The Hip
The hip is a pivotal ball and socket joint in the human body. This joint is where the pelvis comes in contact with the lower extremity. The hip is made for stability and weight bearing. Due to the protected location and overall stability, this joint is typically injured less than the knee or shoulder. However, the hip can still be predisposed to acute or chronic injury.
If you’re experiencing hip pain, call the office in San Francisco or book an appointment online to get started.
Hip Anatomy
Your hip consists of one major joint called the femoroacetabular joint. This is a stable ball and socket joint that is similar to the shoulder but made for less mobility. The acetabulum is the deep socket portion of the joint that is attached to the pelvis. The socket is deepened by a cartilage structure known as the labrum that helps provide additional support.
The hip joint is surrounded by musculature that helps move the hip and lower extremity. These muscles include the gluteus muscles, hip adductors and abductors, hip flexors also known as the quadricep muscles, and the hamstrings. The hip is in a crucial location of the body that is intertwined with the low back and pelvis. Any injury to any of these structures may present as hip pain and thus must be evaluated thoughtfully.
What causes hip pain?
There are many causes of hip pain. Some of the most common are damage to the cartilage of the hip leading to arthritis, tears of the labrum caused by impingement, inflammation known as hip trochanteric bursitis, or muscular or tendon related injuries. Acute fractures or stress fractures to the hip or pelvis can also occur, but are much less common. Pain from these injuries can be experienced in various locations, including on the lateral hip, groin area, or near the posterior gluteus muscles depending on the cause of your symptoms.
Common Conditions
+ Arthritis
Osteoarthritis is a common type of hip pain, specifically in an older population. Osteoarthritis leads to a loss of cartilage in your joint. This is usually caused by age, prior injury, as well as wear and tear from activity and work. Symptoms usually begin very gradually with only a slight increase in pain or subtle loss of motion in the hip. Sometimes an unrelated injury in the hip can make underlying arthritis suddenly symptomatic. These symptoms tend to worsen over time, especially as you get older. More severe arthritis can be associated with significant loss of motion as well and pain with walking or certain activities.
Hip arthritis is diagnosed primarily on X-ray, as this best shows the extent to which your joint has worn out. Once diagnosed, treatment for arthritis depends on its severity. For more mild cases preservation of range of motion and activity with physical therapy is very helpful. Significant flares of pain can sometimes also be controlled with cortisone injections. In severe cases, hip replacement can be a very effective option for restoring full range of motion and eliminating pain.
+ Fractures
Fractures in the hip joint are typically rare and are treated quite seriously. The hip joint is one of the most stable joints in the body and so it often takes a high impact injury for a fracture to occur, specifically in a younger person. Fractures can result from a fall, high energy accidents or contact sports. Less commonly, a stress fracture can occur from repetitive use. In the hip region the most common fractures are to the upper portion of the femur (femoral neck), or to the pelvis.
All of these injuries should be first evaluated by a medical provider. The extent of the fracture can be evaluated on X-ray. Once the positioning and extent of the fracture are understood, a treatment plan can be put into place. Non-surgical treatment can involve non-weightbearing on crutches for a period of time while the break heals. Surgical treatment will often involve placing a combination of plates and screws at the site of the fracture in order to stabilize the bone and allow for good future outcomes and function.
+ Trochanteric bursitis
Trochanteric bursitis is a condition characterized by inflammation of the bursa on the side of the hip. The bursa is a fluid filled sac that sits on the side of the femur bone. The bursa can get irritated by repetitive use when the IT band is tracking over the bursa. This typically occurs as point tenderness on the lateral side of the hip that is noticeable with activity. A diagnosis is made by a physical exam. Once diagnosed, treatment includes anti-inflammatories, rest from repetitive activity, physical therapy stretches, and, occasionally, a corticosteroid injection into the bursa.
+ FAI - Labral Tear
Labral tears are a common cause of hip pain in all age groups. The labrum is the cartilage bumper that sits between the femoral head and the acetabulum. Labral tears can be caused by degeneration, acute or repetitive trauma, or by something called femoroacetabular impingement (FAI). FAI is an anatomical variant that causes abnormal contact between the femur and acetabulum that over time can wear down the cartilage.
Labral tears are characterized by a vague groin or hip pain that can worsen with activity and cause a snapping sensation. Official diagnosis of a labral tear typically comes from an MRI, but a physical exam and x-ray can also give the provider a good sense of the condition. Depending on the extent of the tear, treatment begins with physical therapy, anti-inflammatories, and occasionally a steroid injection. In cases where symptoms are not improving, a surgical arthroscopic debridement can be done.
+ Muscle or tendon strain
There are many muscles surrounding the hip that aid in lower leg function and strength. These muscles include the quadriceps, hamstrings, gluteus muscles and others. Injuries to these tendons and muscles can vary from simple tendonitis from overuse to partial or full tears from an acute injury. Symptoms of tendonitis include pain at the site of the muscle that's worse with activity or walking. Strains or tears to the muscles usually come after an immediate injury and vary in severity from mild pain at the site to swelling, bruising, and weakness in the area. Most muscle strains or partial tears are treated with physical therapy and rest. Depending on the extent of the tear and a patient's age, full tears may require surgical fixation to prevent long-term weakness.
Treatment
At Urgently Ortho, we customize a treatment plan to meet your individual needs. In the hip, some of the most common treatments can include different types of injections, use of anti-inflammatories, physical therapy, or rest and non-weight bearing in crutches. For some conditions, surgery is indicated as the best option. The team at Urgently Ortho can help refer you to the proper surgeon if a hip specialist is needed.
Ephraim Dickinson, MD and Breiana Brady, PA-C at Urgently Ortho have extensive experience treating your hip pain and providing therapies to prevent future problems and to keep you active and healthy. Don’t continue to suffer from hip pain or immobility. If you have questions about hip pain, call Urgently Ortho in San Francisco or use the online booking tool to schedule an appointment today.