Common Causes of Hip Pain
Your hip is the joint where your thigh bone meets your pelvis bone. Hips are called ball-and-socket joints because the ball-like top of your thigh bone moves within a cup-like space in your pelvis.
Hip pain results from damage to the hip joint-a ball and socket joint that connects the ball-shaped top of the leg bone (femur) to the hip socket. Damage to the hip joint results from a number of causes, including:
- Certain diseases:
- Injury from playing sports, running, overuse or falling:
Certain diseases lead to hip pain including osteoarthrits, rheumatoid arthritis and avascular necrosis.
Osteoarthritis is the breakdown of cartilage in the joints. This is followed by chronic inflammation of the joint lining. Healthy cartilage is a cushion between the bones in a joint. People with osteoarthritis usually have joint pain and limited movement of the affected joint.
- Causes. Osteoarthritis is associated with aging. The exact cause is unclear. As osteoarthritis develops, you experience loss of cartilage, bone spurs around the joint, and muscle weakness of the extremity.
- Risk Factors. Obesity, genetic factors, injury to the joint surface, occupations and physical activities that put stress on joints and neuromuscular disorders, like diabetes, increase your chance of developing osteoarthritis.
- Symptoms. Mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time. Creaking or grating sound in the joint. Swelling, stiffness, limited movement of the joint, especially in the morning. Weakness in muscles around the sore joint. Deformity of the joint.
- Diagnosis. The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include and x-ray, blood tests and/or an arthrocentesis, a procedure that involves withdrawing fluid from a joint.
- Treatment. There is no treatment that stops cartilage loss or repairs cartilage that is damaged. The goal of treatment is to reduce joint pain and inflammation and to improve joint function. Treatments may include medications, dietary supplements, alternative therapies (eg, acupunture, relaxation therapy, tai chi, yoga), mechanical aids (eg, shock-absorbing shoes, splints or braces, firm mattress, canes, crutches, walkers), losing weight, exercise and physical therapy, heat and ice, corticosteroid injections or surgery.
- Prevention. To reduce your chance of getting osteoarthritis, maintain a healthy weight, do regular, gentle exercise (eg, walking, stretching, swimming, yoga), avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40, and, with advancing age, certain activities may have to be dropped or modified. But, continue to be active.
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Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body.
- Causes. RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes include genetic factors, defects in the immune system can cause ongoing inflammation, environmental factors and hormonal factors.
- Risk factors. Family members with RA, females, individuals with Pima Indian ethnic background and smoking increase your chance of developing RA.
- Symptoms. When RA begins, symptoms may include joint pain and stiffness, red, warm, or swollen joints, joint deformity, mild fever, tiredness, loss of appetite and small lumps or nodules under the skin.
- Diagnosis. The doctor will ask about your symptoms and medical history. You will also be examined. To be diagnosed with RA, you must have at least one swollen or tender joint or a history of a swollen joint. How many joints, and which joints are involved will help aid your doctor in coming to the diagnosis. The doctor will also rule out other conditions that may have similar symptoms, like lupus or gout. To aid in the diagnosis, your doctor will order tests, such blood tests to determine if you have an automimmune disease and imaging tests, such as x-rays.
- Treatment. There is no cure for RA. The goals of treatment are to relieve pain, reduce inflammation, slow down joint damage and improve functional ability. There are a variety of medicines to treat the pain and inflammation of RA. Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility and preserving joint mobility. Devices that help with daily activities can also reduce stress on joints. Stress reduction can ease the difficulties of living with a chronic, painful disease (eg, joining a support group, cognitive behavioral therapy, meditation). Joint replacement and tendon reconstruction help relieve severe joint damage.
- Lifestyle measures. Although there are no guidelines for preventing RA, these may relieve stiffness and weakness and reduce inflammation: maintain a balance between rest and exercise, attempt mild strength training, participate in aerobic exercise (eg, walking, swimming, dancing), avoid heavy impact exercise, quit smoking, control weight and participate in a physical therapy program.
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Aseptic necrosis of the hip is the death of bone tissue in the head of the femur due to an inadequate blood supply. Certain bones have a fragile blood supply. The head of the femur in the hip joint is the most likely to suffer loss of blood supply. This can cause tissue death. If unidentified and uncorrected, it will progress to deformity, causing pain and a limp.
- Causes. Any event or condition that damages the arteries that feed the head of the femur raises the risk of aseptic necrosis. The most common events are fractures in the upper femur and dislocations of the hip. Other causes reduce the blood supply by closing off or compressing the blood vessels.
- Risk Factors. Femoral neck fractures, dislocation of the hip, radiation therapy, prolonged or repeated use of cortisone-like drugs, decompression sickness, sickle cell disease, gaucher disease, excessive alcohol use, systemic lupus erythematosus, renal transplantation and HIV infection increase your chance of developing aseptic necrosis of the hip.
- Symptoms. The few symptoms of aseptic necrosis of the hip are nonspecific and may be caused by other, less serious health conditions. Groin pain is the most common symptom, especially with weight-bearing actions. Buttock, thigh, and knee pain and limping are other common symptoms. A small number of patients do not experience the typical symptoms.
- Diagnosis. Your doctor will ask about your symptoms and medical history and perform a physical exam. If the diagnosis is suspected, you will be referred to an orthopedic surgeon. Tests may include x-ray, CT scan, radioisotope bone scan and MRI scan.
- Treatment. Talk with your doctor about the best treatment plan for you. Taking nonsteroidal and other pain relievers and performing non-weight-bearing exercises may prevent or minimize disease progression. There are several surgical procedures used to treat aseptic necrosis of the hip. The choice depends upon the extent of disease and the age and health status of the patient. Bone grafts, decompression of the inside of the bone, realignment of the bone, and prosthetic hip replacement are all available.
- Prevention. To help reduce your chances of getting aseptic necrosis of the hip, minimize the dose and duration of cortisone-like drugs and avoid decompression disease when diving underwater.
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Tumors that start in the bone ( bone cancer) or that spread to the bone can cause pain in the hips, as well as in other bones of the body.
- Causes. The cause of primary bone cancer is unknown. Genetics play a major role in most cases. Conditions that cause increased bone breakdown and regeneration over an extended period of time increase the risk of tumor development.
- Risk Factors. Paget's disease, exposure to radiation, injury to the bone and family history of bone cancer increase your change of developing bone cancer.
- Symptoms. Symptoms of bone cancer vary, depending on the location and size of the tumor. Symptoms may include pain at the tumor location, swelling or a lump at the location of the tumor, deep bone pain severe enough to wake you up, bone fractures (rarely), unexplained weight loss, fatigue, trouble breathing and fever or night sweats.
- Diagnosis. The doctor will ask about symptoms and medical history. A physical exam will be performed. Tests may include a blood test, x-ray, bone scan, CT scan, MRI scan and a biopsy.
- Treatment. Once cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. Treatment depends on the type, stage, and location of the cancer, and your overall health. Talk with your doctor about the best treatment plan for you. Treatment options include radiation therapy, chemotherapy, surgery and myeloablative therapy with stem cell support.
- Prevention. There are no guidelines for preventing primary bone cancer. Early diagnosis and treatment improve your chance of successful treatment.
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Injury from playing sports, running, overuse or falling can sometimes lead to hip pain. These include sprains and strains, bursitis, dislocations and fractures.
Bursitis occurs when the bursa, or fluid-filled sac between bones in the joints, becomes irritated or inflamed. The bursa in the hip joint is rather large and can easily become irritated, causing hip pain. The pain may be sharp or a dull ache, and may worsen after lying on the hip or sitting for long periods.
- Causes. Some common causes of hip bursitis, courtesy of the National Library of Medicine, include repeated stress on the area, from running, biking, climbing stairs or standing for a long time; a hip injury, including falling on it, bumping or bruising it, or lying on it for a long period; scoliosis and other diseases of the spine; legs of unequal length; rheumatoid arthritis; hip surgery; and bone spurs or calcium deposits in the hip.
- Symptoms. The American Academy of Orthopaedic Surgeons says signs of hip bursitis may include pain that occurs right at the point of the hip; radiates from the hip to the thigh, starts as severe and sharp, and becomes more aching and widespread; gets worse at night or when you lie on the bad hip, gets worse when standing after sitting for a long period; and gets worse after prolonged periods of climbing stairs, squatting or walking.
- Treatment. You can usually treat bursitis with rest, ice, and medicines to ease pain and reduce swelling. Other treatments include ultrasound, physical therapy, steroid injections and, in rare cases, surgery.
- Prevention. Stretching before you exercise, strengthening your muscles and resting when you do repetitive tasks might help prevent bursitis.
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Inflammation in the tendon or its sheath is called tendinitis. Iliotibial band tendinitis causes pain on the outside of the hip.
- Cause. Overuse of the the tendon (repetitive strain injury) is the most common cause of iliotibial band tendinitis. Acute injury to the tendon, such as an excessive stretch, can also cause tendinitis.
- Risk factors. Factors that increase your chance of tendinitis include muscle imbalance, decreased flexibility, overweight, advancing age, female gender and alignment abnormalities of the leg.
- Symptoms. Symptoms include pain, particularly with activity, decreased motion of related joints and local swelling.
- Diagnosis. The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will ask about your activity and the location of the pain. In the majority of cases your doctor will make a diagnosis based on the exam and history. If your symptoms are severe your doctor may order x-rays and MRI scan.
- Treatment. Conventional treatment consists primarily of avoiding the movement that caused the injury and allowing the body to heal on its own. Treatment may also include ice after activity, shoe orthotics for foot alignment problems, gentle stretching of the tendon, hip muscle strengthening, nonsteroidal anti-inflammatory drugs (such as ibuprofen) and steroid injection into the iliotibial band tendon.
- Prevention. To prevent tendinopathy gradually work yourself into shape for a new activity, gradually increase the length of time and intensity of activities, gradually stretch out that muscle/tendon unit, strengthen the muscle to which the tendon is attached, learn to back off from activities if you are tired or not used to the activity and warm-up the affected area before activity.
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Sprains and Strains
Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When these structures become inflamed from overuse, they can cause pain and prevent the hip from functioning normally.
- Cause. Pulling a muscle too far in a direction it does not want to go, contracting a muscle hard against resistance and contracting a muscle hard when the muscle is not ready can cause sprains and strains to muscles, tendons and ligaments that support the hip.
- Symptoms. Symptom include pain, limited motion, muscle spasms, and possibly muscle weakness at the hip.
- Treatment. Rest, ice, compression, elevation and over-the-counter or prescription nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen, to help decrease pain and inflammation. Severe sprains and strains may require surgery to repair the torn ligaments, muscle or tendons. Exercise program designed to prevent stiffness, improve range of motion and restore the joint's normal flexibility and strength.
- Prevention. Good flexibility can lower your chances of muscle strain. Always stretch well after warming up. The more flexible you are, the less likely you are to stretch beyond your capacity and pull or tear a muscle, tendon or ligament.
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A hip dislocation occurs when the ball of the thighbone (femur) moves out of place within the socket of the pelvic bone (acetabulum). This ball and socket forms the hip joint.
- Causes. Hip dislocations are relatively rare and severe injuries. They are often associated with pelvic fractures. A normal hip joint is stable and strong. A hip dislocation can only occur when a strong force is applied to the hip joint, such as severe falls, especially from heights, motor vehicle accidents and sports injuries.
- Risk factors. Prior hip replacement surgery, abnormal hip joint, alcohol use and poor muscle control or weakness leading to falls increase your chance of developing this condition.
- Symptoms. Symptoms include severe pain in the hip, especially when attempting to move the leg; leg on the affected side appears shorter than the other leg; hip joint appears deformed; and pain or numbness along the sciatic nerve area (back of thighs) if injury presses on this nerve.
- Diagnosis. The doctor will ask about your symptoms, how the injury occurred, and will examine your hip and leg. Tests may include x-rays and a CT scan.
- Treatments. Using closed reduction, the doctor will manipulate the thigh and leg. This is to try to put the ball of the femur back into the hip socket. You may be given medications to relax. If closed reduction is doesn't work, you may need surgery. Open reduction is often needed if the thigh or pelvic bones are also broken.
- Prevention. There are no guidelines for preventing hip dislocation. Most come from car accidents or sports injuries. To reduce your risk, take the following steps wear your seatbelt in the car, obey speed limits and other traffic laws, do not drink and drive and wear proper safety equipment for sports.
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A hip fracture is a break in the thigh bone just below the hip joint.
The hip joint consists of a ball at the top of the thigh bone (femur) and a rounded socket (acetabulum) in the pelvis. Most hip fractures occur in the neck of the femur 1-2 inches below the ball portion of the hip.
- Causes. Factors that may contribute to a hip fracture include falls (the most frequent cause of hip fractures), osteoporosis (a bone-thinning condition that weakens all bones including the hip), motor vehicle accidents and other types of major trauma, stress fractures in athletes (rare), bone conditions such as osteomalacia (rare) and bone tumors (rare).
- Risk factors. Risk factors for a hip fracture include previous hip fracture or history of falling, 65 years or older, female gender (especially after menopause), heredity, poor nutrition, deficient intake or absorption of calcium and vitamin D, low body weight, physical inactivity, weakness, poor balance and coordination, smoking, excessive alcohol use, chronic disease or fragile health, irregular heart beat or low blood pressure, arthritis, Parkinson's disease, history of stroke, mental impairments including Alzheimer's disease, problems with vision, certain medications which cause dizziness, drowsiness, or weakness, systemic cortisone or other steroids, thyroid disorder and heart failure.
- Symptoms. Symptoms may include pain in the hip; difficulty or inability to stand, walk, or move the hip; and abnormal appearance of the broken leg (looks shorter, turns outward)
- Diagnosis. The doctor will ask about your symptoms and how the injury occurred. A physical exam will then be performed. Tests may include x-rays, bone scan or MRI scan.
- Treatment. The goal is to get you back on your feet again as quickly as possible while your broken bone heals. For older patients, staying in bed for even several days may lead to serious complications. Treatment includes prompt emergency treatment and surgery to set the broken bone and hold it in the correct position.
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A hip pointer is a bruise to the upper part of your hip. This part of the hip bone is called the iliac crest. Many muscles, including abdominal muscles, attach at this site. A pointer can involve injury to bone and soft tissue. The injury can be very painful.
- Causes. Hip pointers are caused by a direct blow to the boney part of the pelvis. This commonly occurs in football or hockey when another player's helmet hits the pelvis. It can also occur by taking a hard fall onto the hip in any sport.
- Risk factors. Participating in contact sports increases your chance of developing a hip pointer. Football players and hockey players are especially at risk. Hip pointers are also more common while playing basketball and soccer.
- Symptoms. Symptoms include severe pain, tenderness, pain with activity, swelling, bruising, soreness, muscle spasms and decreased range of motion.
- Diagnosis. Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to an orthopaedic specialist. You may have an x-ray to rule out fractures.
- Treatment. Hip pointers are treated with rest, nonsteroidal antiinflammatory drugs (NSAIDs) and ice. For severe pain, your doctor may inject a steroid directly into your hip. A physical therapist may be recommended to help you regain mobility and build muscle strength. Hip pointers may take several weeks to heal and for the pain to go away and for normal movement to return.
- Prevention. Hip pointers occur through direct blows to the affected area. This is often accidental. As a result, not all hip pointers can be prevented. However, make sure to wear proper sports equipment and padding to decrease your chance of any injury.
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Hip Labral Tear
A hip labral tear is an injury to the cartilage inside the hip joint.
The hip joint is made of a ball and socket. The ball is the end of the thigh bone (femur). This ball fits into the bowl-shaped socket in the pelvic bone (acetabulum). Cartilage lines the socket to keep movement smooth and the joint cushioned. When the cartilage tears it is called a hip labral tear.
- Causes. Hip labral tears can result from wear and tear or from an acute injury. Causes may include wear and tear of hip joint from different activities (eg, golf, softball), traumatic injury to hip, twisting injuries, motor vehicle accident and degenerative diseases like osteoarthritis.
- Risk factors. Femoroacetabular impingement syndrome (FAI), Legg-Calve-Perthes disease, hip dysplasia, osteoarthritis, trauma to hip and slipped capital epiphysis increase your chance of a hip labral tear.
- Symptoms. Symptoms vary and can be subtle. They include hip pain (sharp, deep, disabling), locking or clicking of hip, feeling of hip "giving way," limited range of motion, tenderness on exam, groin pain, buttock pain, thigh pain and pain during activity.
- Diagnosis. Your doctor will ask about your symptoms and medical history. A physical exam will be done. You will likely be referred to an orthopaedic specialist. Tests may include and MRI arthrography, x-rays and diagnostic injection of local anesthetic is sometimes performed.
- Treatment. Talk with your doctor about the best plan for you. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), modified activity and physical therapy to strengthen muscles. Generally this treatment is tried for several weeks. If there is no improvement surgery is considered.
- Prevention. There are no known guidelines to prevent a hip labral tear.
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Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted March 2011