Question:The doctor sent me to a physical therapist for hip bursitis. I've had the same pain off and on for five years. After doing a lot of tests, the therapist seemed to think it could be arthritis. My internal rotation and hip flexion are especially limited in motion. How can I find out for sure if this is arthritis?
Early, mild osteoarthritis can be difficult to diagnose. Sometimes it isn't until the patient has been treated on and off for several years that it becomes clear what is the true problem. By that time changes in the joint space start to show up.
Morning stiffness and stiffness after sitting are common with hip arthritis. If there's no fever and only mild to moderate pain, a diagnosis of hip synovitis can often be ruled out. Hip bursitis doesn't usually last five years. Limited hip internal rotation and hip flexion aren't typical with hip bursitis. These motions are limited more often with arthritis.
There are two ways to approach this problem. The first is to treat the hip as if it were a case of arthritis. Improved motion, strength, and function are the goals. If you get better then follow whatever program the therapist suggests. If you don't get better or the symptoms get worse, make a follow-up appointment with the doctor. You may need further tests, including X-rays.Michael T. Cibulka, PT, MHS, OCS, and Julie Threlkeld, BS, ATC. The Early Clinical Diagnosis of Osteoarthritis of the Hip. In Journal of Orthopaedic & Sports Physical Therapy. Vol. 34. No. 8. Pp. 461-467.
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