When the diagnosis of an arthritic hip is not clear, it is important to consider other problems that might cause similar pain in the groin and thigh. Problems in the lumbar spine, such as disc herniation and spinal stenosis, can cause pain in the hip. This is because the nerve roots that supply feeling to the hip are affected by the disease. A disc herniation or herniated nucleus pulposus can cause hip pain if it presses a nerve root on the affected side.
By the same token, spinal stenosis which also causes inflammation of the nerve roots, can mimic the symptoms of an arthritic hip. It is important to consider both of these diagnoses, especially in patients who have a history of spinal problems. Clinically, there are several ways to separate spinal dis-ease from hip disease. In a disc herniation, the pain will be radicular; that is, it will extend down the leg. There may be some loss of feeling or weakness of the muscles and loss of a reflex. Straight leg raise test will often be positive. There will, however, be normal range of motion of the hip, and movement of the joint itself will not be painful. In an arthritic hip, joint motion will be both limited and painful.
MRI of the spine will show the disc herniation and confirm the diagnosis. Spinal stenosis usually develops after age 50 years. As with disc herniation, pressure on the L2 or L3 nerve roots can cause pain in the hip. Stenosis pain, however, usually develops after an individual has been walking for several minutes. It begins as a burning or numbing and then becomes pain. It is completely relieved when the individual sits down to rest. Physical examination in spinal stenosis is often unremarkable.
Again, this contrasts to an arthritic hip where motion is limited and painful. As with other spinal problems, MRI can be used to confirm the diagnosis. Some elderly patients have symptoms and radiographic findings of both an arthritic hip and spinal stenosis. When this occurs, it is important to determine the primary cause of pain. Some situations require a frank discussion between doctor and patient as to which problem is more symptomatic and which should be treated first. It is important to realize that no matter which problem is treated, some symptoms will remain.
Neuropathy, like disc herniation and spinal stenosis, is a neurological problem. In neuropathy, however, the nerve itself is inflamed rather than being compressed. It is sometimes present in patients with diabetes mellitus. Neuropathy can cause hip or thigh pain, but examination of the hip will again be normal. If neuropathy is suspected, consultation with a neurologist will be obtained. Arterial insufficiency or narrowing of one of the main arteries in the leg can cause pain in the hip and thigh.
Most often, symptoms are in the lower leg, but they can occur closer to the hip. Arterial problems can be easily diagnosed by the absence of pulses or by tests that measure the blood flow to the leg. Other causes of hip pain include inguinal hernia, urologic problems, and gynecologic disease. Pain localized to the groin can sometimes be caused by an inguinal hernia.
This can be easily detected on physical examination by either your family physician or a general surgeon. Urologic problems such as prostate disease may also cause pain that radiates to the groin area. In this case, evaluation and testing by an urologist can help to diagnose the problem. Finally, some pelvic problems such endometriosis can cause pain in the area of the hip and can be diagnosed by a gynecologist.