Chronic hip pain is hard to describe, but the cause is easier to uncover if the right questions are asked. This leads to the correct diagnosis, and a better chance for pain relief. Health care professionals are taught to ask about pain in an organized manner. If the proper questions are not asked, incorrect testing and treatment may lead to poor results. Sometimes time does not allow detailed questioning about all possible causes of hip pain. In that instance I find customized, location-specific questioning is very helpful.
First the exact pain location is identified. This is followed with specific questions based upon the location of the painful spot.
For example, if a patient comes in complaining of hip pain, I will need to confirm her hip is actually the cause of her pain. My first question is, “Can you point to me with one finger where it hurts? If she indicates the groin area at the top of her leg, then the next questions are directed toward a common cause of pain in this area; osteoarthritis. “Does it hurt there when you stand and start to walk? Is it better sitting down? Will it feel better after you walk several steps? If you walk too far will it start to hurt again? Is it improved with Tylenol or ibuprofen? (Many of these questions are the same ones asked on Painspot.com.)
If so, the pain may be coming from the hip joint. If moving her hip causes the pain, she may have osteoarthritis, and X-rays are ordered to help confirm the diagnosis and exclude other conditions.
But if she points to the side of her hip it is usually not arthritis. The next question then would be “Does it hurt there when you lie on it at night?” If she says yes, and the side of the hip very tender to push on, it may be simple bursitis which therapy or a cortisone shot will relieve. X-rays may not be necessary.
If she points to the back of her hip, in the buttock region, this pain is usually not from the hip joint, but from the low back, muscles or even the sacroiliac joint. Burning or tingling pain that may extend down into the calf or ankle may be from a pinched nerve in the lower spine.
What if the pain location is difficult to pinpoint, and never goes away even at night? In this case questions about fevers, weight loss or night sweats are asked an infection or cancer may be causing the pain. Detailed and urgent testing is started immediately, as delays may lead to permanent damage to the joint – or worse. Again, the location and type of pain provide the best direction to finding the cause and directing treatment.
Of course, detailed questioning followed by a thorough physical exam by a doctor who knows you well is the highest standard of care. When this is followed by appropriate testing the best results may be expected. Unfortunately we do not live in a perfect world. The reality is that we often need to focus on the most efficient way to find the answer, and to be certain the most serious diseases are not missed.
Douglas Roberts MD is a board certified rheumatologist in private practice in Sacramento, and volunteers teaching medical students and residents at the University of California, Davis. He has treated his patients’ painful arthritis symptoms for over twenty years, and is the founder of PainSpot.com, an interactive website focused on helping patients identify the cause of their pain.