Overview

 

The hip joint attaches the leg to the torso of the body. In the hip joint, the head of the thigh bone (femur) swivels in a socket made up of pelvic bones, called the acetabulum. While many causes of hip pain can arise from the joint itself, there are numerous structures surrounding the hip that can also be the source of pain.

Hip pain is common problem, and it can be confusing because there are many causes. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the underlying problem.



If you have hip pain, some common causes include:

Hip Pain Causes

Pain can arise from structures that are within the hip joint or from structures surrounding the hip. The hip joint is a potential space, meaning that there is a minimal amount of fluid inside it to allow the femoral head to glide in the socket of the acetabulum. Any illness or injury that causes inflammation will cause this space to fill with fluid or blood, which stretches the hip capsule and results in pain.

The femoral head and the acetabulum are lined with articular cartilage that allows the bones to move in the joint with less friction. Also, the socket area of the acetabulum is covered with tough cartilage called the labrum. Just like any other joint cartilage, these areas can wear away or tear and be the source of pain.

There are thick bands of tissue that surround the hip joint, forming a capsule. These help maintain joint stability, especially with movement.

Movement at the hip joint is possible due to the muscles that surround the hip and the tendons that attach across the hip joint, allowing motion in different directions. Aside from movement, these muscles act in concert to maintain joint stability. There are large bursas (closed fluid-filled sacs) that surround areas of the hip where muscles intersect and allow the muscle and tendon to glide more easily. Any of these structures can become inflamed.

Pain from other sources can be referred to the hip, meaning that while the hip hurts, the problem originates elsewhere. Hip pain is a non-specific complaint that requires the health care practitioner to find the underlying cause.

Hip Pain Symptoms

Hip pain is often difficult to describe, and patients may complain that the hip just hurts. The location, description, and intensity of pain; what makes it better and what makes it worse depend upon what structure is involved and the particular structure that is inflamed or injured.

Trauma :

a fall, direct blow, twist, or stretch, the pain is felt almost immediately.

Overuse injury :

the onset of pain may be delayed by minutes or hours as inflamed muscles surrounding the hip joint go into spasm or joint surfaces inflame, causing fluid accumulation.

Pain :

Most often pain is felt in the front of the hip, but the joint is three-dimensional. Pain may be also felt along the outside part of the hip or even in the buttock area.

Limp :

Limping is the body's way of compensating for pain by trying to minimize the amount of weight the hip has to support while walking. Limping is never normal. Also, when limping occurs, abnormal stresses are placed on other joints including the back, knees, and ankles.

Fracture :

With a hip fracture, there is an acute onset of constant pain after the injury that is made worse with almost any movement. The leg may appear shortened and rotated outward. Pelvic fractures may have similar pain.

Sciatica pain :

Pain from sciatica tends to start in the back and radiate to the buttocks and to the front or side of the hip. It may be described in different ways because of nerve inflammation. Some descriptive terms used may include sharp, stabbing, or burning. The pain of sciatica may be made worse with straightening the knee which stretches the sciatic nerve and may make it difficult to stand from a sitting position, or walk with a full stride.

Arthritis :

If arthritis narrows the hip joint or impinges on the way the femoral head can glide in the acetabulum, or if there is a cartilage or labrum tear, the pain may be associated with a "catch," or a feeling like there is something impeding hip movement.



When to Seek Medical Care

People often decide to seek care after an injury based upon their ability to stand, bear weight, and walk. If there is a concern that a bone is broken, medical care should be sought in an urgent manner. Since patients with a broken hip tend to have significant pain even with minimal movement, it may be wise to call emergency medical services (usually by calling 911) for help in lifting and transporting the fall victim.

If the pain is more gradual in onset and does not respond to rest, ice, and over-the-counter pain medications, it is reasonable to seek help. This is especially true if the hip pain begins to limit the range of motion of the hip or causes limping.

If there is loss of bowel or bladder function, this may signal that the pain is coming form the back and a true emergency called cauda equina syndrome may exist. Medical care should be accessed immediately.

Children whose pain and limp are associated with a fever are at risk for having a joint space infection and should be seen by their health care provider emergently. Even if no obvious injury has occurred, it is wise to have them evaluated within a few days if the pain and limp have not resolved.

Childhood Hip Problems:

Developmental Dysplasia

When the hips are dislocated or out of position in infancy, the joint may not develop properly. While this is not usually painful as a child, it will lead to early arthritis and problems with walking.


Legg-Calve-Perthes Disease

Also called Perthes disease, this is a problem similar to osteonecrosis (see above) but in childhood. If severe, it can lead to permanent damage to this hip joint and early arthritis.

Physical examination

Physical examination for hip pain will focus on the hip, leg, and back, however, the rest of the body will not be ignored, looking for associated findings that may help explain the patient's complaints.

Observation of the hip at rest and while standing or walking, palpation (or feeling) of the hip and surrounding structures, testing for range of motion and strength, and checking for sensation and pulses all may be appropriate.


Imaging

Many times plain X-rays of the hip and pelvis are done to look at the bones and the joint spaces. In a fall, this may diagnose an acute fracture, but occasionally, the break can not be seen on routine films. In these cases computerized tomography (CT) or magnetic resonance (MRI) imaging must be done to pinpoint the fracture.

Narrowed joint spaces and arthritis can be seen on plain X-rays and help confirm the diagnosis of osteoarthritis and degenerative joint disease.

When looking for cartilage or labrum tears in the hip, an arthrogram may be done, in which a radiologist injects contrast dye into the hip joint using a long thin needle. Either plain X-rays or MRI images are taken to look at the joint surfaces outlined by the dye.

A bone scan may be performed to look for inflammation. Radioactive dye is injected intravenously and the whole body is scanned. The radiologist looks for abnormal accumulations of the dye that may help establish a diagnosis.


Blood tests

If the health care practitioner is concerned that a systemic (body-wide) illness is the cause of the hip pain, blood tests may be ordered.

Hip Pain Treatment

The treatment of hip pain depends upon the diagnosis and any underlying illness that may be present.


Self-Care at Home

As we age, the body tends to tolerate falling less easily. Falls often can cause contusions (or bruising) and inflammation of the tissues that are damaged. This pain may not be felt immediately, and over a few hours the injured area may begin to stiffen and get sore. If the patient can stand and walk relatively easily with minimal limp, then it is reasonable to rest and ice the injured areas and begin activity as tolerated. Over-the-counter pain medications may be used. Usually, the pain and stiffness will resolve over a few days. If the pain persists or starts to worsen instead of getting better, medical evaluation may be helpful.

Hip pain and soreness that develop because of overuse but without any specific injury may be cared for at home with rest and gradual return to full activity. While rest is important, it is also important to maintain range of motion, meaning that attempts should be made to stretch the leg, hip, and back and keep the whole body moving.

Care for hip pain that exists because of an underlying medical condition should be coordinated with the health care practitioner. Often, the hip pain will be episodic depending upon the control of the medical condition.


Medical Treatment

The cause of the hip pain will direct the treatment provided. Aside from medications, therapy will be directed to maintain the strength and range of motion of the hip. As with any illness or injury, the goal is to return the patient to their normal level of function. A team approach involving the health care practitioner, physical therapist, or chiropractic care provider may be considered.

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