Red Flags/Surgical referral • Traumatic Injuries • Inability to weight bear • New symptoms in a previous arthoplasty • Abdominal/inguinal hernia (+ve seated Valsalva test) 178631p • Systemic symptoms (fever, night pain, loss of body weight – 30% in < 2/12) • • • • Patient is referred to the MSK triage service with Hip pain Know or suspected OA Traumatic injuries Non traumatic pain with mechanical symptoms Congenital problems Non-­arthritic pain Sudden onset pain during exercise Labral injuries +/-­
CAM or Pincer Tendon ruptures/partial tears • Painful clicking • Painful restriction to flexion • Difficulty weight bearing • Painful groin/anterior hip clicking • Known and worsening Perthes • Previous/worsening hip dyplasia • Greater trochanteric hip pain • Groin pain • Adductor pain • Muscle sprains • Non mechanical symptoms • Lateral hip clicking LL consultant clinic MSK SERVICE ESP review Physiotherapy If • >45 years old • Activity related joint pain (groin, inner thigh or deep buttock) • < 30 minutes or NO early morning stiffness Conservative measure steps in primary care • Advice, activity modification, lifestyle change, weight loss (↓by 5% can equal up to 50% less pain). • Smoking cessation • Surrey iMSK website for self-­
management advice. • Physiotherapy • OTC analgesia (paracetamol, Ibuprofen) • Prescribed medication (Naproxen, Volterol, Codeine) OA Clinic To consider: • Ultrasound guided joint injection (if not available in primary care) • Joint replacement surgery August 2016 – PS, CC, JP, MC, BL, LP, PT, LG