ePoster #1213 - ISHA Annual Scientific Meeting 2016

The Hip Spine Connection: How To Differentiate Hip Conditions From Those Masquerading As Spine Pathology. A Review Article

Lyall Ashberg, MD, Westmont, IL UNITED STATES
Mary R. Close, BS, Westmont, IL UNITED STATES
Itay Perets, MD, Westmont, IL UNITED STATES
John P. Walsh, MA, Westmont, IL UNITED STATES
Edwin Chaharbakhshi, BS, Hinsdale, IL UNITED STATES
Benjamin G. Domb, MD, Chicago, IL UNITED STATES

American Hip Institute, Westmont, IL, UNITED STATES

FDA Status Not Applicable

Summary: We present some diagnostic guidelines which may make it possible to streamline the workup and management of patients presenting with confusing symptoms related to the hip and masquerading as a spine disorder.

Abstract:
Background Context: Practitioners who treat spine pathology will commonly encounter patients with pain around the hip; this can manifest as discomfort in the groin, buttock, lateral hip region, thigh, and even the knee. There has been shown to be a complex biomechanical interaction between the axial and appendicular skeleton, which, when abnormal, can result in compensatory changes in each system. Together with cross-innervation between the spinal pain generators and nerves that the supply the hip and surrounding tissues, these biomechanical interactions can make diagnosing the primary source of discomfort difficult and, at times, confusing. This can lead to delayed diagnosis. Purpose: The purpose of this paper is to try to elucidate the interaction between the hip and spine, to assist the spine clinician in recognizing the hip as a potential confounding source of pain, and to direct the workup and management accordingly. Methods: We review the biomechanical and neurologic interactions between the hip and spine and present an algorithm for evaluating the patient with hip and/or spine pain Results: An overview of treatment options utilized by clinicians who treat hip conditions is provided in order to help the spine clinician rule out potential hip pathology that may be mimicking spine disorders. Conclusions: A history of groin pain, lack of radicular symptoms, a positive impingement sign and favorable response to intra-articular injection of local anesthetic are all good indicators of hip pathology. We present some diagnostic guidelines which may make it possible to streamline the workup and management of patients presenting with confusing symptoms related to the hip and masquerading as a spine disorder.