Tips for Evaluating the Painful Hip in a Young Adult

    What are the key points for assessing patients with hip pain? Not the postoperative total hip arthroplasty patient, but the young adult who presents with an acute hip pain unrelated to any surgery.

    Raymond H. Kim, MD, from The Steadman Clinic in Vail, Colorado, shared his top 5 tips for evaluating these patients at the recent ICJR East ISK Hip & Knee Course. Find out what he had to say.

    Tip 1: Listen to the patient’s history

    Pay attention to how patients describe their symptoms.

    • Do they feel a catching or popping?
    • Is the pain sharp or dull?
    • Do they feel a snapping or clunking in the hip?
    • Is there pain with sitting?
    • Is the pain worse with weight-bearing?
    • How long have they had these symptoms?
    • Have they experienced a recent trauma or new activity?

    Tip 2: Perform a systematic hip exam

    Don’t forget: The hip exam should include a examination of the spine, since spine pathology can refer pain to the hip.

    For the hip exam, be sure to evaluate:

    • Gait
    • Alignment
    • Range of motion
    • Motor and sensory function
    • Pulses

    Specific exams should also be done with the patient in the supine position and the lateral position, such as flexion, adduction, and internal rotation (FADIR) and flexion, abduction, and external rotation (FABER) in the supine position and Ober’s test in flexion, neutral, and extension while the patient is in the lateral position.

    Tip 3: Critically evaluate radiographs

    The anteroposterior pelvis view and the false profile view provide insights into acetabular pathology, while the cross-table lateral, frog leg lateral, and 45° and 90° Dunn views show proximal femoral pathology.

    Tip 4: Start with a broad differential diagnosis

    “Hip pain” can have orthopaedic and non-orthopaedic causes and may not involve the hip at all. Rule out non-orthopaedic causes first, such as inguinal hernia, lymphadenopathy, and gynecologic conditions, and then move through the orthopaedic causes, such as femoroacetabular impingement (FAI), stress fracture, and avascular necrosis (AVN).

    Also, determine if the pain is intra-articular or extra-articular. In other words, where does the patient feel the pain? Anterior hip pain generally means the hip joint is involved, while buttock pain usually originates in the spine. Lateral thigh pain typically means trochanteric bursitis or involvement of the iliotibial band.

    Tip 5: Watch for red flags

    Night pain could mean the patient has a tumor. A patient who reports a previous trauma or steroid use could have AVN. Trauma can also signal a fracture. A patient with a history of childhood hip problems may have dysplasia or FAI. Pain in other joints may have a rheumatologic cause. Pain with weight-bearing could indicate a fracture or infection.

    Click the image above to hear more from Dr. Kim about evaluating the painful hip in the young adult.


    Dr. Kim has no disclosures relevant to this presentation.