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 Spence Rehabilitation Center 9305 Calumet Ave. Suite C-1 Munster, IN 46321 Phone : (219) 513-2267 Fax      : (219) 836-1276         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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