Referral Pain – Is Your Hip the Problem or Knee?

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What is Referral Pain?

Not a day goes by that a patient doesn’t arrive at the office of Dr. Rashid Ganji, chief orthopedic surgeon of Sina Hospital, complaining of knee pain.

Just recently, a woman in so much pain arrived in his office. The discomfort was so severe that she needed assistance from her daughter to go anywhere. She, like everyone else that day visiting, was complaining of the pain in her knee. Dr. Ganji, however, examines the patient, takes a look at her x-rays and notices more than a simple knee issue. Due to a car accident many years ago, the patient developed a hip problem. As a consequence of being left untreated of over the years, even a total knee replacement wouldn’t solve her knee issue.

What this patient and other patients commonly are experiencing is what is known as “referral pain,” which doctors say it is an area of pain in the body that is not located near the source of pain. A common example of this is when someone suffers a heart attack and their left arm experiences pain.

You should think of innervation (pathways of the nerves to parts of the body) in the nervous system as a sort of shared “wiring” system, so to speak. If you have liver abscess, it may cause pain in the shoulder because the liver is below the diaphragm and the nerves in the diaphragm enter the spine at the same place as the shoulder nerves do. They share the same neurologic pathways to the brain and the sensations or signals become crossed.

Osteoarthritis in the Knee Joint

This is very common among patients with arthritis. It’s extremely common to occur in joints, especially people with hip osteoarthritis. It’s not uncommon for patients with hip osteoarthritis to have pain in their groin. There may also be pain in the thigh that goes all the way down to the knee.

Knee pain that goes with hip osteoarthritis tend to get worse over time. Pain and discomfort will come from movement of the hip rather than the knee, since hip-to-knee referral pain doesn’t go both ways.

If a patient complains of consistent knee pain, it doesn’t necessarily mean it’s the hip, because knee osteoarthritis is common. Dr. Ganji examines the knee, but he also examines the hip and back. If he concludes the knee joint is normal, he would assess the patient’s mobility. After the doctor examines the x-rays he can determine the source of the pain.

Sometimes specialists cannot determine the source of pain, so they inject a numbing agent into the hip. If the knee pain goes away, then the problem is not the knee. Dr. Ganji doesn’t practice this technique since he focuses solely on total knee replacement. He recommends patients to a qualified orthopedist that specializes in a patients specific ailment.

If the knee pain is found to be coming from the arthritic hip, nonsteroidal anti-inflammatory drugs, physical therapy or finally hip replacement is recommended.

Treating Knee Pain

Referral pain is not something to ignore. It is something tangible and should be addresses soon. Patients shouldn’t wait a long time and deal with the pain in hopes of the pain hopefully disappearing. Even if you come to see Dr. Ganji, and it’s not necessary to have a total knee replacement, he can diagnose the problem and recommend a suitable specialist to solve the issue.

Regarding the patient who complained of knee surgery, she first needs to see a hip specialist and then come back to be re-evaluated by Dr. Ganji. You can watch the video of Dr. Ganji's diagnosis  below.

So talk to your doctor sooner rather than later if you are experiencing any type of persisting pain. Keep track of the type of pain and location so that you can explain it to your physician. This way you can rest assured that the condition is addressed before it becomes a serious issue.