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[Misleading "hip" or buttock pain: proximal arteritis or lumbar spinal stenosis?]

Michel Lequesne1, Afif Zaoui

  • 1Service de Rhumatologie, Hôpital Léopold Bellan, Paris. mlequesne@noos.fr

Presse Medicale (Paris, France : 1983)
|April 15, 2006
PubMed

Insights

Proximal arterial stenosis can cause hip and buttock pain, mimicking other conditions. Doppler ultrasound confirms arterial stenosis, guiding angioplasty when medical treatment fails.

Area of Science:

  • Vascular Surgery
  • Orthopedics
  • Radiology

Background:

  • Proximal arterial stenosis, particularly in the aortic bifurcation, common iliac, and hypogastric arteries, can manifest as misleading hip or buttock pain.
  • This pain pattern, characterized by relief upon cessation of walking, is distinct from articular hip complications or periarthritis.

Purpose of the Study:

  • To differentiate proximal arterial stenosis from other causes of hip and buttock pain, such as neurogenic intermittent claudication and lumbar canal stenosis.
  • To highlight the diagnostic utility of Doppler ultrasound and arteriography in managing arterial stenosis.

Main Methods:

  • Clinical presentation analysis, distinguishing arterial stenosis from hip joint issues and neurogenic claudication.
  • Exclusion of articular complications and periarthritis through physical examination and imaging.
  • Diagnostic confirmation using Doppler ultrasound.
  • Interventional guidance with arteriography for angioplasty.

Main Results:

  • Proximal arterial stenosis presents with characteristic intermittent claudication relieved by rest.
  • Standard physical examination and imaging can exclude articular hip pathologies.
  • Neurogenic intermittent claudication may present with paresthesia and trunk anteflexion.
  • Lumbar canal stenosis may be asymptomatic and incidentally found.
  • Reduced femoral pulse or ankle pressure index may be absent in hypogastric or gluteal artery stenosis.
  • Doppler ultrasound is effective in confirming arterial stenosis.

Conclusions:

  • Proximal arterial stenosis is a significant, often overlooked, cause of hip and buttock pain.
  • Accurate diagnosis requires differentiating it from musculoskeletal and neurological conditions.
  • Doppler ultrasound is crucial for diagnosis, and arteriography is indicated for treatment guidance when medical management is insufficient.

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