Hip pain is the broad term that denotes the pain in the hip joint and nearby structures. The hip joint is a ball and socket joint and is involved in the day to day activities of load bearing. Hip pain may originate from the joint itself, from nearby structures or could be referred from other places.
The location of hip pain can provide valuable clues about the underlying cause. Hip joint problems tend to result in pain on the front of your hip or groin. Hip pain on the outside of your hip, upper thigh or outer buttock generally comes from muscles, ligaments, tendons and other soft tissues surrounding hip joint.
Hip pain can sometimes be caused by diseases and conditions in other lower back or knees. This type of pain is called referred pain.
Relevant Anatomy of Hip
The hip joint is a ball-and-socket synovial joint that connects the axial skeleton [pelvis] to the lower limb [femur]. The ball of the joint is formed by femoral head, and the socket is formed by the acetabulum. The acetabulum is formed by the merging of the ossification centers of ilium, ischium and pubis bones of the pelvis.
The hip joint is designed to be a stable weight-bearing joint. To achieve this, a large range of movement is sacrificed for stability. This is in contrast to the shoulder joint where stability has been compromised for movement.
[Read more about hip joint anatomy]
Causes of Hip Pain
Arthritis of Hip Joint [noninfectious]
Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that normally cushions your hip bones. The pain gradually gets worse as arthritis progresses. People with arthritis also feel stiffness and have a reduced range of motion in the hip.
Psoriatic arthritis, spondyloarthropathies, and ankylosing spondylitis also involve the hip joint and may lead to hip pain.
Apart from this secondary osteoarthritis due to joint changes caused by any pathology may occur.
Hip region is commonly injured in adults and less common in children. Hip fractures are more common in the elderly due to the weakening of the bone due to osteoporosis.
In children and young adults, substantial trauma is required to break the bone.
Dislocation of the hip is also a significant injury.
Intertrochanteric fractures, fractures of pelvis, acetabulum, and neck of femur fractures can cause hip pain.
Apart from major injuries, sprains and soft tissue injuries also may cause hip pain.
Bursitis and Tendinitis
Bursitis is the inflammation of the bursae- small, fluid-filled sacs that protect muscles and tendons are usually due to repetitive activities that overwork. There are many bursae around the hip that could get inflamed and cause pain.
Tendinitis is degenerative changes in the tendon usually caused by repetitive stress from overuse.
Bacterial and mycobacterial arthritis are more common in young children. Proximal femoral osteomyelitis also can be cause of pain. Soft tissue abscess like gluteal abscess can give rise to pain.
Systemic features like fever and malaise could be present.
Following conditions may be responsible for radiated pain in the hip
Tumors of the bone, either primary can affect the hip region and cause pain. In addition to that tumors elsewhere in the body might metastasize to this region.
It is a disorder where there is congenital or developmental deformation or misalignment of the hip joint and on the extreme of the spectrum, a dislocation.
Legg-Calve-Perthes disease occurs when blood supply is temporarily interrupted to the femoral head resulting in an insufficient flow which makes bone die, making it brittle and poor in healing.
Legg-Calve-Perthes disease can affect children of nearly any age but most commonly occurs between ages 4 and 8 and is most common in boys than in girls.
Slipped upper femoral epiphysis is a disorder of adolescence where the upper femoral epiphysis slips in backward direction due to the weakness of growth plate.
Often, it develops during periods of accelerated growth, shortly after the onset of puberty. The cause of SUFE is not known. It is more common in males than females
Rickets and Osteomalacia
Once common due to nutritional deficiency, these are less common now. The knee is the most common joint affected and results in valgus or varus deformities.
Transient synovitis is the most common cause of acute hip pain in children aged 3-10 years. It causes pain in the joint due to transient inflammation of the synovium of the hip.
The pain location would provide the clue to causation. Fractures would mostly be associated with a history of fall or another kind of trauma.
The hip pain may be in the hip joint and adjoining regions like groin, buttocks, and thigh.
Sometimes, the pain can radiate from affliction in the back.
There may be an accompanying limp.
The pathologies of the joint cause a pain that worsens with activity and weight bearing and better on rest. Movements of the joint could be limited.
A hip pain that is deep seated in the groin or anterior aspect, and worsens with activity suggests hip joint involvement. The range of motion might be affected.
Pain on the posterior aspect of the hip or gluteal musculature may be associated with low back pain and tends to radiate down the posterolateral aspect of the thigh as well
A pain on lateral side on the trochanter suggests trochanteric bursa. Direct palpation over trochanter would reveal tenderness.
The examination would further clarify the likelihood of a particular condition. Tenderness in the hip joint is present in conditions affecting the joint.
Wasting may be present if the patient is not able to use the limb.
Disproportionate wasting generally indicates infection.
Infections of the joint or soft tissues may be associated with redness and fullness of the area and could be accompanied by fever and other systemic symptoms. There is a severe limitation of the joint movements.
A pain from the back is often radiating in character and often becomes better when the patient lies down. The pain may worsen with coughing and sneezing.
In the case of fracture, there would be a history of trauma or fall.
Some pathologies occur in growing skeletons and should be suspected in children. These are Perthes disease, slipped upper femoral epiphysis etc.
Various joint conditions do not affect the blood profiles. ESR, C reactive protein and other markers of inflammation are raised in infection and inflammatory conditions.
Xrays would reveal the joint changes and helps to reach a diagnosis. CT or MRI may be required in cases where diagnosis could not be reached at. The area of discomfort depends on the causation. The pain might be felt in the thigh, groin buttocks or seep seated in the joint.
Xray of Pelvis is the most common imaging ordered in cases of hip pain. Appropriate xrays of spine and knees may be required in selected cases.
CT and MRI are less frequently required but needed when xrays are normal, to catch the suspected disease in early stages or to know greater details of the lesions.
Soft tissue afflictions are better shown by MRI.
Home Management of Hip Pain
Diagnosing hip pain is the physician’s job. But minor pains can be managed at home.
Treatment of hip pain involves treatment of the underlying cause. Most of the minor pains can be tackled by over the counter pain relieving medicines and rest.
In case the pain is not relieved or worsens, the advice of the physician must be sought who would put you on the proper treatment after making a diagnosis.
Rest and Precautions
Provide rest to the affected area. Avoid repeated bending at the hip and direct pressure on the hip. Avoid sleeping on the affected side.
If your hip pain is related to overuse or increased physical activity, take following precautions as well
- Always warm up and stretch your muscles before work out.
- Reduce the amount of exercise you do.
- Run on the softer ground instead of concrete.
- Use good running shoe and proper dress for the workout.
Acetaminophen, Ibuprofen (Brufen) or other NSAIDs other over the counter drugs may ease your pain.
Local Ice or Heat
Ice cubes in a bag can be used in acute pain resulting from a sprain. If ice cubes are not available, a bag of frozen vegetables may be used.
In other pains, warm compresses may help.
If these measures do not make a difference, consider an appointment with your physician.
Scheduling a Visit to Physician
Apart from injury as discussed above, you should plan a visit to your physician if
- Your hip is still painful after 1 week of home treatment
- You also have a fever or rash along with pain in the hip
- Hip pain is sudden and intense
- You have a history of sickle cell anemia or long-term steroid use
- Pain is also in the other hip or other joints.
Treatment of Hip Pain
Treatment would depend on the diagnosis. For example, for rheumatoid arthritis, the treatment includes anti-inflammatory and disease-modifying anti-rheumatic drugs like methotrexate and sulfasalazine.
For tuberculosis anti TB medications along with traction for joint are started.
Orthotic devices are indicated in conditions like Perthes disease.
Some of the conditions require surgical treatment. These are fractures not treatable by nonoperative means, slipped upper femoral epiphysis, hip replacement for degenerated joints etc.
When osteoarthritis becomes so severe that the pain is intense or the hip joint becomes deformed, a total hip replacement may be a consideration.
Infections would be controlled by antibiotics and in case of need arises- evacuation of pus.
Tumors are treated according to their type and extent.
Causes of Pain in Both Hips
Pain in both hips can be due to back condition or the disease of the hip affecting both hip joints. Bilateral hip joints being affected by a disease is less common than the single hip disease.
Pain in both hips should raise the suspicion of the possibility of following diseases
Avascular Necrosis of Hip
Avascular necrosis of the hip occurs due to attenuation of blood supply to the head of the femur. The exact cause of the disease is not known through an association with prolonged steroid use and alcoholism is known. The disease typically gets symptomatic in one hip and in quite a number of cases, imaging reveals that both the hips are involved.
Sometimes, the presentation may be the pain in both hips.
Rheumatoid Arthritis or Seronegative Arthropathies
These arthritides may are typically symmetrical and both hip involvement is known. Pain in both hips can occur in these arthropathies
Systemic Diseases Affecting Joints
Disorders of vitamin D deficiency or increase in parathyroid hormones may affect both the hips.
This congenital abnormality can be unilateral or bilateral. Uncorrected DDH can in later life lead to pain in both hips.
This disease is usually in the single hip but rarely can affect both hips simultaneously. It is a disease of childhood.
This is found in children near puberty and involves slippage of the upper femoral epiphysis.
Hip osteoarthritis, primary and secondary, is a common cause of pain in both hips. Primary osteoarthritis occurs without any other factor and secondary osteoarthritis develops due to degeneration of hip due to some other disease.
Ankylosing spondylitis commonly involves hip joints and usually symmetrical. A person with back pain and pain in both hips should be evaluated for ankylosing spondylitis as well.
Trauma to both hips would result in pain in both hips. It is quite rare though.
Infection in both hips is extremely rare.