Arthritis Pain of the Hip

THE CLINICAL SYNDROME

Arthritis of the hip is a common painful condition encountered in clinical practice. The hip joint is susceptible to the development of arthritis from a variety of conditions that have in common the ability to damage the joint cartilage. Osteoarthritis of the joint is the most common form of arthritis that results in hip joint pain. However, rheumatoid arthritis and post-traumatic arthritis are also common causes of hip pain secondary to arthritis. Less common causes of arthritis-induced hip pain include the collagen vascular disease, infection, villonodular synovitis, and Lyme disease. Acute infectious arthritis will usually be accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized by the astute clinician and treated appropriately with culture and antibiotics, rather than with injection therapy. The collagen vascular diseases will generally present as a polyarthropathy rather than a monarthropathy limited to the hip joint, although hip pain secondary to collagen vascular disease responds exceedingly well to the treatment modalities described here.

SIGNS AND SYMPTOMS

The majority of patients presenting with hip pain secondary to arthritis of the hip joint will present with the complaint of pain that is localized around the hip and upper leg. The pain may initially present as ill-defined pain in the groin and occasionally is localized to the buttocks. Activity makes the pain worse, with rest and heat providing some relief. The pain is constant and characterized as aching in nature. The pain may interfere with sleep. Some patients will complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination.

The pain of arthritis of the hip is localized to the hip, groin, and upper leg and is made worse with weight-bearing exercise.

In addition to the pain, patients suffering from arthritis of the hip joint will often experience a gradual decrease in functional ability, with decreasing hip range of motion making simple everyday tasks such as walking, climbing stairs, and getting in and out of automobiles quite difficult. With continued disuse, muscle wasting may occur and a “frozen hip” due to adhesive capsulitis may develop.

TREATMENT

Initial treatment of the pain and functional disability associated with arthritis of the hip should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. For patients who do not respond to these treatment modalities, an intra-articular injection of local anesthetic and steroid may be a reasonable next step.

Intra-articular injection of the hip is performed by placing the patient in the supine position. Coexistent bursitis and tendonitis may also contribute to hip pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate. The injection technique described is extremely effective in the treatment of pain secondary to the aforementioned causes of arthritis of the hip joint. The use of physical modalities, including local heat as well as gentle range of motion exercises, should be introduced several days after the patient undergoes this injection technique for hip pain. Vigorous exercises should be avoided as they will exacerbate the patient’s symptomatology.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.