing your symptoms. Your doctor will take a history, perform some standard tests, and possibly order lab work to look for inflammation or infection.

Based on the results of these tests, further work-up may be advised. A set of standard X-rays may be needed. MRIs or CT scans are reserved for cases where further detail is required to make the diagnosis.

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.

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The doctor gave my mother a shot into her hip, to find out if it was her hip or back causing her pain. How does that work?

February 25th — admin

My mother had a shot into her hip – the doctor said it was to find out if it was really her hip causing her hip pain or if it was her back. Could you explain how this works?

Many people who have hip or groin pain could have arthritis in the hip or in the lumbar spine, the lower part of the back. X-rays, while helpful in many cases, often can’t help in this situation. However, in order to treat your mother’s pain properly, the doctor needs to know where the pain is originating.  

A procedure called a fluoroscopically guided intra-articular injection is one way to determine this. By injecting a medication directly into the joint, the doctor can find out if this helps decrease the pain. If the pain does decrease, then the problem is with the hip. If it doesn’t decrease, there is a good chance that it is the spine.

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.

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Adult protection from childhood hip problems.

January 27th — admin

When I was a child, I had a hip problem called Perthes disease. As an adult, sometimes I have hip pain but not always. Should I do anything special to keep this from getting worse?

The natural history and long-term results of Perthes disease (also known as Legg-Calvé-Perthes) are still largely unknown. Some studies following children with this condition into their later years have been done. Our current treatment for this condition is based on the results of those studies.

We know that the duration of the disease from start to complete healing depends on the extent and severity of the condition. As you might expect, the children with the greatest amount of damage to the growth plate have the worst results.

Age makes a difference, too. Younger children (less than six years old) with Perthes tend to have milder deformity compared with older children (10 years old or older).

One study from the University of Iowa showed that patients treated with range of motion programs had better motion and function at age 45. But 10 years later, there was significant deterioration of the hip. By the time these patients were 55 years old, 40 per cent of the group had a total hip replacement. And another 10 per cent had enough pain and arthritis to need a joint replacement, too.

Individuals who receive physical therapy do show improvement in hip motion and strength. Whether or not lifelong exercise makes a difference has not been studied.

It might be a good idea to see an orthopedic surgeon. An X-ray can show the current condition of your hip. A physical therapy exam can establish your levels of motion and strength. Any other loss of function or disability can be addressed with a specific rehab program.

Regular follow-up visits with both the surgeon and the therapist may help identify any developing problems and nip them in the bud.

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.

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