Photo Essay: Images of Hip Pain

May 31, 2013

Does the lupus patient have comorbid age-related osteoarthritis? Is it iliopsoas bursitis or trochanteric pain syndrome? Eight images with reflections on differential diagnosis of hip pain.

 

 

 

 

 

 

 

 

 


A simple start: Hip fracture, your first suspicion in any patient "of a certain age." In the elderly, achieving hip replacement within three days is essential to avoid long-term loss of mobility and a host of attendant problems.

To review the surgical options and postsurgical precautions, read this.

For other explanations of pain when the radiographs don't show this kind of picture, read on.

These are the hips of a 65-year-old man whose right-sided pain traces to a fall he took as a paratrooper 40 years earlier.

The left hip has a normal appearance for his age.

What do you see on the right?

Your choice: Read further details about this case of post-traumatic degenerative osteoarthritis.

Or instead, contemplate a different cause of hip pain.

 

 

This patient, a 42-year-old man, reported pain in the right hip that had gradually worsened within the past month.It was aggravated by lifting the right leg and by walking and relieved by ibuprofen. The patient denied recent trauma, but he had had a discectomy for a herniated lumbar disk several years earlier.

What is the arrow pointing to in his right hip? Can you guess the diagnosis? For the answer, click here.

For another cause of pain in the pelvis, read on.

Your next patient, a 41-year-old white woman, reported hearing a "snap" and feeling sudden pain in her right groin while walking across a room. She also spoke of having felt pain in her left upper arm for the past 2 weeks.

On examination, she showed full range of motion in her hip and upper left humerus, but the hip remained painful.

Hint: Her body mass index is 12.2.

Read about this and other fractures due to vitamin D deficiency. Or go on to the next case study.

Here, a 29-year-old patient with lupus was enduring excruciating pain in her left hip and some discomfort in the right hip on weight-bearing and sometimes even at rest. This had been worsening over the past 3 months.

What would you suspect in this case, given her history of lupus?

Read all of the details about this case of corticosteroid-induced osteonecrosis, or continue on to ponder an example of hip pain in a child.

This 10-year-old boy has pain in his right hip, and a limp. He is not taking medications and has not experienced any relevant trauma.

Differential diagnosis includes fracture, osteomyelitis, hip dislocation, and avascular necrosis of the femoral head.

The radiograph confirms the latter possibility: necrosis of the femoral head. This is a case of Legg-Calv-Perthes disease.

In the next case, radiographs were uninformative. You will be asked to consider an MRI for someone who was not in pain (but might have been).

Here a 40-year-old active-duty soldier noted a mass in his groin. It was not painful.

The radiographs were normal, so his doctors ordered ultrasound and MRI.

Among your diagnostic options are snapping hip syndrome, trochanteric bursitis, and lumbosacral radiculopathy.

The mass in this MRI represents iliopsoas bursitis. Although the condition often arises secondary to osteoarthritis or rheumatoid arthritis, this man is otherwise healthy.

The final case involves hip pain in another rheumatologic condition..

 

In this 50-year-old man with advanced ankylosing spondylitis, both sacroiliac joints are fused. But he also has inflammatory arthritis of the right hip (arrow).

Despite the spinal deformity, says this review of ankylosing spondylitis, a measure of pain relief may be achieved with treatment for the inflammatory condition.