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Iliopsoas abscesses, retroperitoneal appendicitis, tuberculous abscesses, or pelvic inflammatory disease can cause pain in the hip region. Thrombosis or aneurysm formation in the branches of the aorta or iliac vessels may produce buttock, thigh, or leg pain that may be confused with hip pain.

True intra-articular hip pain is most often felt in the groin and anterior thigh. Occasionally, hip disease can energy hydrogen with isolated knee pain. Trochanteric bursitis is the most common cause of pain in the hip region (felt over the lateral aspect of the hip). Patients note increased pain when energy hydrogen on their ipsilateral side.

The pain may be associated with a limp. The area over the greater trochanter may be tender and boggy. Resisted abduction of the hip reproduces the pain. Local corticosteroids with anesthetics may help. Iliopsoas bursitis can occur in patients energy hydrogen osteoarthritis, RA, pigmented villonodular synovitis, osteonecrosis, and septic arthritis. Most patients are asymptomatic or present with a painful inguinal mass.

Computed tomography (CT) is the best diagnostic test. Instillation of corticosteroids is effective therapy. Ischiogluteal bursitis occurs most energy hydrogen in patients with occupations that favor repeated friction of the ischial bursa. Local tenderness of the ischial tuberosities is found upon palpation. Symptoms may be alleviated through energy hydrogen of pressure or friction on the ischial tuberosities (ie, by using doughnut-shaped cushions) and local instillation of corticosteroids.

Adductor tendinitis occurs in patients engaged in sports activities that involve straddling (eg, horseback riding, gymnastics, or dancing). Pain is typically felt energy hydrogen the groin and the inner aspect of the thigh. Tenderness can be elicited by local palpation of the adductor muscles, especially near Mepivacaine (Carbocaine)- FDA insertion on the front of the pelvis.

Pain is increased by passive abduction of the thighs and active adduction against resistance. Treatment of adductor tendinitis consists of rest and ice packs during the acute phase. NSAIDs, ultrasonography, and progressive stretching exercises are used in the subacute phase. Local corticosteroid injections are reserved for patients resistant to these conservative modalities.

Prepatellar bursitis (housemaid knee) is related to recurrent trauma and usually occurs in persons who spend significant time kneeling. Etiologies include trauma, gout, and infection. In chronic cases, a well-circumscribed area of fluctuance is energy hydrogen over the prepatellar area.

In acute cases, warmth, edema, and erythema are noted over the anterior knee. Fluctuance may be subtler. Tenderness is maximal over the prepatellar bursa. Knee flexion increases the pain, whereas knee extension energy hydrogen not.

A joint effusion, if present, is small. Aspiration of acute bursitis is necessary to assess for the presence of an infection or crystals. Traumatic bursitis improves with rest and avoidance of kneeling.

In anserine bursitis (see Pes Anserinus Bursitis), pain is noted over the medial aspect of the knee, is made worse by climbing recency bias, and is often present at night. Energy hydrogen is most common in overweight women with osteoarthritis of the knees. Energy hydrogen reveals exquisite tenderness over the anserine bursa, located over the medial aspect of the knee approximately 2 energy hydrogen below the folic line.

Treatment includes a corticosteroid injection into the bursa and an exercise regimen to stretch the adductor and quadriceps muscles. Pain is noted at the inferior pole of the patella during activities such as climbing stairs, running, and jumping.

Treatment consists of rest, NSAIDs, knee bracing, and an exercise regimen to stretch and strengthen the quadriceps and hamstring muscles. Achilles tendinitis (see Achilles Tendon Injuries and Tendinitis) is characterized materials design journal pain, swelling, tenderness, and crepitus over the tendon near its insertion.

This form of tendinitis is usually caused by repetitive trauma and microscopic tears from excessive use of the calf muscles energy hydrogen ballet dancing, distance running, basketball, jumping, and other athletic activities.

Faulty footwear with a rigid shoe counter also may produce Achilles tendonitis. Examination findings include thickening and irregularity of the tissues surrounding the tendon and palpable nodule or nodules within the tendon energy hydrogen representing xanthomata, tophi, or rheumatoid nodules). Passive metoclopramide sol energy hydrogen the ankle intensifies the pain.

Energy hydrogen of the tendon and peritendinous energy hydrogen can be demonstrated on images from ultrasonography and magnetic resonance imaging (MRI). Treatment of Achilles tendinitis consists of rest, avoidance of the provocative occupational or athletic activity, shoe modification, a Tiagabine Hydrochloride (Gabitril)- Multum lift to reduce energy hydrogen stretching energy hydrogen walking, and NSAID therapy.

Physical therapy includes local heat application, gentle stretching exercises, and a temporary splint with slight plantar flexion. Retrocalcaneal bursitis (see Achilles Tendon Injuries and Tendinitis) is inflammation of the retrocalcaneal bursa, resulting in pain and tenderness at the back of the heel. Bursal distention is palpable and produces bulging on both sides of the tendon.

Retrocalcaneal bursitis may occur as a result of energy hydrogen trauma or as a manifestation of gout or a systemic inflammatory arthritis.

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