Top 10 Causes of Hip Joint Pain

The hip is the largest joint in the human body and it attaches the femur (thigh bone) to the pelvic bones of the torso. This joint which bears the body’s weight during activities like standing, walking and running can become painful due to the following conditions:

1. Arthritis

Osteoarthritis is one of the most common causes of pain in the hip. This type of arthritis develops as a result of the wear and tear of the cushioning cartilage within the joint. Mild cases of osteoarthritis are treated by resting the joint and taking non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and naproxen. Severe cases treated with hip replacement surgery.   

Rheumatoid arthritis and psoriatic arthritis are other types of arthritis which cause pain in the hip. These conditions are treated with disease modifying anti-rheumatic drugs (DMARDs) like methotrexate and sulfasalazine.

2. Fractures and Dislocations

Fractures are common causes of sudden pain in the hip. The bones of the hip joint can be broken by major trauma from automobile accidents or they can crack after minimal trauma in persons with conditions like osteoporosis which weaken the bones. Hip fractures are usually treated surgically by implanting screws and plates.   

Dislocations are relatively rare since the hip is a stable joint. However, large forces from road traffic accidents and falls from heights can dislodge the ball of the femur from its socket in the pelvic bone. Hip dislocations are treated surgically.  

3. Inflamed Tendons

Iliotibial band tendinitis causes hip pain which is felt on the outside of the joint. This ligament which connects the muscles to the bones usually becomes inflamed in athletes because of excessive running and stretching. Iliotibial band tendinitis is treated by applying heat, resting the joint and taking NSAIDS to reduce the pain and inflammation.   

4. Inflamed Bursae

Inflammation of the bursae which are sacs that provide cushioning between the bones and other structures in the joint also causes hip pain. These fluid-filled sacs usually become inflamed due to overuse from athletic activities. Bursitis is treated by taking pain relievers like ibuprofen and resting the joint. 

5. Torn Cartilage

Cartilage tears like labral tears are other causes of pain in the hip joint of insidious onset. The labrum cartilage surrounds the acetabulum (hip socket) to secure the head of the femur inside it and stabilize the joint. It can be torn by trauma from car accidents or it can develop in athletes due to repetitive movements. Torn labrum can be treated with arthroscopic hip surgery or physiotherapy.

6. Cancer

Cancer is another cause pain in the hip joint. It many cases it is often advanced cancer which has metastasized from another part of the body like the breast or prostate. However, cancers can also arise from the bone and cause pain in the hips. Cancers are treated with radiotherapy and cancer medications known as chemotherapy.

7. Infections

Infections of the bone like osteomyelitis are common causes of hip pain in children. Skin infections like herpes (shingles) can also cause pain that is felt at the hip in persons of all ages. These infections are treated with analgesics as well as antibiotics and antivirals.

8. Nerve Pain

Though sciatica usually causes pain that radiates down the leg, it can also cause pain that is felt in the back of the hip joint. This pain which arises when the sciatic nerve is pinched as it leaves the spinal cord is treated with NSAIDS and physiotherapy. Inflammation of the lateral femoral cutaneous nerve is another cause of nerve pain that is felt at the hip.    

9. Hernias

Inguinal and femoral hernias can also cause pain that is felt at the hip joint. Inguinal hernias often develop in pregnant women due to the extra pressure of the growing uterus on the abdominal wall. Hernias are usually treated surgically.  

10. Avascular Necrosis

Avacsular necrosis of the hip, which is also known as osteonecrosis, is another relatively common cause of hip joint pain. This condition which can be caused by fractures and dislocations develops when the blood supply to the ball or head of the femur is compromised. As a result, the ball begins to die and its cartilage degenerates. Avascular necrosis of the hip is treated with bed rest, pain relievers, wearing splints and hip replacement surgery.

Medical Licensing Exam Revision Questions

Question 1

A 70-year-old fair-skinned Caucasian man presents to the hospital complaining of lesions on his scalp which he says feel like sandpaper. His past medical history is not significant and he is a retired missionary who spent most of his life in Australia. On examination you note several scaly and erythematous papules on his scalp.

What is the most likely diagnosis?

A. Actinic keratosis 
B. Keratoacanthoma 
C. Dysplastic nevus 
D. Seborrheic keratosis 
E. Discoid lupus erythematosus

Correct Answer A

The clinical presentation is suggestive of Actinic keratosis which are also known as solar keratosis. These lesions develop on skin which has been damaged by prolonged exposure to the sun’s ultraviolet (UV) rays on the scalp, face, lips and hands. 

AK are scaly, erythematous papules with a typical sandpaper texture when palpated. Biopsy of actinic keratosis lesions reveals atypical keratinocytes in the basal layer, hyperkeratosis or hyperplasia of the stratum corneum and parakeratosis which is the retention of the nuclei by keratinocytes in the stratum corneum together with solar elastosis. 

If left untreated AK can evolve into squamous cell carcinoma (SCC). Treatment is with topical medications like 5-Flourouracil 5% cream and diclofenac sodium 3% gel. Cryotherapy with liquid nitrogen is also used to treat them. 

Keratoacanthoma are dome shaped lesions with a central keratinous crater. 

Dysplastic nevi or atypical moles are characterized by a variety of colors which range from pink to brown and the combination of macules and papules within one lesion giving them a "fried egg" appearance. Their borders are irregular and scalloped. 

Seborrhoiec keratosis present as crusty plaques with a warty surface. Their borders are sharply demarcated and their bases non-erythematous. Seborrheic keratosis have a greasy, “pasted on the skin” appearance and their color ranges from white to brown-black. 

Discoid lupus erythematosus is characterized by roundish plaques with scaling and sharply demarcated borders. The central area is atrophied and hypopigmented while the surrounding borders are hyperpigmented.

Question 2

A 55-year-old Caucasian woman presents to the hospital complaining of tingling sensations in her hands and feet for the past one month. She is not on any medications and her past medical history is significant for one previous admission for a jejunoileal bypass. She is a married clerk who does not drink alcohol, smoke cigarettes or use illicit drugs.

What is the most likely diagnosis?

A. Celiac disease 
B. Whipple disease 
C. Tropical sprue 
D. Lactose intolerance 
E. Short bowel syndrome

Correct Answer E

The clinical presentation is suggestive of Short bowel syndrome (SBS) which can be caused by surgical operations like the jejunoileal bypass, vascular accidents, diseases and any condition which causes a loss of more than 50% of the small intestines. The resultant reduced absorptive surface area in SBS causes diarrhea, weight loss, pale greasy stools and other signs and symptoms of malabsoption. 

Nutrient deficiencies associated with SBS include Vitamin B12 deficiency which causes paraesthesias, fatigue and a megaloblastic anemia. Iron deficiency also causes fatigue and an anemia which is microcytic. Calcium malabsorption causes pain in the bones and carpopedal spasms. The treatment of short bowel syndrome treatment includes nutritional support and replacement of the deficient nutrients. 

Lactose intolerance develops as a result of lactase deficiency which breakdown the lactose in milk into galactose and glucose. Symptoms of lactase intolerance develop after ingesting lactose containing foods and they include flatulence, borborygmi, nausea, abdominal cramps and loose stools. Laboratory investigations reveal that the diarrheal stools are acidic. Treatment includes following a lactose-free diet. 

Celiac disease is a genetic disorder which is caused by intolerance to gluten which is found in wheat, barley, oats and other grains. Symptoms of gluten intolerance include abdominal distention with discomfort and diarrhea. Steatorrhea or pale, foul smelling stools which are difficult to flush are another symptom of celiac disease. Fatigue and weakness may also be present in patients who develop iron or folate deficiency. Bone pains are characteristic of calcium deficiency. The diagnosis of celiac disease is confirmed by taking a biopsy of the small intestines which shows a flat mucosa due to villous atrophy and subsequent improvement after treatment with a gluten-free diet. 

Tropical sprue affects locals and tourists of tropical areas like the Caribbean islands and South India. Its cause is not known and it is associated with symptoms like diarrhea, weight loss and soft, bulky stools. Laboratory investigations done for patients suspected to have tropical sprue include stool microscopy for cysts and trophozoites. Treatment is with antibiotics like tetracycline. 

Whipples disease is caused by Tropheryma whippelii and it affects the small intestines, joints, eyes, brain and other organs. Symptoms of this multisystemic disease include diarrhea, steatorrhea, weight loss and pains in the abdominal and joint. Biopsies of the small intestines are done and they reveal PAS positive foamy macrophages. Treatment is with antibiotics like trimethoprim-sulfamethoxazole or chloramphenicol.

Question 3

A 25-year-old African American woman presents to your clinic complaining of a painless swelling on her neck for half a year. This swelling does not affect her eating or breathing. On examination you note that she has a tachycardia, hyperhidrosis and an anterior neck swelling which rises with deglutition. 

What is the most likely cause of her condition?

A. Iodine deficiency 
B. Hashimoto’s disease 
C. Thyroid cancer 
D. Grave’s disease 
E. Medications

Correct Answer D

The clinical picture is suggestive of a goiter which is basically an enlarged thyroid gland. It is characterized by an anterior neck swelling which rises with deglutition. The causes goiter are as follows: 
1. Iodine deficiency develops when the body is unable to get enough of this mineral from the diet. Iodine is utilized by the body to produce the thyroid hormones triiodothyronine or T3 and thyroxine or T4. Deficiency of this mineral is the most common cause of goiter in the world. However, it is a rare cause of goiter in countries like the US which have iodized table salt. 

2. Graves’ disease develops when thyroid stimulating immunoglobulin (TSI) is produced by the immune system. It stimulates the thyroid gland to produce hormones and the resultant excessive production of thyroid hormones makes it the most common cause of hyperthyroidism in the US. Other symptoms of this autoimmune disease that may be present in addition to the enlarged goiter include tachycardia, hyperhidrosis, weight loss, heat intolerance may also be present. 

3. Hashimoto’s disease is the most common cause of hypothyroidism in the US. It is an autoimmune disease which arises when the immune system attacks the thyroid and causes inflammation. This results in hypothyroidism due to reduced production of T3 and T4. The pituitary gland attempts to increase the production of thyroid hormones by producing TSH or thyroid stimulating hormone and this results in thyroid enlargement. Signs and symptoms of hypothyroidism like fatigue, feeling weak, cold intolerance, constipation, dry skin and brittle nails may also be present. 

4. Thyroid cancer is a relatively rare condition which usually presents as an enlargement of one side of the thyroid. 

5. Medications which can cause goiters include lithium which is prescribed to treat bipolar disorder.

Vitiligo

Vitiligo is a condition in which the skin loses its normal color. Its cause is not known but it is suspected to develop as a result of an autoimmune process in which cells from the immune system destroy those which produce melanin which is the pigment that gives skin its color.

Genes are also thought to play a role since a good number of patients also have relatives with vitiligo.

Symptoms of Vitiligo

The main symptom of vitiligo is patches of white skin which gradually increase in size. These patches are not itchy or scaly. Though vitiligo can affect skin on any part of the body, these patches often begin on the face, hands and feet.

Other symptoms of vitiligo include premature whitening of the scalp hair, eyebrows and beard. Vitiligo can also cause psychological effects like emotional stress, low self-esteem and depression especially when it affects the face and private parts.

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Vitiligo Tests

The diagnosis of vitiligo is made after the doctor listens to the symptoms and examines the skin. The doctor may also perform a skin biopsy by removing a small piece of the affected skin and sending it to the laboratory to be examined.

Blood tests like blood glucose and thyroid function tests may also be requested to look for other autoimmune diseases.

Medical Treatment of Vitiligo

The treatment of vitiligo can be challenging due to the absence of a medication that works on all patients. Most patients therefore have to try different treatment options before they discover the one that works for them. 

Medications used to treat vitiligo include:

1. Corticosteroid creams

Steroid containing creams like Triamcinolone are applied on the skin to help with repigmentation or the restoration of normal skin color.

2. Immunomodulator creams

Creams which affect the functioning of the immune system like Tacrolimus are also used to treat vitiligo.

3. Topical PUVA

Topical psolaren plus ultraviolet A (PUVA) involves the application of a chemical known as a psolaren which makes the skin more sensitive to ultraviolet (UV) light. After around 30 minutes, the skin is exposed to UVA light.

4. Oral PUVA

Oral psolaren plus ultraviolet A (PUVA) involves taking a tablet containing a psolaren and then exposed the skin to UVA light after around 2 hours.  

5. Depigmentation

For patients who have vitiligo patches covering more than half their skin, depigmentation or removing the remaining pigment is another option. This is usually done by the application of the monobenzone ether of hydroquinone twice a day to the normal skin until it also loses its color.

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Supportive Therapies for Vitiligo

Supportive therapies for vitiligo include the use of:

1. Sunscreen

Sunscreens that offer protection from UVA and UVB light should be applied on all areas affected by vitiligo to prevent sunburns and skin cancer. These sunscreens should have a SPF of at least 30.

2. Camouflage cosmetics

Camouflage cosmetics like foundations can be used to cover affected areas on the face. Self-tanning lotions can also be used to mask larger depigmented patches on the legs and other parts of the body.

3. Psychological treatment

Counseling and cognitive therapy is important since it helps improve the coping mechanisms of those who are psychologically affected by the spreading white patches on their faces, hands, genitals and other parts of their body. 

Medications Which Cause Depression

Depression is a condition which is characterized by persistently feeling sad, hopeless and helpless. These feelings can be compounded by difficulties concentrating or making relatively simple decisions and losing interest in everyday activities.

Excessive sleepiness and weight gain due to overeating are other symptoms of depression though some patients develop insomnia and lose weight as their appetite dwindles. 

Headaches, indigestion and body aches that do not improve with treatment are also typical of depression.

Suicidal ideation or thinking about committing suicide is another serious symptom of depression which must be addressed quickly.

Depression Causing Prescription Medications

Medications which can cause depression include:

1. Beta blockers like atenolol, metoprolol and carvedilol which are used to treat high blood pressure, angina chest pain and heart failure.

2. Calcium channel blockers (CCB) are other medications used to lower high blood pressure that can also lower the mood. Nifedipine, verapamil and diltiazem are some of the more commonly used CCB.

3. Statins are used to lower high cholesterol levels but they can also depress the mood. Examples of such statins include atorvastatin, lovastatin and simvastatin. 

4. Diazepam, lorazepan and flurazepam belong to a group of drugs known as benzodiazepines which are used to treat anxiety and insomnia and known to cause depression.

5. Barbiturates like phenobarbitone and secobarbital, which are used to prevent epilepsy and treat anxiety, can also increase a person’s predisposition for developing depression.

6. Analgesics like codeine, morphine and oxycontin are known to leave a person feeling dejected after taking away their pain.

7. Anticonvulsants like ethosuximide and methsuximide which are used to treat seizure disorders, can also cause depression.  

8. Antibiotics, and especially the flouroquinolones like ciprofloxacin and ofloxacin which are used to treat infections of the urinary tract, can also increase a person’s risk of developing depression.

9. Acyclovir, an antiviral used to manage herpes or shingles, is another prescription medication that can cause melancholy.

10. Isotretinoin is a potent vitamin A derivative which is used to treat severe acne and sadly also causes medication induced depression.

Other Causes of Depression

If you are taking any of these medications and you begin feeling blue, do not stop taking them without consulting your doctor because depression has many other causes.

For starters, genetics have a role to play in the development of depression since it has been known to run in some families. Major life events like getting divorced or getting a baby, losing a job, starting a new one and even retiring can all cause depression.

Ongoing traumatic experiences like physical or sexual abuse and even those which happened in a person’s past can all darken their present with depression. These depressing effects of abuse are compounded by social isolation and substance abuse which can also cause depression by their own.

Therefore if you start feeling sad while taking drugs prescribed by your doctor, do not stop taking them. Consult your healthcare provider, tell them your symptoms, voice your suspicions and ask them what you should do.

Top Five Life Threatening Consequences of Summer Grilling

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To many, summer is synonymous with grilling and though this is a relatively harmless activity, it can cause the following five potentially life threatening complications:

1. Summer grilling can cause internal bleeding

The CDC (Center for Disease Control) recently sent out a warning after several patients in a Rhode Island hospital suffered injuries after ingesting fragments of steel bristles from wire grill cleaning brushes.

These steel fragments break off from the brush being used to clean the grill, stick to the grill grate and cling to the food being cooked before entering the digestive system of the person eating the “steel burgers”.

These steel burgers can cause severe pain, internal bleeding and can even get stuck to the esophagus (gullet) or intestines necessitating a visit to the operating room for surgical removal.

To prevent this summer hazard of eating “steel steaks”, simply clean your grill with nylon scrubbers instead of bristled brushes and wipe the clean grill with a wet cloth before you begin cooking.

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2. Summer grilling can cause food poisoning

Food poisoning can develop from eating grilled steaks, chicken, and burgers which have not been thoroughly cooked.

To prevent being poisoned by grilled food, use a meat thermometer and make sure that the temperature inside the meats reaches 160 degrees F. If you are not able to use a thermometer, ensure that the juices flowing from the grilled meats is clear and not any of the numerous shades of pink and red.

3. Summer grilling can cause cancer

Grilled food that is charred can increase a person's risk of developing cancer of the stomach and colon because of the HCAs (heterocyclic amines) that are formed.

To prevent the formation of these cancer causing agents, ensure that the grilled food is not charred or marinade the meats before grilling with lemon, vinegar or rosemary as they reduce the HCAs.

  

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4. Summer grilling can cause grill burns

Grill burns, which can range from minor scalds to major third degree burns with permanent disfigurement, are common summer accidents which can mar not just the summer, but a person's entire life.

To prevent grill burns always examine the tubes for food particles, grease, insects or anything else that might block them. If you see anything suspicious, use a pipe cleaner to remove it before you start grilling.

If you use non-stick cooking sprays, always spray them before lighting the grill. Should you for any reason feel the need to use an aerosol spray as you grill, ensure that you are at least 10 feet away from the grill so that you do not burn yourself with the blowtorch effect.

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5. Summer grilling can burn down houses

Summer grilling parties have been known to start hours fires that destroyed property and injured people.

To keep your home safe ensure that the grill is at least 10 feet away from your house, garage, porch or anything that is potentially flammable. 

In addition, always ensure that you have a bucket of sand nearby just in case something other than the charcoal catches fire.

How to Ensure your Makeup Stays Intact this Summer

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The summer heat and its resultant perspiration, combined with factors like humidity can conspire and ruin an otherwise flawless complexion. 

They can do this by creasing eye shadow, causing foundation to creep southwards and even making mascara weep.

Therefore, if you want to keep your makeup intact this summer choose products that will curtail the makeup slide that’s bound to happen in the heat. One product you can use to keep your makeup stays where you applied it is the Model in a Bottle Setting Spray .

This beauty product is misted on the face after makeup has been applied and the mascara has dried in order to keep it in place. It is so effective that it not only keeps the foundation and eye makeup intact all day and well into the night, but it also keeps it looking freshly applied.

In addition, Model in a Bottle Setting Spray is also non-comedogenic. This means that it will not clog pores and cause breakouts. Furthermore, it absorbs the excess facial oil that may contribute to the downward slide of makeup. 

This model spray also dries quickly without drying the skin since it contains moisturizing aloe vera extracts which have a fresh scent. It is also not shiny for it leaves a nice, natural and translucent matte finish.

Model in a Bottle Setting Spray does not reduce the effectiveness of sunscreens. This enables users to face the sun confidently without the fear of premature aging or makeup melt down.

This setting spray is a cruelty free product which is not tested on animals. It is available in travel size bottles for those who want to test its effectiveness before committing to the full size. It is however economically priced since for less than $20, or more specifically for $15.95, one can get the bottle with over 300 sprays.

Persons with sensitive skin or rosacea should use Model in a Bottle Sensitive Skin Makeup Setting Spray because it contains soothing lavender essential oil. 

Danger Signs of Pregnancy

Though most mothers experience safe pregnancies, watching out for the following signs of danger in pregnancy can avert the development of the severe complications associated with them. These top danger signs of pregnancy include:

1. Vaginal bleeding

Vaginal bleeding can occur at any time during pregnancy. When it occurs in early pregnancy, it can be a sign of miscarriage. When it occurs later in pregnancy, it could be a sign of placenta abruptio or the placenta detaching from the walls of the uterus.

Therefore, regardless of when it occurs and whether it presents as red spots of blood on the underwear or blood gushing from the vagina, vaginal bleeding in pregnancy is a serious sign which warrants immediate evaluation by a healthcare practitioner.

2. Pelvic pain

Pelvic pain can also develop in any month during pregnancy and it should not be managed with over the counter (OTC) pain relievers since it may herald severe complications. 

When it occurs in the first trimester pelvic pain can be a sign of an ectopic pregnancy or the baby growing in the fallopian tubes. This is a life threatening complication because severe bleeding can occur if the tube ruptures. When it occurs in the later trimesters, it can be a sign of placenta detachment.

Pelvic or abdominal pain in pregnancy should therefore also warrant immediate assessment by a doctor regardless of whether it is continuous or crampy in nature.

3. Blurred vision

Blurred vision or seeing flashing lights is another danger sign of pregnancy since it can be caused by pregnancy induced hypertension (PIH) or eclampsia. Other signs of this life threatening condition which causes the blood pressure to rise include swelling of the face, hands, and feet.  

The development of blurry vision should prompt a visit to the hospital for a blood pressure check and evaluation by an obstetrician since it can progress to convulsions.

4. Lack of fetal movements

Absent fetal movements is another danger sign of pregnancy since it can be a sign of fetal demise or the baby's death. Reduced movements by the baby can also signal fetal distress which can be caused by factors like low blood sugar levels.

Sensing less than four baby kicks in an hour should therefore induce the mother to consume a sugary snack like a chocolate bar as she heads to the hospital for a checkup.