Pelvis/Hip Case 7 History/Physical Exam

Patients in the previously mentioned populations with complaints of pain with ambulation even after minimal trauma, tenderness to palpation of the hip, and pain with range of motion should be further evaluated for an occult fracture if initial x rays are negative and no other diagnosis is apparent.

 

Of note, particularly the elderly and/or cognitively impaired may have normal ambulation and complain only of vague pain in their buttocks, knees, thighs, groin, or back. This is due to the innervation of the obturator nerve.  It has branches in each of these remote locations which can lead to referred pain away from the hip.  Suspicion still must remain high.

 

If a patient with pain in the buttock, knee, thigh, or groin has pain on passive internal hip rotation on exam, be suspicious for hip fracture.