Article overlooked one cause of hip pain.
Drs. Johanns and Knopp provided an excellent review of the classic disorders causing hip pain in children and adolescents (What's causing your young patient's hip pain? J Fam Pract. 2010;59:555-561). There is one common cause of hip pain in children and adults not mentioned, however: leg length discrepancy.
In active patients with recurrent pain around the hips and no history of trauma, I find leg length discrepancy to be a common diagnosis. It is easy to detect in the exam room: Just have the patient stand with bare feet on the floor (facing away from you) and put your hands on the top of each iliac crest and then on the top of each greater trochanter. You'll find that discrepancies [greater than or equal to] 1/2 inch are easily seen.
Using a heel lift in the shorter leg with all athletic shoes and with dress shoes that are frequently worn often resolves the problem. I find that estimating a 1/2-inch or 1-inch heel lift is usually effective, but more formal measurements can be made by a physical therapist.
When I diagnose leg length discrepancy, most patients tell me that many physicians--including orthopedic surgeons--never considered it. Often expensive x-rays have been done and are normal. I recommend that we think of leg length discrepancy in any patient with nontraumatic hip pain and test for it in the exam room. While I find the problem most often in adults, it is also common in children. (1,2)
Joseph E. Scherger, MD, MPH
Rancho Mirage, Calif
(1.) Children's Hospital Boston. Leg length discrepancy. Available at: http://www.childrenshospital.org/az/Site1100/mainpageS1100P0. html. Accessed November 2, 2010.
(2.) Columbia Orthopaedics. Pediatric orthopaedic surgery. Common disorders: leg length discrepancy. Available at: http://www. columbiaortho.org/children/lld.html. Accessed November 2, 2010.
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|Author:||Scherger, Joseph E.|
|Publication:||Journal of Family Practice|
|Article Type:||Letter to the editor|
|Date:||Dec 1, 2010|
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