A Caucasian Man With Hip Pain

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A Caucasian Man With Hip Pain Essay

The Assignment
Examine Case Study: A Caucasian Man With Hip Pain. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.A Caucasian Man With Hip Pain Essay

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At each decision point stop to complete the following:
• Decision #1
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?A Caucasian Man With Hip Pain Essay
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Assignment learning Resources
Learning Objectives
Students will:
• Assess client factors and history to develop personalized therapy plans for clients with pain
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for pain
• Evaluate efficacy of treatment plans for clients presenting for pain therapy
• Analyze ethical and legal implications related to prescribing therapy for clients with pain
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings

– https://ezp.waldenulibrary.org/login?url=https://stahlonline.cambridge.org/

– Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
• Chapter 10, “Chronic Pain and Its Treatment”

– Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab.
• Chapter 5, “Pain Drugs”A Caucasian Man With Hip Pain Essay
– Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:
For insomnia
• amitriptyline
• amoxapine
• carbamazepine
• clomipramine
• clonidine (adjunct)
• desipramine
• dothiepin
• doxepin
• duloxetine
• gabapentin
• imipramine
• lamotrigine
• levetiracetam
• lofepramine
• maprotiline
• memantine
• milnacipran
• nortriptyline
• pregabalin
• tiagabine
• topiramate
• trimipramine
• valproate (divalproex)
• zonisamide
http://dx.doi.org.ezp.waldenulibrary.org/10.1176/appi.books.9780890425596

https://www.ninds.nih.gov/Disorders/All-Disorders/Chronic-Pain-Information-Page

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/07/mm/complex_regional_pain_disorder/index.html

Rubric for Assignment

Excellent Good Poor
Quality of Work Submitted:A Caucasian Man With Hip Pain Essay
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking. 27 (27%) – 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics. 24 (24%) – 26 (26%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics. 21 (21%) – 23 (23%)
Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed. 0 (0%) – 20 (20%)
Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
Quality of Work Submitted:
The purpose of the paper is clear. 5 (5%) – 5 (5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria. 4 (4%) – 4 (4%)
Purpose of the assignment is stated, yet is brief and not descriptive. 3.5 (3.5%) – 3.5 (3.5%)
Purpose of the assignment is vague or off topic. 0 (0%) – 3 (3%)
No purpose statement was provided.
Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:

Understand and interpret the assignment’s key concepts. 9 (9%) – 10 (10%)
Demonstrates the ability to critically appraise and intellectually explore key concepts. 8 (8%) – 8 (8%)
Demonstrates a clear understanding of key concepts. 7 (7%) – 7 (7%)
Shows some degree of understanding of key concepts. 0 (0%) – 6 (6%)
Shows a lack of understanding of key concepts, deviates from topics.
Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:A Caucasian Man With Hip Pain Essay

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources. 18 (18%) – 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view. 16 (16%) – 17 (17%)
Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view. 14 (14%) – 15 (15%)
Minimally includes and integrates specific information from 2-3 resources to support major points and point of view. 0 (0%) – 13 (13%)
Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view.
Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections. 18 (18%) – 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice. 16 (16%) – 17 (17%)A Caucasian Man With Hip Pain Essay
Summarizes information gleaned from sources to support major points, but does not synthesize. 14 (14%) – 15 (15%)
Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped. 0 (0%) – 13 (13%)
Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.
Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance. 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time. 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time. 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.
Written Expression and Formatting

English writing standards: Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) – 4 (4%)
Contains a few (1-2) grammar, spelling, and punctuation errors. 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) grammar, spelling, and punctuation errors. 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting

The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors. 4 (4%) – 4 (4%)
Contains a few (1-2) APA format errors. 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) APA format errors. 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.A Caucasian Man With Hip Pain Essay
Total Points: 100

This chapter will provide a brief overview of chronic pain conditions associated with different
psychiatric disorders and treated with psychotropic drugs. Included here are discussions of the
symptomatic and pathophysiologic overlap between disorders with pain and many other disorders
treated in psychopharmacology, especially depression and anxiety. Clinical descriptions and formal
criteria for how to diagnose painful conditions are only mentioned here in passing. The reader should
consult standard reference sources for this material. The discussion here will emphasize how
discoveries about the functioning of various brain circuits and neurotransmitters – especially those
acting upon the central processing of pain – have impacted our understanding of the pathophysiology
and treatment of many painful conditions that may occur with or without various psychiatric disorders.
The goal of this chapter is to acquaint the reader with ideas about the clinical and biological aspects
of the symptom of pain, how it can be hypothetically caused by alterations of pain processing within
the central nervous system (CNS), how it can be associated with many of the symptoms of
depression and anxiety, and finally how it can be treated with several of the same agents that can
treat depression and anxiety. The discussion in this chapter is at the conceptual level, not at the
pragmatic level. The reader should consult standard drug handbooks (such as Stahl’s Essential
Psychopharmacology: the Prescriber’s Guide) for details of doses, side effects, drug interactions,
and other issues relevant to the prescribing of these drugs in clinical practice.
What is pain?A Caucasian Man With Hip Pain Essay
No experience rivals pain for its ability to capture our attention, focus our actions, and cause
suffering (see Table 10-1 for some useful definitions regarding pain). The powerful experience of
pain, especially acute pain, can serve a vital function – to make us aware of damage to our bodies,
and to rest the injured part until it has healed. When acute pain is peripheral in origin (i.e., originating
outside of the CNS) but continues as chronic pain, it can cause changes in CNS pain mechanisms
that enhance or perpetuate the original peripheral pain. For example, osteoarthritis, low back pain,
and diabetic peripheral neuropathic pain begin as peripheral pain, but over time these conditions can
trigger central pain mechanisms that amplify peripheral pain and generate additional pain centrally.
This may
Table 10-1 Pain: some useful definitions
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explain why research has recently shown that chronic pain conditions of peripheral origin can be
successfully targeted for relief by psychotropic drugs that work on central pain mechanisms.
Many other chronic pain conditions may start centrally and never have a peripheral causation to the
pain, especially conditions associated with multiple unexplained painful physical symptoms such as
depression, anxiety, and fibromyalgia. Because these centrally mediated pain conditions are
associated with emotional symptoms, this type of pain has until recently often been considered not to
be “real” but rather a nonspecific outcome of unresolved psychological conflicts that would improve
when the associated psychiatric condition improved; therefore, there was not a perceived need to
target this type of pain. Today, however, many painful conditions without identifiable peripheral
lesions and that were once
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All rights reserved. Not for commercial use or unauthorized distribution.A Caucasian Man With Hip Pain Essay
Figure 10-1. Activation of nociceptive nerve fibers. Detection of a noxious stimulus occurs at the peripheral
terminals of primary afferent neurons and leads to generation of action potentials that propagate along the axon
to the central terminals. A fibers respond only to non-noxious stimuli, A fibers respond to noxious mechanical
stimuli and subnoxious thermal stimuli, and C fibers respond only to noxious mechanical, heat, and chemical
stimuli. Primary afferent neurons have their cell bodies in the dorsal root ganglion and send terminals into that
spinal cord segment as well as sending less dense collaterals up the spinal cord for a short distance. Primary
afferent neurons synapse onto several different classes of dorsal horn projection neurons (PN), which project via
different tracts to higher centers.
linked only to psychiatric disorders are now hypothesized to be forms of chronic neuropathic pain
syndromes that can be successfully treated with the same agents that treat neuropathic pain
syndromes not associated with psychiatric disorders. These treatments include the SNRIs
(serotonin-norepinephrine reuptake inhibitors: discussed in Chapter 7 on antidepressants) and the 2
ligands (anticonvulsants that block voltage-gated calcium channels or VSCCs: discussed in Chapter
8 on mood stabilizers and in Chapter 9 on anxiety disorders). Additional psychotropic agents acting
centrally at various other sites are also used to treat a variety of chronic pain conditions and will be
mentioned below. Many additional drugs are being tested as potential novel pain treatments as well.
Since pain is clearly associated with some psychiatric disorders, and psychotropic drugs that treat
various psychiatric conditions are also effective for a wide variety of pain conditions, the detection,
quantification, and treatment of pain are rapidly becoming standardized parts of a psychiatric
evaluation. Modern psychopharmacologists increasingly consider pain to be a psychiatric “vital sign,”
thus requiring routine evaluation and symptomatic treatment. In fact, elimination of pain is
increasingly recognized as necessary in order to have full symptomatic remission not only of chronic
pain conditions, but also of many psychiatric disorders.
“Normal” pain and the activation of nociceptive nerve fibers
The nociceptive pain pathway is the series of neurons that begins with detection of a noxious
stimulus and ends with the subjective perception of pain. This so-called nociceptive pathway starts
from the periphery, enters the spinal cord, and projects to the brain (Figure 10-1). It is important to
understand the processes by which incoming information can be modulated to increase or decrease
the perception of pain associated with a given stimulus, because these processes can explain not
only why maladaptive pain states arise but also why drugs that work in psychiatric conditions such as
depression and anxiety can also be effective in reducing pain.
Nociceptive pathway to the spinal cord
Primary afferent neurons detect sensory inputs including pain (Figure 10-1). They have their cell
bodies in the dorsal root ganglia located along the spinal column outside of the CNS and thus are
considered peripheral and not central neurons (Figure 10-1). Nociception begins with transduction –
the process by which specialized membrane proteins located on the peripheral projections of these
neurons detect a stimulus and generate a voltage change at their peripheral neuronal membranes. A Downloaded from http://stahlonline.cambridge.org
by IP 100.111.251.218 on Mon Oct 07 14:37:34 UTC 2019
Stahl Online © 2019 Cambridge University Press.
All rights reserved. Not for commercial use or unauthorized distribution.A Caucasian Man With Hip Pain Essay
sufficiently strong stimulus will lower the voltage at the membrane (i.e., depolarize the membrane)
enough to activate voltage-sensitive sodium channels (VSSCs) and trigger an action potential that
will be propagated along the length of the axon to the central terminals of the neuron in the spinal
cord (Figure 10-1). VSSCs are introduced in Chapter 3 and illustrated in Figures 3-19 and 3-20.
Nociceptive impulse flow from primary afferent neurons into the CNS can be reduced or stopped
when VSSCs are blocked by peripherally administered local anesthetics such as lidocaine.
The specific response characteristics of primary afferent neurons are determined by the specific
receptors and channels expressed by that neuron in the periphery (Figure 10-1). For example,
primary afferent neurons that express a stretch-activated ion channel are mechanosensitive; those
that express the vanillinoid receptor 1 (VR1) ion channel are activated by capsaicin, the pungent
ingredient in chili peppers, and also by noxious heat, leading to the burning sensation both these
stimuli evoke. These functional response properties are used to classify primary afferent neurons into
three types: A, A, and C-fiber neurons (Figure 10-1). A fibers detect small movements, light touch,
hair movement, and vibrations; C-fiber peripheral terminals are bare nerve endings that are only
activated by noxious mechanical, thermal, or chemical stimuli; A fibers fall somewhere in between,
sensing noxious mechanical stimuli and subnoxious thermal stimuli (Figure 10-1). Nociceptive input
and pain can thus be caused by activating primary afferent neurons peripherally, such as from a
sprained ankle or a tooth extraction. NSAIDs (nonsteroidal anti-inflammatory drugs) can reduce
painful input from these primary afferent neurons, presumably via their peripheral actions. Opioids
can also reduce such pain, but from central actions, as explained below.
Nociceptive pathway from the spinal cord to the brain
The central terminals of peripheral nociceptive neurons synapse in the dorsal horn of the spinal cord
onto the next cells in the pathway – dorsal horn neurons, which receive input from many primary
afferent neurons and then project to higher centers (Figure 10-3). For this reason, they are
sometimes also called dorsal horn projection neurons (PN in Figures 10-1, 10-2, and 10-3). Dorsal
horn neurons are thus the first neurons of the nociceptive pathway that are located entirely within the
CNS, and are therefore a key site for modulation of nociceptive neuronal activity as it comes into the
CNS. A vast number of neurotransmitters have been identified in the dorsal horn, some of which are
shown in Figure 10-2.
Neurotransmitters in the dorsal horn are synthesized not only by primary afferent neurons, but by the
other neurons in the dorsal horn as well, including descending neurons and various interneurons (
Figure 10-2). Some neurotransmitter systems in the dorsal horn are successfully targeted by known
pain-relieving drugs, especially opioids, serotonin- and norepinephrine-boosting SNRIs
(serotonin-norepinephrine reuptake inhibitors), and 2
ligands acting at voltage-sensitive calcium
channels (VSCCs). All of the neurotransmitter systems acting in the dorsal horn are potential targets
for novel pain-relieving drugs (Figure 10-2), and a plethora of such novel agents is currently in clinical
and preclinical development.A Caucasian Man With Hip Pain Essay

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There are several classes of dorsal horn neurons: some receive input directly from primary sensory
neurons, some are interneurons, and some project up the spinal cord to higher centers (Figure 10-3).
There are several different tracts in which these projection neurons can ascend, which can be
crudely divided into two functions: the sensory/discriminatory pathway and the emotional/motivational
pathway (Figure 10-3).
In the sensory/discriminatory pathway, dorsal horn neurons ascend in the spinothalamic tract; then,
thalamic neurons project to the primary somatosensory cortex (Figure 10-3). This particular pain
pathway is thought to convey the precise location of the nociceptive stimulus and its intensity. In the
emotional/motivational pathway, other dorsal horn neurons project to brainstem nuclei, and from
there to limbic regions (Figure 10-3). This second pain pathway is thought to convey the affective
component that nociceptive stimuli evoke. Only when these two aspects of sensory discrimination
and emotions come together and the final, subjective perception of pain is created can we use the
word pain to describe the modality (“ouch” in Figure 10-3). Before this point, we are simply
discussing activity in neural pathways, which should be described as noxious-evoked or nociceptive
neuronal activity but not necessarily as pain.

Hip pain is a common symptom that can be described as aching, sharp, or burning and can range in intensity from mild to severe. There are many possible causes of hip pain, including serious ones, like a fracture or joint infection, and ones that are less so (though still potentially debilitating), like arthritis or bursitis.A Caucasian Man With Hip Pain Essay

In order to get to the bottom of your pain, your doctor will perform a thorough medical history, physical examination, and possibly, order imaging tests. Once diagnosed, you and your doctor can work together to formulate a treatment plan—one that may entail surgery, but more commonly includes self-care strategies, like rest and ice, pain control with medication, and physical therapy.2

hip pain causes
Illustration by Alexandra Gordon, Verywell
Note: Hip pain in children is assessed differently than in adults. This article focuses on the latter.

Causes
The hip is a large “ball-and-socket” joint—the “socket” being a pelvic bone called the acetabulum and the “ball” being the femoral head, which is the upper part of the thighbone.3 Covering this ball and socket joint is cartilage—a smooth, white tissue that cushions the bones and allows the hip to move easily.

Problems within the hip joint itself tend to result in pain on the inside of the hip (anterior hip pain).4 On the other hand, pain on the side of the hip (lateral hip pain) or pain on the outside of the hip, near the buttock region (posterior hip pain) is usually caused by problems with muscles, ligaments, tendons, and/or nerves that surround the hip joint.A Caucasian Man With Hip Pain Essay

Differentiating the various causes of hip pain by location—anterior, lateral, or posterior—is perhaps the best way to understand this somewhat complex symptom.

Anterior Hip Pain
Problems within the hip joint, such as inflammation, infection, or a bone fracture, may result in anterior hip pain—pain felt on the inside of your hip and/or within your groin area.6

Osteoarthritis

Osteoarthritis of the hip occurs when the cartilage in the hip joint gradually wears away over time.7 As the cartilage frays and degenerates over time—often with increasing age or as a result of a prior hip injury—the joint space between the bones of the hip joint narrows, so bone may eventually rub on bone.

Depending on the degree of osteoarthritis, pain may be dull, aching, or sharp; although, in nearly all cases, the pain and stiffness of hip osteoarthritis worsen with activity and improve with rest.8

Understanding Hip Osteoarthritis
Inflammatory Arthritis

Various types of inflammatory arthritis may affect the hip, resulting in dull, aching pain, such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus.9 Unlike the pain of osteoarthritis, which is worsened with activity, hip pain from inflammatory arthritis is often eased with activity.A Caucasian Man With Hip Pain Essay

Fracture

A hip fracture, or a break in the upper quarter of the thigh bone, causes a deep, boring pain felt in the outer-upper thigh or groin area.10 A hip fracture may occur after a fall or direct blow to the hip. It may also occur as a result of a stress injury.

Stress fractures of the hip are most common in female athletes who have an eating disorder, menstrual irregularities, and bone weakening (conditions that, together, are known as the female athlete triad).11

Steroid use, a history of smoking, and medical conditions that weaken the bone (e.g., cancer or osteoporosis) are additional risk factors.12

With a stress fracture, as opposed to a complete break from a fall, a person may experience more of a gradual onset of pain that worsens with weight bearing.A Caucasian Man With Hip Pain Essay

Iliopsoas Bursitis

Bursitis simply translates to irritation or inflammation of a bursa, which is a small, fluid-filled sac that serves as a cushion between joints, muscles, and tendons.13 One bursa, located on the inner or groin side of your hip—called the iliopsoas bursa—causes anterior hip pain if inflamed.14

Iliopsoas bursitis, which is most common in runners or soccer players, causes anterior hip pain that may radiate to the front of the thigh area or into the buttock area.5 Sometimes, a snapping, catching, or popping sensation is felt in the hip with this type of bursitis.

Hip Flexor Strain

A hip strain refers to a stretching or tearing of a muscle or its associated tendon (or both).15 Hip flexor muscles, like the iliopsoas muscle or rectus femoris muscle, are often involved in a hip strain.A Caucasian Man With Hip Pain Essay

A person may develop a hip flexor strain from overuse (e.g., cyclists, martial artists, or soccer players), or from some sort of trauma, such as a direct hit during a contact sport.17 In addition to anterior hip pain, hip flexor strains may result in swelling, restricted movement, and muscle weakness.18

Osteonecrosis of the Hip

Osteonecrosis of the hip occurs when the hip bone does not receive a sufficient blood supply, which leads to the death of the bone cells and destruction of the hip joint.19 The vast majority of cases are due to corticosteroid use and excessive alcohol intake.20

Besides anterior hip pain and groin pain that worsens with walking, a person may experience pain in the thighs, buttocks, and/or knees.21

Hip Labrum Tear

Your hip labrum is a band of cartilage-like tissue that courses around the outer rim of your hip socket.22 This labrum helps to support the joint and deepen the socket. Sometimes overuse or an injury to your hip can cause a tear in your labrum, prompting dull or sharp anterior hip pain that worsens with weight bearing.A Caucasian Man With Hip Pain Essay

Femoroacetabular Impingement (FAI)

In femoroacetabular impingement (FAI), bony growths develop around the hip joint.23 These growths can restrict movement and eventually cause tears of the labrum and hip osteoarthritis.

The symptoms of femoroacetabular impingement include an aching or sharp pain in the groin area that moves toward the outside of the hip.24 The pain is often felt once standing after sitting for a prolonged period of time. Stiffness and limping are also common.23

Infected Hip Joint

Uncommonly, the hip joint may become infected (called a septic joint).25 In addition to severe anterior hip and/or groin pain, swelling, warmth, and restricted hip movement are typically present. Fever often also occurs, but may not be present in older individuals.26

Bone Cancer

Rarely, bone cancer (either primary or metastatic) may cause hip pain. Usually, the pain starts off being worse at night, but as the bone tumor progresses, the pain often becomes constant.27 Swelling around the hip area may also occur along with weight loss and unusual fatigue. Due to bone weakening from the cancer, a hip fracture may occur.A Caucasian Man With Hip Pain Essay

Lateral Hip Pain
Lateral hip pain refers to pain on the side of the hip, as opposed to the front or back of the hip.29

Trochanteric Bursitis

Trochanteric bursitis causes sharp lateral hip pain that often spreads down into the thigh and knee.30 The pain is usually worse at night when sleeping on the affected hip and when engaging in physical activities like walking or running.

Over time, the pain may evolve into a deep aching pain that spreads over a larger area of the hip.31 Swelling and limping may also occur.

Snapping Hip Syndrome

Snapping hip syndrome causes a snapping or popping sensation and possibly lateral hip pain with walking or other movements, like getting up from a chair.32 The actual “snapping” is due to one or more tight muscles, tendons, or other soft tissue moving over a bony structure within your hip.

One commonly affected “tight” or irritated tissue is the iliotibial band (IT band)—a thick collection of connective tissue that starts at the hip and runs along the outer thigh.33 The snapping sound results from the area where the IT band passes over the greater trochanter (the upper portion of the thigh bone).A Caucasian Man With Hip Pain Essay

This condition is most common in people who engage in sports or activities that cause them to frequently bend at the hip (one reason why it’s also referred to as “dancer’s hip.”)35

Posterior Hip Pain
Posterior hip pain, which is pain felt on the outside of the hip or buttock area, is usually due to a problem with the muscles, tendons, or ligaments that surround the hip joint, as opposed to the actual joint itself.36

Hamstring Muscle Strain

Muscle strains result from small micro tears in muscles caused by a quick twist or pull to the muscle. When this occurs to the hamstring muscles located around the hip joint, buttock pain and/or pain in the back of your hip occurs.14

Sacroiliac Joint Problem

The sacroiliac (SI) joint connects the lower spine to the pelvis.37 You have one located on both sides of your body.

Various problems with the SI joint, including arthritis of the joint, infection of the joint, and injury to the joint ligaments, may result in posterior hip pain.38 The sharp and/or burning pain is often worse with standing and walking, and may radiate from the hip down the back of the leg.

Sacroiliac Joints of the Sacrum and Ilium
Piriformis Syndrome A Caucasian Man With Hip Pain Essay

Piriformis syndrome—also called deep gluteal syndrome—occurs when the sciatic nerve (a large nerve that branches off from your lower back into your hip, buttock, and leg) becomes irritated or compressed by the piriformis muscle, which is located deep within the buttock, near the top of the hip joint.39

The burning or aching pain of piriformis syndrome typically begins in the posterior hip and buttock region and moves down the back of the thigh.

When to See a Doctor
It’s important to seek immediate medical attention if your hip pain is sudden, severe, getting worse, or if you have fallen or experienced another form of trauma to your hip.36

While not an exhaustive list, other symptoms that warrant immediate medical attention include hip pain associated with:

Fever
An inability to bear weight or walk40
Leg or foot weakness
Swelling
Bruising or bleeding
Warmth over the hip30
Diagnosis
A medical history and thorough physical exam by a primary care physician, sports medicine doctor, or orthopedic surgeon are essential to properly diagnosing the source of your hip pain.A Caucasian Man With Hip Pain Essay

Depending on your doctor’s underlying suspicion, imaging tests, like an X-ray or magnetic resonance imaging (MRI), may be ordered. Less commonly, blood tests are utilized in the diagnosis of hip pain.41

Medical History
When you see your doctor for hip pain, he will likely ask you several questions, such as:

Is your hip pain better with rest or exercise?
Do you have any additional symptoms (e.g., fever, swelling, other joint pain, etc.)?
Do you or any family members have arthritis or a history of joint problems?
Have you experienced any recent trauma to your hip?4
Physical Examination
During your physical exam, your doctor will inspect and press on various landmarks within your hip, leg, lower back, and abdomen.23 He may also perform a neurological exam to assess muscle weakness and reflexes.

In addition, he will maneuver your hip to evaluate its range of motion, examine your gait (how you walk), posture, and ability to bear weight.42

Lastly, based on your doctor’s underlying suspicion for one or more hip pain diagnoses, he will perform certain “special hip” tests. One classic test commonly used to evaluate hip pain is the FABER test.43

FABER Test

The FABER test (which stands for flexion, abduction, and external rotation) is used to diagnose hip pathologies, such as hip osteoarthritis, hip labrum tear, or femoroacetabular impingement.A Caucasian Man With Hip Pain Essay

During the FABER test, while you are lying flat on your back, your provider will move your leg into flexion by 45 degrees and then place your ankle (from the affected side) just above the kneecap of the opposite leg. He will then press down on the knee from the affected side in order to lower the leg.

The test is positive if pain occurs at the hip joint or if the knee/leg from the affected side cannot be lowered so that it is parallel with the opposite leg.22

Other tests include:

Straight leg test
Trendelenburg test44
Leg roll test
Imaging
Certain imaging tests may be needed to confirm or support a diagnosis for your hip pain. For example, an X-ray is the standard test in diagnosing a hip fracture.45 An X-ray may also reveal changes associated with hip osteoarthritis (e.g., joint-space narrowing and bony growths, called osteophytes).7

An MRI may also be used to evaluate for a hip fracture, in addition to other conditions like hip osteonecrosis or an infected hip joint.19 A magnetic resonance arthrography is the test of choice for diagnosing a hip labral tear.46 Finally, an ultrasound may be used to confirm a diagnosis of bursitis.A Caucasian Man With Hip Pain Essay

Blood or Other Tests
For certain suspected diagnoses, various blood tests may be ordered. For instance, if an infected joint is suspected, your doctor will likely order a white blood cell count, blood cultures, and inflammatory markers, like an erythrocyte sedimentation rate.48

In addition, cultures from a hip aspiration (removing synovial fluid from the hip joint) are usually taken to both diagnose and treat septic arthritis.25

What Is Synovial Fluid Analysis?
Differential Diagnoses
While it is logical to think that hip pain is related to a problem within the actual hip joint, or the muscles or other soft tissues surrounding the joint, this is not always the case.

Here are some conditions that refer pain to the hip, meaning they do not originate within the hip joint or within structures that closely surround the hip:

Kidney Stone

Some lower abdominal processes may cause pain that feels like it is coming from the hip. For example, a kidney stone can cause severe pain in the flank area (between the top of your hip and the bottom of your ribcage in your back).49 The pain may radiate toward your groin or inner thigh.A Caucasian Man With Hip Pain Essay

Meralgia Paresthetica

Meralgia paresthetica refers to compression of a pure sensory nerve—called the lateral femoral cutaneous nerve—as it passes under the inguinal ligament.50 Besides a burning pain felt mainly in the upper-outer thigh, numbness and tingling are usually reported.

This condition is most common in older adults and those with diabetes mellitus.51 Obesity, pregnancy, and wearing tight pants or belts also increases your risk for developing this condition.52

Aortoiliac Occlusive Disease

Aortoiliac occlusive disease, which refers to blockage of the aorta (the main blood vessel in your body) and iliac arteries (the two arteries that branch off from the aorta near your belly button), causes an aching, cramping pain in the buttock, hip, and/or thigh.53

This pain—termed claudication—is induced by exercise and relieved with rest. The blockages in these arteries are most commonly due to a condition called atherosclerosis, in which plaque builds up in the blood vessel walls, ultimately narrowing them enough that blood flow to the legs and groin area becomes insufficient.A Caucasian Man With Hip Pain Essay

Lumbar Radiculopathy

Sometimes, nerve pain (a burning or tingling sensation) felt in or around the hip joint may actually be referred from an irritated nerve in the lower spine. This condition, called lumbar radiculopathy, can be diagnosed with an MRI of the lower (lumbar) spine.55

Treatment
While the treatment of your hip pain depends on the diagnosis made by your healthcare professional, it’s common for a patient’s therapy plan to involve a combination of self-care, medication, physical therapy, and less commonly, surgery.1

Self-Care Strategies
Your doctor may recommend a number of self-care strategies—a way for you to take an active stance in managing your hip pain.

A few examples of these possible strategies include:

Limiting or avoiding activities that aggravate your hip pain, like climbing stairs
Using a walking assistive aid like a cane or walker to improve independence and mobility
The R.I.C.E. protocol: If you experience hip pain while performing a sport or other activity, follow this progression of rest, ice, compression, and elevation until you can get in to see your doctor.14
Medications
Various oral medications, such as Tylenol (acetaminophen) or an over-the-counter nonsteroidal anti-inflammatory (NSAID), are used to ease hip pain related to a number of conditions, including osteoarthritis, labrum tear, bursitis, or femoroacetabular impingement.56 Opioids, which are stronger pain medications, may be prescribed to treat severe pain from a hip fracture or an infected hip joint.57

Depending on your diagnosis, other medications, like a disease-modifying anti-rheumatic drug (DMARD) to treat rheumatoid arthritis or intravenous (through the vein) antibiotics to treat an infected joint may be used.A Caucasian Man With Hip Pain Essay

Physical Therapy
Physical therapy is an essential component to easing the pain of and treating most causes of hip pain.59 In addition to exercises to improve the strength, flexibility, and mobility of your hip, your physical therapist may use massage, ultrasound, heat, and ice to soothe inflammation within the hip. He may also offer guidance on when it is safe to return to sports or other activities (depending on your underlying diagnosis).

Exercises to Keep Your Hips Strong and Mobile
Surgery
Surgery may be required for certain hip pain diagnoses. For example, surgery is often used to repair a hip fracture.60 Likewise, for hip osteoarthritis that worsens despite conservative measures, a surgeon may perform a total hip replacement.61 Finally, a procedure called a hip arthroscopy may be used to correct a torn hip labrum.62

An Overview of Total Hip Replacement
Prevention
While you may not be able to prevent all causes of hip pain, there are several things you can do to be proactive in this regard:63

Lose weight if you are overweight or obese
Eat a balanced, nutritious diet that contains sufficient vitamin D and calcium to maintain bone health64
Opt for low-impact activities like swimming or biking
Stretch before and cool down after exercising
Obtain a special shoe insert if you have leg-length inequality65
Wear properly cushioned, fitted shoes and avoid or limit running on hard surfaces like asphalt
Discuss a daily exercise routine for maintaining muscle and bone strength with your doctor A Caucasian Man With Hip Pain Essay
Considering yoga or tai chi to help prevent falls, one of the most common causes of hip fractures66
3 Exercises to Prevent Falls
A Word From Verywell
Hip pain is a disabling condition with many potential causes. While the diagnostic process can be challenging and a bit tedious at times, try to remain patient and proactive. Once diagnosed, your doctor may move forward with devising a treatment plan that suits your needs—one that uniquely addresses your pain and optimizes your healing.A Caucasian Man With Hip Pain Essay

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