Hip pain: causes, treatment, and when to see a doctor

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Hip pain is a common symptom that can be described as aching, sharp, or burning and can range in intensity from mild to severe. There are many possible causes of hip pain, including serious ones like a fracture or joint infection, and less serious (though potentially debilitating) ones like arthritis or bursitis.

To understand the cause of your pain, your healthcare provider will closely examine your medical history, perform a physical exam, and possibly order imaging tests. Once a diagnosis is made, you and your healthcare provider can work together to develop a treatment plan that may involve surgery, but more often includes self-help strategies such as rest and ice, pain relievers with medication, and physical therapy.

Get Medical Information / Alexandra Gordon

Note. Hip pain is evaluated differently in children than in adults. This article focuses on the latter.

Causes

The femur is a large hinge joint: the "socket" is the pelvic bone called the acetabulum, and the "ball" is the head of the femur, which is the top of the femur . The glenoid is cartilage, a smooth white tissue that softens the bones and allows the hip to move easily.

Problems in the hip joint itself often cause pain in the inner thigh (pain in the front of the thigh). On the other hand, hip pain (pain in the side of the hip) or pain outside the thigh. , near the buttock area (pain in the back of the thigh) is usually caused by problems with the muscles, ligaments, tendons and / or nerves that surround the hip joint .

Differentiating the different causes of hip pain by location (anterior, lateral, or posterior) is perhaps the best way to understand this rather complex symptom.

Pain in the front of the thigh.

Problems in the hip joint, such as inflammation, infection or bone fracture, can cause pain in the front of the thigh, pain that is felt inside the thigh and / or in the groin area .

Osteoarthritis

Osteoarthritis of the hip occurs when the cartilage in the hip joint gradually wears down over time. As cartilage wears down and degenerates over time, often with age or as a result of a previous hip injury, the joint space between the bones of the hip joint narrows, so over time bone can rub against bone.

Depending on the degree of osteoarthritis, the pain may be dull, aching, or sharp; although in almost all cases the pain and stiffness of hip osteoarthritis increase with physical activity and decrease with rest .

Inflammatory arthritis

Various types of inflammatory arthritis can affect the hip, resulting in a dull ache , such as rheumatoid arthritis , ankylosing spondylitis , and systemic lupus erythematosus . it is often relieved by activity.

Fracture

A hip fracture or fracture of the upper quarter of the femur causes deep, aching pain that is felt in the upper outer thigh or groin. A hip fracture can occur after a fall or a direct blow to the thigh. It can also occur as a result of stress trauma.

Hip stress fractures are more common in athletes with an eating disorder, menstrual irregularities, and weakened bones (conditions collectively known as the female athlete triad) .

Steroid use, a history of smoking, and diseases that weaken the bones (such as cancer or osteoporosis) are additional risk factors .

With a stress fracture, unlike a complete break in the fall, a person may experience a more gradual onset of pain that increases with weight gain.

Iliopsoas bursitis

Bursitis simply results in irritation or inflammation of the bursa, which is a small fluid-filled sac that serves as a cushion between the joints, muscles, and tendons. A bursa, located on the inner or groin side of the thigh, is called a lumbosacral sac; when inflamed, it causes pain in the front of the thigh .

Iliopsoas bursitis , which is more common in runners and soccer players, causes pain in the front of the thigh that can radiate to the front of the thigh or buttocks. Sometimes there is a snapping, grabbing, or popping sensation in the thigh. with this type of bursitis.

Hip flexor stretch

A hip sprain refers to the stretching or tearing of an associated muscle or tendon (or both). The hip flexor muscles , such as the iliopsoas or rectus femoris, are often involved in stretching the hip .

A person can develop strain on the hip flexors due to overuse (for example, by cyclists, martial artists, or soccer players) or due to some type of injury, such as a direct hit during contact sports. In addition to pain in the front of the thigh, hip flexor sprains can lead to swelling, limited movement, and muscle weakness .

Hip osteonecrosis

Osteonecrosis of the hip occurs when the thigh bone does not receive an adequate blood supply, resulting in the death of bone cells and destruction of the hip joint. The vast majority of cases are associated with the use of corticosteroids and excessive alcohol consumption.

In addition to pain in the front of the thigh and pain in the groin that is worse when walking, a person may experience pain in the hips, buttocks, and / or knees .

Tear of the upper lip of the thigh.

The upper lip of the thigh is a strip of cartilage that runs along the outer edge of the hip socket. This lip helps support the joint and deepens it. Occasionally, overuse or an injury to the hip can tear the upper lip , causing a dull or sharp pain in the front of the thigh that is worse with exertion .

Femoroacetabular impingement (FAI)

Femoroacetabular impact (FAI) creates bony growths around the hip joint that can restrict movement and ultimately cause upper lip rupture and hip osteoarthritis.

Symptoms of femoral-acetabular impingement include sharp or aching pain in the groin that travels to the outside of the thigh . Pain is often felt when standing after sitting for a long time. Stiffness and lameness are also common .

Infected hip joint

In rare cases, an infection of the hip joint (this is called a septic joint ) is possible. In addition to severe pain in the front of the thigh and / or groin, there is usually swelling, warmth, and limited movement of the thigh. Fever is also common, but may not be present in older people .

Bone cancer

In rare cases , bone cancer (primary or metastatic) can cause hip pain. The pain is usually worse at night, but as the bone tumor progresses, the pain usually becomes constant. Swelling in the thigh area, weight loss, and unusual fatigue can also occur. The weakening of the bone due to cancer can result in a hip fracture .

Lateral hip pain

Pain in the side of the hip is pain in the side of the thigh, not the front or back of the thigh .

Trochanteric bursitis

Acetic bursitis causes acute lateral hip pain that often spreads to the hip and knee . The pain is usually worse at night when you sleep on the affected hip and when you engage in physical activity such as walking or running.

Over time, the pain can develop into a deep ache that spreads over a large area of the thigh. Swelling and lameness can also occur.

Hip snap syndrome

Hip snapping syndrome causes a popping or popping sensation and possibly lateral hip pain when walking or other movements, such as getting up from a chair. The actual "click" is due to the movement of one or more tight muscles, tendons, or other soft tissues. on the bone structure of the thigh.

One of the most commonly affected "heavy" or irritated tissues is the iliotibial band ( IT band), a thick accumulation of connective tissue that begins in the thigh and runs along the outer thigh . The clicking sound comes from the area where the TI band is playing. over the greater trochanter (upper part of the femur) .

This condition is more common in people who play sports or play sports, often causing the hips to flex (one reason it is also called a "dancer's hip" ) .

Pain in the back of the thigh

Pain in the back of the thigh that is felt on the outside of the thigh or buttocks is usually due to a problem with the muscles, tendons, or ligaments that surround the hip joint, rather than the joint itself .

Hamstring strain

Muscle sprains are the result of tiny micro-cracks in the muscle caused by a rapid twisting or stretching of the muscle. When this happens to the hamstring muscles located around the hip joint, it causes pain in the buttocks and / or pain in the back of the thigh .

Sacroiliac joint problem

The sacroiliac (SI) joint connects the lower spine with the pelvis. One of them is on both sides of your body.

Various sacroiliac joint problems , including joint arthritis, joint infection, and joint ligament damage, can lead to pain in the back of the thigh. Sharp and / or burning pain is often worse with standing and walking, and can radiate from the hip to the back of the leg.

Piriformis syndrome

Piriformis syndrome , also called deep gluteal syndrome, occurs when the sciatic nerve (a large nerve that branches from the lower back to the thigh, buttocks, and leg) is irritated or compressed by the piriformis muscle that is found deep in the buttocks. , at the top of the hip joint .

The burning or aching pain of piriformis syndrome usually begins in the back of the thigh and buttocks and spreads down the back of the thigh.

When to contact a healthcare provider

It is important to seek immediate medical attention if your hip pain is sudden, severe, worsens, falls, or experiences another form of hip injury .

While this is not an exhaustive list, other symptoms that require immediate medical attention include hip pain associated with:

  • Hot
  • Inability to bear weight or walk.
  • Weakness in the legs or feet
  • Swelling
  • Bruising or bleeding
  • Heat in the thighs

Diagnostics

Obtaining a complete history and physical examination from a treating physician, sports medicine provider, or orthopedic surgeon is essential to properly diagnose the source of hip pain.

Imaging tests, such as X-rays or magnetic resonance imaging (MRI), may be ordered depending on your main concern. Less often, blood tests are used to diagnose hip pain.

History of the disease

When you see your doctor about hip pain, they will most likely ask you a few questions, such as:

  • Is hip pain relieved after rest or exercise?
  • Do you have any additional symptoms (eg fever, swelling, other joint pains, etc.)?
  • Do you or any member of your family have a history of arthritis or joint problems?
  • Have you had a recent hip injury?

Physical exam

During your physical exam, your healthcare provider will examine and press various landmarks in the area of your hip, leg, lower back, and abdomen. You can also do a neurological exam to assess muscle weakness and reflexes.

In addition, you will maneuver your hips to assess your range of motion , to check your gait (how you walk), posture, and ability to bear weight.

Finally, based on your primary care provider's suspicion of one or more hip pain diagnoses, they will perform certain HP 'special tests'. One of the classic tests commonly used to evaluate hip pain is the FABER test.

FABER test

The FABER test (which stands for flexion, abduction, and external rotation) is used to diagnose hip abnormalities such as osteoarthritis of the hip, tear of the upper lip of the hip, or impact to the femur.

During the FABER test, while you are lying on your back, your doctor will bend your leg 45 degrees and then place your ankle (on the affected side) just above the kneecap of the opposite leg. He will then press on the affected side of the knee to lower the leg.

The test is considered positive if there is pain in the hip joint or if the knee / leg on the affected side cannot be lowered so that it is parallel to the opposite leg.

Other tests include:

Display

Certain imaging tests may be required to confirm or confirm a diagnosis of hip pain. For example, X-rays are the standard test to diagnose a hip fracture . X-rays can also show changes associated with hip osteoarthritis (for example, joint space narrowing and bone growths called osteophytes) .

MRI can also be used to diagnose a hip fracture in addition to other conditions such as osteonecrosis of the hip or infection of the hip joint. Magnetic resonance arthrography is the test of choice to diagnose a hip fracture of the lips. Finally , ultrasound can be used to confirm the diagnosis of bursitis .

Blood or other tests

For some suspicious diagnoses, different blood tests may be ordered. For example, if an infected joint is suspected, your healthcare provider will likely prescribe white blood cell counts, blood cultures, and markers of inflammation, such as erythrocyte sedimentation rate .

Additionally, cultures from a hip aspirate (removal of synovial fluid from the hip joint) are generally taken for both the diagnosis and treatment of septic arthritis.

Differential diagnosis

While it makes sense to think that hip pain is related to a problem with the hip joint itself or with the muscles or other soft tissues that surround the joint, this is not always the case.

Here are some conditions that are related to hip pain, that is, they do not occur in the hip joint or the structures that closely surround it:

Kidney stones

Certain processes in the lower abdomen can cause pain as if it came from the hip. For example, a kidney stone can cause severe pain in the groin area (between the upper thigh and the lower chest in the back) . The pain can radiate to the groin or inner thigh.

Meralgia paraesthesia

Meralgia paresthetica refers to the compression of a purely sensory nerve, called the lateral cutaneous nerve of the thigh, as it passes under the inguinal ligament. In addition to the burning pain that is felt mainly in the upper outer thigh, numbness and a tingling sensation are usually noted.

This disease is more common in the elderly and people with diabetes. Obesity , pregnancy, and wearing tight pants or belts also increase the risk of developing this condition .

Aortoiliac occlusive disease

Aortic occlusive disease, which refers to a blockage of the aorta (the main blood vessel in your body) and the iliac arteries (the two arteries that branch off from the aorta near the navel), causing pain, cramps in the buttocks and the hips. . and / or thigh .

This pain, called lameness, is caused by exercise and is relieved by rest. Blockages in these arteries are most often due to a condition called atherosclerosis , in which plaque builds up on the walls of the blood vessels and eventually narrows them so much that blood flow to the legs and groin becomes insufficient .

Lumbar radiculopathy

Sometimes nerve pain (burning or tingling) felt in or around the hip joint can be caused by an irritated nerve in the lower spine. This condition, called lumbar radiculopathy , can be diagnosed with an MRI of the lower spine (lumbar) .

Watch out

Although treatment for hip pain depends on the diagnosis made by your healthcare provider, the patient's treatment plan generally includes a combination of self-care, medication, physical therapy, and, less often, surgery .

Self-service strategies

Your healthcare provider can recommend several self-care strategies to help you be proactive in managing your hip pain.

Here are some examples of these possible strategies:

  • Limit or avoid activities that make hip pain worse, such as climbing stairs.
  • Use of walking aids such as a cane or walker to increase independence and mobility.
  • RICE Protocol: If you experience hip pain during sports or other activities, follow this sequence of rest, ice, compression, and lifting until you can see your doctor.

Medicines

Various oral medications, such as Tylenol (acetaminophen) or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) , are used to relieve hip pain associated with a number of conditions, including osteoarthritis, broken upper lip, bursitis, or femoral-acetabular impingement . Opioids , which are stronger pain relievers, may be prescribed to treat severe pain from a fractured hip or infected hip .

Depending on your diagnosis, other medications may be used, such as a disease-modifying antirheumatic drug (DMARD) to treat rheumatoid arthritis or intravenous antibiotics (through a vein) to treat an infected joint .

Physiotherapy

Physical therapy is an important component of pain relief and treatment of most causes of hip pain. In addition to exercises to improve hip strength, flexibility, and mobility, your physical therapist may use massage, ultrasound, heat, and ice to relieve inflammation in your thigh. It can also advise you when it is safe to return to sports or other activities (based on your primary diagnosis).

Operation

Some hip pain diagnoses may require surgery. For example, surgery is often used to repair a hip fracture. Also , for hip osteoarthritis that worsens despite conservative measures, the surgeon may perform a complete hip replacement. Finally , a procedure called a hip arthroscopy can be used to correct it. upper lip torn from thigh .

Prevention

While you may not be able to prevent all causes of hip pain, there are a few things you can do to be proactive in this regard:

  • Lose weight if you are overweight or obese
  • Eat a balanced and nutritious diet that contains enough vitamin D and calcium to maintain healthy bones.
  • Choose activities that are less stressful, like swimming or biking.
  • Stretch before exercising and then cool down.
  • If your legs are uneven, get a shoe insert.
  • Wear suitable shoes with soft soles and avoid or limit running on hard surfaces such as asphalt.
  • Talk to your doctor about daily exercise to maintain muscle and bone strength.
  • Using yoga or tai chi to prevent falls is one of the most common causes of hip fractures.

Get the word of drug information

Hip pain is a disabling condition that can have many potential causes. While the diagnostic process can be challenging and a bit tedious at times, try to be patient and proactive. Once a diagnosis is made, your healthcare provider can begin to develop a treatment plan that is tailored to your needs, one that uniquely eliminates your pain and optimizes your healing.

Frequently asked questions

  • Hip pain when walking can be caused by conditions that affect the muscles, tendons, or the blood supply to the femur. For example, hip snap syndrome may be caused by tendons hooking into a raised part of the thigh bone.

  • Yes, hip pain is common during pregnancy due to physiological changes in the body. To make childbirth possible, many body systems, including the musculoskeletal system, undergo changes during pregnancy. One study found that pain is most often felt in the third trimester.

  • The main symptom of hip arthritis is mild to severe pain in or around the hip area, which can be described as sharp, stabbing, shooting, or dull pain.

    Other symptoms of hip arthritis include:

    • Limited range of motion
    • Thigh stiffness
    • Pain that spreads to the groin, buttocks, lower back, thigh, or knee.
    • Lame walking

  • There are several types of hip bursitis. Iliopsoas bursitis causes pain in the front of the thigh that spreads to the front of the thighs or buttocks. Trochanteric bursitis , meanwhile, is described as pain in the outer thigh that usually spreads to the hip and knee.

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