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Patient history, physical examination are important for differentiation of hip, lumbar pathology
Investigators found it is important for patient history to be obtained and for a complete examination to be performed to help surgeons differentiate hip from spine pathologies and to guide treatment.
According to researchers, for physicians to differentiate between hip pathology and spine pathology they must obtain a thorough patient history which includes a temporal onset assessment; information on pain duration, severity, location and character; and information about antecedent trauma. Patients should undergo a physical examination that includes an inspection and palpitation of the affected areas, gait observation, and evaluation of both the hip and spine.
A forward bend test can assess spinal rotational deformity and surgeons should assess a patient’s antalgic gait and assess for the presence of an abductor lurch. Physicians should also perform a hip range of motion test and assess for internal rotation loss with pain at the terminal range of motion to determine hip pathology.
To determine the pathology source, plain radiographs should be performed first, followed by MRI and CT scans. Injections, such as nerve-root injections, epidural injections and intra-articular injections, can be used for both diagnosis and therapy. Researchers noted principles of probability and importance are the basis of diagnosis for hip, spine and other pathologies.
Patients with back pain or lower extremity pain are more likely to be diagnosed for hip osteoarthritis pathologies or lumbar radiculopathy; however, tumors, stress fractures and infections cannot be missed during diagnosis as investigators noted these may lead to serious consequences. ‒ by Monica Jaramillo
Disclosures: Razi reports he is a board or committee member of the American Academy of Orthopaedic Surgeons and the American Orthopaedic Association and is on the editorial board for Journal of Surgical Education. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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It has been shown there is a complex biomechanical interaction between the hip and lumbar spine, which is often referred to as hip-spine syndrome. It is crucial for physicians to recognize and differentiate symptoms of both pathologies that usually overlap.
When attempting to differentiate hip and spine pathologies in patients with confusing exam findings, the clinician must follow an evaluation algorithm to minimize misdiagnosis.
Presented herein is a detailed differential diagnosis that we find valuable in approaching symptoms that arise from the hip and/or spine. Proper patient history, as well as physical exam and radiographic imaging findings, are presented and well-described. We have found that hip ultrasound-guided diagnostic injections with anesthetics (intra-articular or extra-articular) are a vital, quick, and cost-effective tool that can be used during routine clinic appointments and should be emphasized during the diagnostic process.
Multiple studies have shown that patients with hip-spine syndrome may demonstrate improvement in their lower back pain following properly-indicated hip surgery; however, problems of each may negatively affect prognosis of surgery for the other condition.