CRPS in the hips?

There are cases of CRPS affecting the hips or lower limbs but, this, is a condition that, statistically, mostly affects the upper limbs. While we can find cases of CRPS affecting the foot or the knee, the hips are among the rarest cases. Therefore, it is very important to be sure of the diagnosis as it could be some other condition with very similar symptoms.

CRPS is a condition that, even in more simple and clear cases, can only be diagnosed by ruling out any other possibility. This is even more important when the chronic pain affects the hips, because it is harder to evaluate the situation with the methods proposed by the Budapest Criteria. A tri – phase bone scan is, to this day, the best way to diagnose CRPS and it is vital when this condition is allegedly affecting the hips: with this type of conditions it is important to assess the correct diagnosis and to treat the patient as soon as possible.

When this condition affects the hips the cases of misdiagnose are most frequent: on of the possible similar conditions is what is known as Transient Osteoporosis. These conditions are treatable as well and, luckily, they are treated with bisphosphonates too. Both conditions show a loss of bone mass, but the treatment’s protocol is very different. It is also important to notice that not any type of Osteoporosis can be treated with any type of bisphosphonates: a precise evaluation and treatment path must be discussed with the doctor.

In absence of certain important clinical signs like, for example, a triggering event or trauma, autonomic and dystrophic changes it becomes vital to perform an RMI and Scintigraphy. In these cases, it is equally important to perform these tests more than once, as the two conditions have a different evolution. This is important especially because, in absence of positive outcomes from pharmaceutical treatments, patients are often put in front of a surgical option, that could hugely worsen the symptoms of CRPS.

In conclusion, many doctors’ opinion is to consider these “incomplete cases” a type of CRPS as well, even if they don’t show important clinical signs like skin or vasomotor alterations. The best way to treat these situations are to consider different medical opinions and accept a multidisciplinary approach that could comprehend minor pain medications. It is vital not to use the pain medications as the only approach because they could prevent the patient from appreciating the benefits of rehabilitative programs and least invasive paths. The best thing would be to have the opinion of a Rheumatologist as well as an Orthopedic specialist that could easily look at the scans and suggest the correct approach.