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“НАШЕ ЖИТТЯ”, КВІТЕНЬ 2014 WWW. UNWLA.ORG 33 Oh No, I Think It's My Hip! by Ihor Magun, MD, FACP The diagnosis of hip pain frequently pr e- sents a challenge. The differential diagnosis is broad and varies by age group. For this reason, an accurate history and physical examination are helpful in identifying a possible cause. Obviously, any traumatic injury to the lo w- er body, such as through a fall, needs immediate attention in an emergency room if there is severe pain and/or long-term instability in walking. Ho w- ever, to confirm a probable diagnosis of chronic hip pain, the precise localization of the pain is par a- mount. Indeed, persistent hip pain is mostly r e- stricted to three anatomic regions: the front part of the hip and groin; the lateral part, or side of the hip; and the back of the hip and buttock area. Pain in the groin or buttock area when walking indicates possible osteoarthritis. This di s- ease stems from a decrease in the space between bones due to diminished cartilage in a joint. The pain can feel more like a deep ache, may be a c- companied by a cracking or grinding sound, and improves with rest and no weight bearing. The pathogenesis of this disorder is attributable to an earlier cartilage injury that fails to repair itself by biochemical process. It is important to note that there is minimal or no morning stiffness or joint inflammation associated with this pain. In add i- tion, x-ray examination correlates poorly with the extent of symptoms as the pain may be much more severe than seen on the film. Recommendations for treatment are ind i- vidualized. Weight loss and pain relievers such as acetaminophen (Tylenol) are helpful, and some individuals benefit from ice applications and intra- articular injections such as steroids. Sufferers should certainly refrain from physical activity such as prolonged running; some acute cases may even require complete hip replacement. Pain located on the side of the hip with di s- tinct point tenderness — in other words, tenderness in a two- or three-centimeter area — signals bursitis. This condition occurs from an inflammation of a bursa or fluid-filled sac that functions as a cushio n- ing mechanism. Bursae are present in areas where tendons and muscles move over bony areas. Treatment depends on the severity of the pain, but analgesics and ice compresses are frequently re c- ommended; however, severe pain responds best to localized corticosteroid injections. When pain is limited to the buttock area, a possible diagnosis of tendonitis should be consi d- ered. Tendonitis is the inflammation of a tendon — also known as a sinew — which connects muscles to bones. Hamstring tendonitis is a common cause of this discomfort. In this case, anti-inflammatory agents are helpful as well as ice. Of course, one should mention that hip pain does not necessarily mean a hip condition. When pain and/or numbness radiates down the back-hip-leg, the patient could suffer from a spinal issue despite the feeling of a hip condition. Dia g- nostic possibilities include a spinal disc issue — like the narrowing joint spaces between vertebrae. Treatment is variable and includes radiological evaluation especially, if the pain is unrelenting and presents with neurological issues. Other treatment options run the gamut of anti-inflammatories, pain medications, localized injections, physical therapy, and surgical interventions. Lastly, inflammatory joint pain accomp a- nied by redness, heat, and possible swelling signals a form of arthritis. This degenerative joint disease is associated with morning stiffness lasting longer than sixty minutes and is accompanied by fatigue and malaise. Distinguishing between this type of pain and noninflammatory pain is critical in long- term management. As this article has outlined, the diagnoses and treatments for hip pain vary widely, as the hip is a complex anatomical structure and hip pain may come from sources other than itself. Although you always want to be in the best of health, if you must see your family practitioner on account of hip pain, you will at least be armed with information to help your physician determine the correct diagn o- sis and treatment. НАРОДНА МУДРІСТЬ ПРО СИЛУ ДУХА Гроші втратив – нічого не втратив, час втратив – багато втратив, бадьорість духу вратив – усе втратив. Де кінчається людська сила, там починається Божа. В здоровому тілі здоровий дух. Дух може тільки з Богом говорити, а люди цього не розуміють. І найсильніші дістають силу від Бога.
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