Is It Hip Pain or Sciatica? which one is causing the pain , how do I know and how to treat it ?

Dr. Ebraheim’s educational animated video describes conditions that cause hip pain or sciatica.
symptoms of hip arthritis and sciatica overlap, it can cause confusion and delay in treatment.
Is it hip pain or sciatica? The hip and the spine pathology share the same complaints, and their symptoms may overlap. That will make the diagnosis and treatment difficult and challenging. Because arthritis of the hip and arthritis of the spine can be present in the same patient, it may be difficult to differentiate hip problems from spine problems. Sometimes these patients see multiple physicians and they had multiple imaging studies and they have various procedures without relief. The proximity of the sciatic nerve to the hip joint can cause symptoms resembling sciatica due to irritation of the sciatic nerve or referred pain that resembles sciatica. It is our job as a clinician to find out the primary source of pain. Is it hip pain or spine pain and sciatica? A careful history and physical exam is important to diagnose these two conditions. The pain associated with the hip is in the groin. The pain associated with lumbar stenosis is in the buttock. When you see the patient, if the patient is leaning forward, that's a spinal stenosis. If the patient is limping, that's a hip arthritis. Patients with lumbar stenosis or disc herniation may have similar problems of difficulty in walking as in patients with hip arthritis. If we find that the patient has one condition, we should make sure the patient does not have the other condition. If the patient has a spine problem, ask the patient if they have a hip problem, and if you suspect a hip problem, ask the patient to point to the area of the hip pain. Ask the patient if the pain is located in the front, on the side or is it in the back. The patient's understanding of the hip pain is different than our understanding of the hip pain. The patient may point to the buttock when meaning the hip, and the hip joint itself may be normal. You must correlate the clinical examination with the X-ray findings and the MRI findings if the patient has a hip or a spine problem. Just because you have an X-ray that shows arthritis of the hip, it doesn't mean it is causing the problem. MRI may be helpful in differentiating hip pain from a spine pain, but many positive findings can be seen in asymptomatic patients, which increases with age, so you must correlate the clinical findings with the MRI findings. In hip arthritis, the patient have a classic presentation. The patient will have hip and groin pain. The patient will be limping and will have antalgic gait. A patient with groin pain is seven times more likely to have a hip disorder than a spine condition alone. So if you see a patient with a limp, groin pain and decreased range of motion of the hip, then the patient probably has an arthritis of the hip. Pain radiating below the knee can occur from spine problem or hip arthritis, about 50% in hip arthritis. If the patient has a history of claudication, then this is spinal stenosis. In lumbar stenosis, the patient will have neurogenic claudication with back and lower extremity pain that is worse by walking and is relieved by sitting and bending forward. In lumbar stenosis, what increases the symptoms? Standing for spinal stenosis, tying a shoe for hip arthritis. In spinal stenosis, the physical exam is probably normal and the patient rarely has neurological deficit. If the patient has paresthesia or radiculopathy, then the workup emphasis should be on the spine. In patients who have the two conditions, the lumbar stenosis and the hip arthritis, sometimes injection of the hip joint may differentiate what is the primary source of pain. If the primary source of pain is undetermined, the patient may need to have an injection. And if the patient gets more than 50% relief from the injection of the hip, then it is hip problem. Pain over the greater trochanter is usually a hip pathology and rarely a spine pathology. Trochanteric bursitis that occurs in a middle-aged person occasionally radiates down the thigh to the lateral knee. Women are more affected. You'll find tenderness to palpation on the lateral aspect of the hip or pain when resting on the involved side, especially at night.
Quiz Questions:
1. Where is pain typically felt when the patient has true hip joint pathology?

Groin
Buttock
Lower back
Lateral thigh
Answer: Groin
Explanation: True hip pathology usually causes pain localized in the groin area.

2. Which symptom strongly suggests lumbar spinal stenosis rather than hip arthritis?
A) Pain in the groin
B) Limping gait
C) Pain relieved by leaning forward
D) Pain below the knee

Answer: Pain relieved by leaning forward


3. If the patient has both hip and spine arthritis, what diagnostic method may help differentiate the source of pain?
A) MRI alone
B) CT scan
C) Hip joint injection
D) Ultrasound examination

Answer: Hip joint injection