Hip Conditions
The hip joint is designed to withstand repeated motion and a fair amount of wear and tear. This ball-and-socket joint — the body’s largest — fits together in a way that allows for fluid movement.
Whenever you use the hip (for example, by going for a run), a cushion of cartilage helps prevent friction as the hip bone moves in its socket.
Despite its durability, the hip joint isn’t indestructible. With age and use, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. The hip bone itself can be fractured during a fall or other injury. Any of these conditions can lead to hip pain.
If your hips are sore, here is a rundown of what might be causing your discomfort and how to get hip pain relief.
Dislocated Hip
A traumatic hip dislocation occurs when the head of the thighbone (femur) is forced out of its socket in the hip bone (pelvis). It typically takes a major force to dislocate the hip. Car collisions and falls from significant heights are common causes and, as a result, other injuries like broken bones often occur with the dislocation.
A hip dislocation is a serious medical emergency. Immediate treatment is necessary.
Gluteus Medius Tear
At the side of the hip in the upper thigh, there is a bony prominence called the greater trochanter. Three important structures come together at this point: the trochanteric bursa, the gluteus medius muscle and the iliotibial band. The trochanteric bursa is a small, fluid-filled sac that pads the prominent bone over the greater trochanter. At times, this bursa can become inflamed, leading to significant pain over the side of the hip. Trochanteric bursitis can occur from direct pressure, after injury or with overuse, but is also linked to tears of the gluteus medius. The gluteus medius is one of the key muscles surrounding the hip. This muscle starts in the buttock and attaches at the greater trochanter, on the side of the hip. Activation of the gluteus medius allows us to lift our leg to the side (abduct). Tendonitis or tears of the gluteus medius can occur after injury or with long-term wear and tear. These tears generally cause pain and weakness on the side of the hip (not the groin). The iliotibial band is a stiff band of tissue that runs along the outside or lateral part of the leg from hip to knee. It extends over the prominence of the greater trochanter and can become tight in this area.
Hip Arthritis and Osteoarthritis
Sometimes called “wear-and-tear” arthritis, osteoarthritis is a common condition that many people develop during middle age or older. In 2011, more than 28 million people in the United States were estimated to have osteoarthritis. It can occur in any joint in the body, but most often develops in weight-bearing joints, such as the hip.
Osteoarthritis of the hip causes pain and stiffness. It can make it hard to do everyday activities like bending over to tie a shoe, rising from a chair, or taking a short walk.
Because osteoarthritis gradually worsens over time, the sooner you start treatment, the more likely it is that you can lessen its impact on your life. Although there is no cure for osteoarthritis, there are many treatment options to help you manage pain and stay active.
Hip Bursitis
- A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between moving tissues of the body.
- There are two major bursae of the hip.
- Bursitis, or inflammation of a bursa, is usually not infectious, but the bursa can become infected.
- Treatment of noninfectious bursitis includes rest, ice, and medications for inflammation and pain.
- Infectious bursitis (uncommon) is treated with antibiotics, aspiration, and surgery.
- Bursitis of the hip is the most common cause of hip pain.
- Trochanteric bursitis frequently causes tenderness of the outer hip.
- Ischial bursitis can cause dull pain in the upper buttock area.
Hip Femoroacetabular Impingement (FAI)
Femoroacetabular impingement (FAI) occurs in the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.
Hip Fracture
A hip fracture is a femoral fracture that occurs in the proximal end of the femur (the long bone running through the thigh), near the hip.
A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age.
Older people are at a higher risk of hip fracture because bones tend to weaken with age (osteoporosis). Multiple medications, poor vision and balance problems also make older people more likely to trip and fall — one of the most common causes of hip fracture.
A hip fracture almost always requires surgical repair or replacement, followed by months of physical therapy. Taking steps to maintain bone density and avoid falls can help prevent hip fracture.
Hip Instability
Instability can be classified as traumatic or chronic in nature.
Traumatic instability ranges from severe dislocation to subtle hip subluxation (hip joint sliding out of place, but immediately re-establishing correct anatomical positioning). Traumatic instability most often occurs from motor vehicle accidents and extreme athletic events. These injuries often cause damage to the femoral head, labrum and cartilage, along with the formation of loose bodies.
Chronic instability may arise from congenital or developmental variants, as well as overuse of the hip joint.
Once a patient has failed conservative measures, including physical therapy, surgery may be considered to correct their hips condition. Hip arthroscopy is capable of addressing causes of hip instability, as well as any damage after a traumatic instability event.
The hip capsule and ligaments surrounding the joint, can be tightened arthroscopically to give the hip greater stability, known as a capsular plication. This involves suturing the ligaments around the joint arthroscopically in order to give the hip greater stability.
Hip Labral Tear
A hip labral tear involves the ring of cartilage, called the labrum, that follows the outside rim of the socket of your hip joint. The labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket.
Athletes who participate in such sports as ice hockey, soccer, football, golfing and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also can lead to a hip labral tear.
Hip Muscle and Tendon Strains
Your gluteal tendons are the tough fibres that connect your gluteal muscle to your hip bone. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.
Typically, tendon injuries occur in three areas:
musculotendinous junction (where the tendon joins the muscle)
mid-tendon (non-insertional tendinopathy)
tendon insertion (eg into bone)
Non-insertional tendinopathies tends to be caused by a cumulative microtrauma from repetitive overloading eg overtraining.
Hip Tendinitis
Tendinitis occurs when a muscle is overused and pulls on the tendon that attaches it to the bone. In your hip, which is the largest ball-and-socket joint in your body, tendons perform an important role by keeping strong muscles attached to the femur (thigh bone) as your legs move.
One kind of tendinitis that occurs as a result of overuse is called iliacus tendinitis or iliopsoas tendinitis. The iliac muscle, which starts at your hip bone, and the psoas muscle, which starts in your lower spine, are used when lifting the leg toward the chest to keep you stable. They come together in a tendon at the top of the femur, and that is the point where tendinitis occurs.
Hip Pain and Tendinitis: Who Is at Risk
Damage is most likely to occur from an activity that requires repeatedly lifting the leg while turning it out at the hip, as in ballet or gymnastics. Athletes in sports that require a lot of high kicking or squatting and lifting weights may also put strain on this area.
This injury occurs primarily in female ballet dancers, but is otherwise rare, says Brian Parsley, MD, assistant professor of orthopedic surgery at the Baylor College of Medicine in Houston, Texas.
People who could be at risk for hip pain from iliacus tendinitis are:
- Ballet dancers
- Gymnasts
- Older people who have an uneven or unsteady walk
- Long-distance runners who have been running on hills or increasing their distance too quickly
This can also occur if you have a snapping hip, a condition in which the tendon repeatedly “pops” over a boney projection, gradually wearing down the tendon.
Iliotibial Band Syndrome
Iliotibial band syndrome (ITBS or IT band syndrome) is an overuse injury of the tissues located on the outer part of thigh and knee. It causes pain and tenderness in those areas, especially just above the knee joint. Iliotibial band syndrome is more common in runners and bicyclists.
The iliotibial band is a thick band of tissue that begins at the iliac crest in the pelvis, runs down the outer part of the thigh, and crosses the knee to attach into the top part of the tibia or shinbone. The iliotibial (IT) band helps stabilize the outside part of the knee through its range of motion.
Irritable Hip Syndrome
Irritable hip is a common childhood condition that causes symptoms such as hip pain and limping.
Doctors sometimes refer to irritable hip as transient or toxic synovitis.
Hip pain isn’t usually severe, but your child may be reluctant to place weight on the affected leg.
Occasionally, an irritable hip may also cause:
- Pain in the knee or thigh
- Restricted movement in one of the hip joints
- Slightly higher temperature than normal – a normal temperature is around 37C (98.6F)
In younger children who are unable to speak, the only noticeable symptom may be crying at night.
Slipped Capital Femoral Epiphysis (SCFE)
Slipped upper femoral epiphysis (SUFE) is also known as a slipped capital femoral epiphysis (SCFE) and is a relatively common condition affecting the physis of the proximal femur in adolescents. It is one of commonest hip abnormalities in adolescence and is bilateral in ~20% of cases.
Epidemiology
The age of presentation is somewhat dependent on gender. Typically boys present later (10-17 years) than girls (8-15 years). Obesity is a significant risk factor. It is more common in boys than girls and more common in Afro-Caribbeans than Caucasians
Clinical Presentation
Clinically patients present with hip pain progressing to a limp and even leg length discrepancy.
Sacroiliac Joint Pain and Dysfunction
What are the sacroiliac (SI) joints?
The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is the triangular-shaped bone in the lower portion of the spine, below the lumbar spine. While most of the bones (vertebrae) of the spine are mobile, the sacrum is made up of five vertebrae that are fused together and do not move. The iliac bones are the two large bones that make up the pelvis. As a result, the SI joints connect the spine to the pelvis. The sacrum and the iliac bones (ileum) are held together by a collection of strong ligaments. There is relatively little motion at the SI joints. There are normally less than 4 degrees of rotation and 2 mm of translation at these joints. Most of the motion in the area of the pelvis occurs either at the hips or the lumbar spine. These joints do need to support the entire weight of the upper body when we are erect, which places a large amount of stress across them. This can lead to wearing of the cartilage of the SI joints and arthritis.
What is sacroiliac joint dysfunction?
There are many different terms for sacroiliac joint problems, including SI joint dysfunction, SI joint syndrome, SI joint strain, and SI joint inflammation. Each of these terms refers to a condition that causes pain in the SI joints from a specific cause.
