Causes of Hip Pain

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

 

Hip Pain

Causes of Hip Pain

• Pain can arise from the structures that are within the hip joint or from the structures surrounding the hip joint.
• The most important thing is to ask the patient to locate the site of pain. Ask the patient to point at the site of pain.
• When the patient states that their hip hurts, it doesn’t mean that the pain is coming from the hip joint itself, so ask the patient to point at the site of the pain.
• The pain can arise from structures that are within the hip joint or from structures surrounding the hip.
• The hip joint is a weight bearing joint. The joint consists of two parts: the Femoral Head (ball), and Acetabulum (socket).
• The hip pain can be of four types, Anterior hip pain (deep groin pain), Lateral hip pain, Posterior hip pain, or it can also be far Posterior hip pain coming from the sacroiliac join and the lower spine.

Anterior Hip Pain
Anterior hip pain is usually deep within the groin and it can result due to arthritis of the hip. There are mainly four reasons for the anterior hip pain which are arthritis of the hip, labral tear, stress fracture

Arthritis of the hip
Treatment
Conservative treatment
• Physical therapy
• Anti – inflammatory medication
• Possible injections
• Surgery (done in late cases, usually by total hip replacement)

Labral tear
It is usually diagnosed by clinical examination with a provocative test of flexion, adduction and internal rotation. The diagnosis is confirmed by an MRI arthrogram.
Treatment
Conservative treatment
• Physical therapy
• Anti – inflammatory medication
• Injections
Surgical treatment – it provides good result and it is usually done by arthroscopic debridement or repair of the tear.

Stress Fracture
Stress fracture is usually diagnosed by an MRI. The X-ray may be normal in this case. Here early diagnosis is important before the fracture displaces and gives a bad result.
Treatment
• Usually surgical fixation of the fracture.
– The fixation of the fracture is usually performed utilizing screws.
– Femoral head replacement is done in rare and late cases.

Avascular necrosis of the femoral head
Avascular necrosis means death of a segment of the bone. When the blood supply of the femoral head is interrupted, a segment of the bone dies and becomes necrotic (femoral head will collapse).
The diagnosis is usually done by an MRI.

Treatment
• Early stages of AVN without collapse of femoral head
• Decompression by drilling of this segment in the femoral head to bring a new blood supply to the area.
• In severe cases with collapse of the femoral head (usually diagnosed by an x-ray), the treatment is usually total hip replacement.

Lateral Hip Pain

Inflammed bursa
Lateral hip pain is usually due to inflamed bursa.
Treatment
• Usually conservative treatment.
– Physical therapy
– Anti-inflammatory medication
– Injection
• Surgical treatment by excision of the bursa is rarely done.

In case of chronic, resilient trochanteric bursitis, try to get an MRI to exclude a tear of the abductor muscles of the hip (gluteus medius & gluteus minimus muscle tear).

Posterior Hip Pain

It is usually due to piriformis syndrome. The sciatic nerve can be irritated from the piriformis syndrome.
Treatment
• Usually, physical therapy
• Stretching
• Anti-inflammatory medication
• Injections

Surgical treatment is usually rare and it is the last resort. It includes release of the piriformis tendon and exploration of the sciatic nerve. It is done in cases that fail to improve with conservative treatment.

Far Posterior Hip Pain

• Far posterior pain may come from the sacroiliac joint or from the lower spine conditions.
• Sacroiliac joint (SI) problems are a challenging diagnostic and treatment entity.
• There are a lot of clinical diagnostic examinations that can be used to diagnose sacroiliac joint (SI) problems such as the Faber test and others.
• However, injection of the Sl joint is probably the method to diagnose pain originating from the SI joint. If there is improvement of the condition of the patient after injection of the SI joint, then we will probably consider that the problem is in the SI joint.
• The SI joint problems are usually under estimated and are unappreciated.
• Lower spine conditions can cause referred pain to the buttock and hip area. In fact, symptoms of hip and lower spine conditions can overlap or both of them can coexist in the same patient. You have to separate pain from the hip from pain that comes from the spine.