Letters to the Editor

Additional Differential Diagnosis for Adult Hip Pain

 

Am Fam Physician. 2021 Jul ;104(1):9.

Original Article: Hip Pain in Adults: Evaluation and Differential Diagnosis

Issue Date: January 15, 2021

See additional reader comments at: https://www.aafp.org/afp/2021/0115/p81.html

To the Editor: We applaud Dr. Chamberlain for the outstanding review of the evaluation and differential diagnosis of hip pain. We have found that many family medicine residents are uncomfortable with the evaluation and examination of hip pathology. Dr. Chamberlain did an excellent job delineating anatomic locations, dynamic testing, and considerations for anterior, lateral, and posterior hip locations. We suggest that lateral femoral cutaneous nerve entrapment (i.e., meralgia paresthetica) be included in the differential diagnosis.1 Lateral femoral cutaneous nerve entrapment is a common clinical entity that presents as hip pain. It is treatable if physicians are familiar with lateral femoral cutaneous nerve anatomy and ultrasound location. This injury is amenable to nerve hydrodissection guided by point-of-care ultrasonography because it courses over the proximal sartorius muscle. Corticosteroids and dextrose prolotherapy have been successfully used for years to avoid surgical management. Most patients are treated successfully with one or two injections.2

Editor's Note: This letter was sent to the author of “Hip Pain in Adults: Evaluation and Differential Diagnosis,” who declined to reply.

Author disclosure: No relevant financial affiliations.

References

1. Haim A, Pritsch T, Ben-Galim P, et al. Meralgia paresthetica: a retrospective analysis of 79 patients evaluated and treated according to a standard algorithm. Acta Orthop. 2006;77(3):482–486.

2. Tagliafica A, Serafini G, Lacelli F, et al. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med. 2011;30(10):1341–1346.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

 

 

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