Topics in diagnostic imagingPosterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging
Introduction
Self-reported hip pain is common, afflicting approximately 14% of the population over the age of 60 years.1 Providing a focused differential diagnosis for a chief complaint of hip pain is challenging, and sources may originate around, or within, the bony ring between the lumbar spine and the pubic symphysis. Clinicians need to consider both local and distant osteoligamentous, tendinous, nervous, and muscular anatomy when examining patients with complaints related to the posterior, lateral, or anterior hip. Additionally, myofascial pain syndrome is a common and overlooked cause of pain.2 Genitourinary, gastrointestinal, and vascular pathology should be excluded when examining a patient with hip pain but are beyond the scope of this review.
History and physical examination are crucial in the evaluation of any patient complaint. Unfortunately, the history and physical examination results of a patient with hip pain are typically nonspecific,3 reflecting the complex anatomy of the hip and pelvis and the overlapping organ systems that are included in the differential diagnosis. As such, diagnostic imaging is indispensable in narrowing and arriving at an accurate differential diagnosis that will guide efficient and cost-effective treatment. Therefore, the aim of this review was to provide musculoskeletal differential considerations for posterior, lateral, and anterior hip pain in the adult patient.
Section snippets
Methods
A narrative review of the English medical literature was conducted. For the purpose of organizing hip pain into a clinically useful context, it was subdivided into posterior (ie, ischial), lateral (ie, trochanteric), and anterior (ie, inguinal) locations. Furthermore, myofascial pain was considered separately as a source of hip pain. Randomized controlled trials, cohort and case-control studies, case series, and both systematic and narrative reviews were included. Individual case reports were
Results
The authors selected 116 papers to include in this narrative review.
Discussion
The following is a discussion of posterior, lateral, and anterior hip pain in an adult patient. Myofascial pain is discussed first as a separate entity because it may present in any hip compartment, although the underlying pathophysiology is constant. Additionally, there is limited information on objective clinical examination and imaging findings for the diagnosis of myofascial pain. For these reasons, myofascial pain is discussed separately, with the understanding that it should be considered
Limitations
This was a narrative review and therefore was not a rigorous systematic review; by default, lower-quality studies were included. However, the aim of our work was to present a comprehensive yet practical review of studies on hip pain to serve clinicians in daily practice. Some diagnostic entities (eg, obturator internus tendinopathy) may be important to consider clinically but have been investigated very little and therefore have limited findings on history and physical examination or imaging.
Conclusions
The diagnosis of hip conditions may be challenging for clinicians. Although the history and physical examination are useful, the results are often equivocal. Diagnostic imaging is used routinely to achieve a differential diagnosis and thus increase the specificity, advance a diagnosis, and aid in the development of a prognosis. Furthermore, once a diagnosis is established, imaging may be used to monitor treatment response. This review has presented the diagnostic possibilities of the
Supplementary data
Supplementary data to this article can be found online at doi:10.1016/j.jcm.2016.08.004.
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Contributorship Information
Concept development (provided idea for the research): P.J.B., K.D., N.W.K.
Design (planned the methods to generate the results): P.J.B., K.D., N.W.K.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): P.J.B., K.D., N.W.K.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): P.J.B., K.D., N.W.K.
Analysis/interpretation (responsible for statistical analysis, evaluation, and
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