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What Tests Do Health-Care Professionals Use to Diagnose Hip Pain?

History
Making the diagnosis of the cause of hip pain begins with the health-care
professional talking with the patient, their family, or caregivers and taking a careful
history of the what, where, and when of the pain as well as reviewing any other
underlying complaints. By factoring in the past medical history of the patient, the
health-care professional can make a differential diagnosis or list of what potential
causes might be considered. The physical examination helps refine that list, and
tests may be done to confirm a specific diagnosis.
Sometimes the diagnosis is evident. The patient fell, hurt their hip, can't bear weight,
and X-rays show a fractured hip. Sometimes the diagnosis requires more searching
and may take time and repeat visits to find the source of the hip pain.
The history may involve many questions regarding everything from the onset of the
hip pain to what makes it better or worse. The goal is for the health-care professional
to understand the frequency, duration, and context of the pain in relationship to the
daily activities of the patient.
Aside from the history of the pain, other information looking for a systemic illness
may be helpful in finding the cause of pain. Has there been an injury? Has there
been a history of fever or chills? Weight loss? Abdominal pain? Diarrhea? Do other
joints hurt or swell? While the questions may seem unrelated to the hip, it is
necessary for the health-care professional to consider all possibilities. A review of
past medical history, including medications, may give direction to assessing the
situation.
Physical Examination
The physical examination for hip pain most often will focus on the hip, leg, and back,
however, the rest of the body will not be ignored; a health-care professional will look
for associated findings that may help explain the patient's complaints.
Observation of the hip at rest and while standing or walking, palpation (or feeling) of
the hip and surrounding structures, testing for range of motion and strength, and
checking for sensation and pulses all may be appropriate.
Imaging
Many times plain X-rays of the hip and pelvis are done to look at the bones and the
joint spaces. In a fall, this may diagnose an acute fracture, but occasionally, the
break cannot be seen on routine films. If the suspicion for fracture is high,

computerized tomography (CT) or magnetic resonance (MRI) imaging may be


considered to confirm or disprove that a fracture is present, even in the presences of
normal plain X-rays. The bone fracture may be occult (hidden).
Narrowed joint spaces and arthritis can be seen on plain X-rays and help confirm the
diagnosis of osteoarthritis and degenerative joint disease.
When looking for cartilage or labrum tears in the hip, an arthrogram may be done, in
which a radiologist injects contrast dye into the hip joint using a long thin needle.
Usually, MRI images are taken to look at the joint surfaces outlined by the dye. With
the test, a local anesthetic is injected prior to the dye. It is helpful to know if the
anesthetic resolves the pain, because if so, it may confirm that the source of the pain
is from within the joint.
A bone scan may be performed to look for inflammation. Radioactive dye is injected
intravenously, and the whole body is scanned. The radiologist looks for abnormal
accumulations of the dye that may help establish a diagnosis. This might be helpful
in determining whether it is a single hip joint that is involved or whether multiple parts
of the body are also inflamed.
Blood Tests
If the health-care professional is concerned that a systemic (body-wide) illness is the
cause of the hip pain, blood tests may be ordered. Some markers for inflammation
include elevation of the white blood cell count, erythrocyte sedimentation rate (ESR),
and C-reactive protein (CRP). These are nonspecific tests but can help direct further
testing based upon the clinical situation. A white blood cell count may also be helpful
as a screening test for infection and inflammation.
When to see a doctor
You may not need to see a doctor if your hip pain is minor. Try these self-care tips:
Rest. Avoid repeated bending at the hip and direct pressure on the hip.
Try not to sleep on the affected side and avoid prolonged sitting.
Pain relievers. Over-the-counter pain relievers such as acetaminophen
(Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium
(Aleve) may help ease your hip pain.
Ice or heat. Use ice cubes or a bag of frozen vegetables wrapped in a
towel to apply cold treatments to your hip. Conversely, a warm bath or
shower may help prepare your muscles for stretching exercises that can
reduce pain.

If self-care treatments don't help, make an appointment with your doctor.


Seek immediate medical attention
Ask someone to drive you to urgent care or the emergency room if your hip pain is
caused by an injury and is accompanied by:

A joint that appears deformed


Inability to move your leg or hip
Inability to bear weight on the affected leg
Intense pain
Sudden swelling
Any signs of infection (fever, chills, redness)

Help for Your Hip Pain


Your hip hurts, and you dont know what to do. Is it serious enough to see a doctor?
Or should you tough it out a little longer?
It depends on what the problem is.
"The hip is a complicated region with the bony joint itself, 24 muscles that cross it,
and a lot of nerves," says Peter Moley, MD, of the Hospital for Special Surgery in
New York.
The first step is to get clear on what you feel and whether its a new problem or an
old one thats flaring up.
Or maybe its not even your hip at all.
"Most people dont know where their hip is," says Andrew Freiberg, MD, chief of the
Center for Hip & Knee Replacement at Massachusetts General Hospital in Boston.
When you "put your hands on your hips," you might actually put them on part of your
pelvis. Your hip joint is much deeper, closer to the groin, and harder to feel with your
fingers.

"If youre sitting in a chair and you put your right hand across your body to your left
hip and you bend your knee up towards the ceiling a little bit, you can feel where it
rotates and bends," Freiberg says. "Thats where the hip joint is."
Keep Moving
Did your hip pain begin after you started a new workout plan or activity? "Stop the
program, but dont stop all activity," Moley says.
"Frequent moderate activity is probably the healthiest thing you can do for a joint,
whether its the joint or the muscle thats causing you pain," Moley says. "Completely
shutting down isnt good for you."
Try These Exercises
While you take a few days rest from the activities that might cause your pain, try
these other exercises that Moley recommends. "Work on stretching, balance, and
range of motion," he says.
Figure-four stretch: Hold onto something if you need to while doing this exercise.
Stand on one leg.
Bend the knee of the other leg, and place the ankle of that leg on your
standing knee. Your legs should make the shape of the number four.
Bend your standing knee as if you were sitting down in a chair with one leg
crossed over the other. You should feel a deep stretch in the hip muscles on
the standing leg side.
Do this on both sides.
Try These Exercises continued...
Hip flexor stretch: Hip flexors are the muscles at the hip that allow you to raise your
leg, for example, when you walk, run, or kick.

Kneel on one knee so that the leg you're kneeling on forms a 90-degree
angle.
Extend the other leg behind you so that the knee is on the floor. You might
want to put a towel under the knee to cushion it.
Shift your pelvis forward until you feel a stretch in the muscles across the top
of the hip and thigh in the extended leg.
Do this on both sides.
Balance exercise: Practice standing on one leg. Alternate sides for several
repetitions.
Range of motion: Stand on one leg and raise the knee of the other leg towards your
chest. Keep the knee bent and open the leg out to the side. Do several repetitions on
each side.
Should You Ice It?
If the pain is truly in your hip joint, ice probably wont reach it. The hip joint isnt close
to the surface of the skin like the knee, Freiberg says.
If its muscle pain and swelling at the front or side of the hip, ice might help. "Ice can
be good for bursitis because its pretty near the skin," Freiberg says.
Bursitis is a painful swelling of the bursae. These are fluid-filled sacs that cushion
ligaments, muscles, and tendons so they can glide smoothly over bone. When these
sacs swell, that movement becomes painful.
What Can You Take?
Over-the-counter anti-inflammatory pain medications, such as ibuprofen or
naproxen, can help.

Moley tells his patients to take painkillers for about 48 hours, but not for weeks or
months on end. Taking an anti-inflammatory for too long can have side effects.
"Normal healing requires a certain amount of inflammation, so just take a short
dose," he says.
You can ask your doctor or pharmacist to make sure its OK for you to take a
medicine. And of course, you should follow the directions on the label.
When to See a Doctor
A little rest, ice, and over-the-counter painkillers might be all you need.
"If your pain is lasting for 4 to 6 weeks and not improving, you should probably have
someone look at it," Moley says.
If your pain returns as soon as you get back to your regular exercise routine, it could
be a stress fracture, Freiberg says.
If you lose range of motion, limp, or feel pain when you walk, these are signs you
should see a doctor. "You dont just suddenly lose range of motion in your hip. That
happens over years. Not weeks or months," Freiberg says.
People with hip arthritis might find it hard to put on their shoes. They might feel
especially stiff after long periods without movement, such as sitting or sleeping or
after a hard workout.
Groin pain, which may be worse at night, could also be a sign of hip arthritis.

If you notice any of these things, get it checked out. For hip pain, you can see your
regular doctor, an orthopaedic surgeon, or a nurse practitioner or physician assistant
who works with an orthopaedic surgeon.
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