Causes of Chronic Hip Pain Undiagnosed or Misdiagnosed by Primary Physicians in Young Adult Patients: a Retrospective Descriptive Study

Abstract

BackgroundHip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ≤ 50 years old.MethodsWe retrospectively analyzed a consecutive cohort of 150 patients (≤ 50 years old) with chronic hip pain (≥ 6 weeks), which was not diagnosed or misdiagnosed based on the information provided on the referral form.ResultsOverall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants.ConclusionMost (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.

No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

“…This highlights the need for more research on clinical mimickers of hip pain, which has been noted to be a challenging diagnosis for orthopaedic surgeons, primary care physicians, and gynecologists alike. 42 , 43 , 44 …”

“…This highlights the need for more research on clinical mimickers of hip pain, which has been noted to be a challenging diagnosis for orthopaedic surgeons, primary care physicians, and gynecologists alike. [42][43][44] Arthroscopic hip surgery and IUDs are both becoming increasingly common. To avoid surgery that may ultimately prove unbeneficial to the patient, ruling out alternative etiologies of hip pain is paramount.…”

Clinical Insights into the Importance of Scars and Scar Release in Paediatric Chronic Myofascial Pain

“…A staggering one-third of this six-year-old population has chronic musculoskeletal pain and 44.6% of them report that pain is multisite in nature [152]. Despite its prevalence, reported musculoskeletal pain is often under-diagnosed in adolescents [153,154]. Healthcare providers may be unfamiliar or not trained to diagnose chronic pain, muscle trigger points, palpable pain points, and fascia in tension [155][156][157][158].…”

Mosaicplasty of the Femoral Head: A Systematic Review and Meta-Analysis of the Current Literature

“…Neumann et al found that up to 76% of patients (from the age of 17 to 76 years old) presenting with mechanical hip complaints have hip chondral lesions visible on magnetic resonance imaging (MRI) [1]. Trauma, labral tears, femoroacetabular impingement (FAI), arthritis, osteonecrosis, and dysplasia have been identified as causative factors [1][2][3][4]. Osteochondral lesions of the femoral head account for only about 2% of all osteochondral lesions.…”