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How can severe hip pain and hip arthritis be treated?

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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1933 Questions

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Posted on Thu, 4 Oct 2018 in Brain and Spine
Question: I have had pain in my left hip for a few days which is very painful. I had been taking Ibuprofen and co-codamol to no effect. I do have hip arthritis. I went to the GP and she prescribed stronger co-codamol and diazepam as she said it was a muscle spasm.

Today the pain has been going down into my thigh and up my left hand side. I also have the pain across my buttocks. There is mild pain in the testicles. The pain is of a burning sensation today. Apart from in the hip itselfl which is a ripping pain.

Should I be worried as walking is difficult and turning is extremely painful. This is the worst pain in my life. There has been no obvious injury to my hip. There is nothing to see on the hip. I have not had any x ray or scan. My observations are all normal apart from high bp probably due to the pain. Can this be sciatica.
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Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:

Must rule out the NEUROGENIC cause for the pain

Detailed Answer:

Hello,

I've read your description of the pains in the left hip which are radiating into the thigh, buttocks, and testicles.

You describe the pain evolving into a burning quality as well as a severe "ripping" feeling in the hip which is as bad a pain as you've ever experienced.

Because of the quality and distribution of the pain, my thought (as a neurologist) is to consider a NERVE ROOT being compressed in the lower back which by the location of your symptoms would strike me as being at the T12-L2/L3 levels of the spinal column.

Herniated disks could cause this picture, as well as a narrowing of the spinal canal, referred to as SPINAL CANAL STENOSIS.

This is unlikely to be a sciatic nerve pathology because the distribution of the sensory symptoms is not contained within its normal domain of sensory activity.

Which is typically a shooting pain from mid-lower back down the buttock, wrapping to the outside of the leg then, shooting across the knee/shin and landing in the GREAT TOE.

That's a sciatic type of pain which is considered classic.

My approach with such a picture is to order an MRI of the thoracic and lumbar spines (no contrast necessary).

Certainly, with a past medical history of Cerebral palsy, I could envision a problem of MUSCLE SPASMS being potentially responsible but if diazepam isn't really calming that down then, I think that particular thought process, in order to explain the pain, is less supported.

An EMG/NCV study could reveal a conduction block or acute demyelinating process is obtained in about 2-3 weeks from now (NOT BEFORE..may not show anything if you've only been having symptoms for a few days).

Also, your symptoms could be consistent with a condition referred to as DIABETIC AMYOTROPHY which would then, point the finger at potentially poorly controlled diabetes mellitus as the primary cause of this sudden onset of symptoms.

I would also get some blood work such as a CBC w/differential, HbA1C, fasting glucose, RF, ESR, and C-reactive protein.

Once the MRI clears you from any type of mass lesion in that area I would get you started on aquatherapy and get you mobilized as soon as possible in the water in order to help with pain.

Depending on the underlying cause of the pain and other symptoms medications and interventions can be better targeted.

If I've provided useful and helpful information to your questions could you do me a huge favour by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Hope I have answered your query.

Take care

Regards,
Dr Dariush Saghafi, Neurologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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