X-rays often show changes in the hip joint associated with osteoarthritis (OA). But arthritis may not show up until more severe damage is done. Physical therapists are studying ways to test for mild OA that don't depend on X-rays. This study is a report on one patient who was diagnosed with OA of the hip based on hip pain and range of motion.
A 43-year-old woman was treated for right hip pain off and on for five years before seeing a physical therapist (PT). The PT gave her a special set of questions to measure pain, stiffness, and function. Follow-up tests included range of motion, strength, and leg length. Her pattern of walking was also reviewed.
The patient had decreased right hip flexion and right hip inward rotation. Trunk and knee motion were normal. Testing showed decreased strength in three groups of hip muscles on the right side. A special test for hip arthritis called Patrick's test was positive on the right.
Studies show that decreased hip internal motion and reduced hip flexion are linked to OA. This patient's X-ray confirmed the presence of joint changes from arthritis. Treatment was begun to restore normal hip motion and strength. Reducing hip pain and improving the patient's gait pattern were also goals of treatment. A program of gentle stretching and proper sitting postures was started. Strengthening exercises were also added.
As the patient's pain decreased, her motion and function improved. The authors conclude it's possible to use decreased hip motion as an early sign of OA. This is especially true when more than one plane of motion is affected. Other signs and symptoms of arthritis will likely be present to guide the diagnosis.
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.'