EpistemisOsteoarticular inguinal pain
Specialty: Musculoskeletal.
Why it occurs
- Osteoarthritis of the coxofemoral joint (advanced coxarthrosis with loss of cartilage)
- Avascular necrosis of the femoral head (epiphyseal bone ischemia)
- Acetabular labrum injury (labrum tear due to microtrauma or femoroacetabular impingement)
- Femoroacetabular impingement type CAM or PINCER
- Rheumatoid arthritis or juvenile idiopathic arthritis involving the hip
- Transient synovitis of the hip (common in pediatrics, self-limited)
Initial workup
AP simple x-ray of the weight-bearing pelvis and axial of the affected hip (allows us to see joint impingement, subchondral cysts, osteophytes or flattening of the femoral head) | Magnetic resonance imaging of the hip (more sensitive method to diagnose avascular necrosis in early stages, type Ficat I or II, and labral tears).
red flags
Severe acute inguinal pain with inability to tolerate load on the leg, high fever, shivering, extreme painful limitation of passive internal rotation of the hip (emergency: septic arthritis of the hip, requires urgent arthrochanthesis and surgical drainage to avoid joint destruction).
Standard management
- Celecoxib — 200 mg once daily orally; Selective anti-inflammatory ideal for osteoarticular hip pain
- Glucosamine (1500 mg) with Chondroitin sulfate (800 mg) daily orally
- Zoledronic acid — 5 mg IV once a year, indicated if associated with avascular necrosis in initial non-collapsed stages to delay the need for prosthesis
- Tramadol (50 mg orally every 8 hours if pain limits sleep).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4