Katherine Margo, MD Jonathan Drezner, MD Daphne Motzkin, MD Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia margok@uphs.upenn.edu
In cases of suspected labral or intra-articular pathology, MR arthrography, anesthetic intraarticular injection and examination under local anesthesia, or diagnostic arthroscopy may be needed.16 These are relatively new techniques that help diagnose disorders not previously recognized.
Treatment
Depending on the presumed cause of pain, treatment options include activity modification, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, corticosteroid injections, physical therapy, and, if necessary, walking support.
Osteoarthritis. When symptoms persist despite conservative treatment for osteoarthritis, fluoroscopically guided intra-articular injection of a corticosteroid—or, more recently, viscosupplementation with hyaluronic acid preparations—may be useful in decreasing pain, and delaying or possibly avoiding hip arthroplasty (LOE=4).27-29
Greater trochanteric bursitis. Corticosteroid injection is also helpful and easily performed by a family physician for treatment of greater trochanteric bursitis, with 77% of patients improving in 1 week, and 61% with sustained improvement at 26 weeks (LOE=4).30
Iliopsoas bursitis. This disorder has been shown to respond to a physical therapy program emphasizing hip rotation strengthening (LOE=4).31 However, recalcitrant cases may require intrabursal injection or surgical lengthening of the iliopsoas muscle (LOE=4).32,33
Meralgia paresthetica. This condition may respond to an injection of corticosteroid adjacent to the anterior superior iliac spine near the emergence of the lateral femoral cutaneous nerve.10 In cases of suspected sacroiliac joint dysfunction, manipulative therapy was shown to provide short-term improvement.34
When To Refer
When hip pain is refractory to conventional treatment, consider referral to a specialist, such as a sports medicine specialist, physiatrist, rheumatologist, or orthopedic surgeon.
