Causes and Treatment of Hip Pain
The hip is the body’s largest ball-and-socket joint, and it is designed to withstand extensive wear and tear as well as a wide range of repeated motions. Still, while the hip is an incredibly durable joint, age, use, and injury can all cause cartilage damage, overuse of muscles and tendons, broken hip bones, and other sources of hip pain. Below are some of the most common causes of hip pain our specialists at Beacon Orthopaedics see.
Arthritis
The most common form of arthritis to impact the hips is osteoarthritis, which happens when the protective cartilage at the end of the hip bone gradually wears down. This can cause pain, stiffness, tenderness, loss of flexibility, a feeling of grating at the nerve, bone spurs, and inflammation. Osteoarthritis can often be treated with over-the-counter or prescription medications and physical or occupational therapy. Cortisone injections may also be helpful. In some cases, the best treatment for hip osteoarthritis is an osteotomy (surgical realignment of the bones) or a total hip replacement.
Inflammatory arthritis is triggered by an overactive immune system that attacks otherwise healthy tissues.The most common forms of inflammatory arthritis to impact the hip joint include rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. These are chronic conditions for which there is no cure, but proper diagnosis and treatment can help patients maintain comfort, function, and mobility and prevent serious damage to the joint.
Inflammatory arthritis of the hip often presents as a dull or aching pain in the buttocks, groin, outer thigh, or knee. The pain is usually at its worst after a person has been sitting or inactive for a while, but may also increase with strenuous activity. Non-surgical treatment for these forms of arthritis includes corticosteroid medications or injections, over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs), regular activity, and physical therapy. In some cases, a total hip replacement is necessary to restore function to an arthritic hip.1
Femoroacetabular Impingement (FAI)
Femoroacetabular impingement (FAI) occurs when extra bone (bone spurs) grows along a bone or bones in the hip joint. This causes the bones to be irregular in shape, preventing them from fitting together as they should. FAI can cause pain, joint damage, and limited activity. Eventually, FAI may result in osteoarthritis or labral tears. While over-the-counter medications may ease discomfort caused by FAI, it is necessary to properly treat this condition in order to prevent further hip damage. Treatment may include changes in activity and physical therapy or surgical interventions.2
Hip Labral Tears
The labrum is the ring of cartilage that cushions the outer rim of the hip joint. In addition to cushioning the hip, the labrum also helps to hold the “ball” portion of the joint securely in the hip socket. Labral tears are most frequently suffered by athletes, which may cause hip or groin pain, locking or clicking of the hip joint, or limited range of motion. This injury may be treated with anesthetic injections, but in some cases surgery may need to be performed to repair the torn labrum.
Bursitis
Bursae are small fluid-filled sacs that lie between bones and soft tissues to cushion them from friction. Bursitis is a condition caused by inflammation of these sacs, and hip bursitis may cause pain in the hip that extends to the thigh or in the groin. Hip bursitis may result from an injury, repetitive overuse, rheumatoid arthritis, bone spurs, or spinal conditions like scoliosis. In some cases, reducing activity, physical therapy, steroid injections, and the use of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can alleviate the pain of hip bursitis. In very rare cases, inflamed bursae may need to be surgically removed.3
Tendinitis
The tendons connect the bones of the hip to surrounding muscles. When tendons or the sheaths that cover them become irritated or inflamed, the condition is called tendinitis. This is often caused by repeated aggravation of the tendon, and is common in athletes. Tendinitis can cause inflammation and pain that usually gets worse with activity. Treatment for tendinitis may include rest, anti-inflammatory medications, immobilizing the tendon, steroid injections, and physical therapy.4
Avascular Necrosis or Osteonecrosis
Avascular necrosis (or osteonecrosis) is a result of a disruption of the blood supply to the head of the thigh bone (femur). This condition may also be referred to as aseptic necrosis, and while it can occur in any bone, the hip is most commonly affected. Osteonecrosis of the hip can eventually cause the top of the femur to die and collapse. Next, the cartilage that covers the hip bone can also collapse. Common causes of hip osteonecrosis include injuries, excessive alcohol use, overuse of corticosteroid medications, and certain medical conditions. What begins with dull, throbbing pain in the buttock or groin can develop to the point that moving the hip joint or putting any weight on the hip is very painful. When caught early, the pain of hip osteonecrosis is most effectively treated. As this condition progresses, however, surgical treatment becomes necessary.5
Muscle or Tendon Strains
Hip strains happen when a muscle that supports the hip joint or a tendon that connects muscles to the hip bones becomes torn or overstretched. Strains can vary in severity from a minor stretch to a complete tear and could be caused by overuse or an acute injury.
Symptoms of a hip muscle or tendon sprain may include pain or soreness, swelling, weakness, and a limited range of motion. In many cases, resting, icing, and elevating the affected area can alleviate pain from a strain and help it to heal. Heat and physical therapy can also be helpful. For more severe strains, surgery may be needed to restore normal function.6
Contusions (Hip Pointer)
A hip pointer is a contusion, or bruise, over the front or top of the hip bone. This is most often caused by a direct blow suffered during a contact sport, a fall, or a crash. A hip pointer causes pain, tenderness, and often (but not always) the appearance of bruising on the skin. The best treatment for a hip pointer is to take weight off the hip, ice it, and elevate the hip to alleviate pressure and swelling. In some cases, physical therapy may be necessary for a total recovery.
Hip dislocation may be common in babies and young children born with developmental dysplasia of the hip (DDH), a condition where the joint of the hip is not properly formed.
This could be a genetic condition, the result of complications during pregnancy, the result of a breech birth, or other factors, and it can often be corrected with the use of a harness or brace. In some cases, surgery may be necessary.7
Pinched Nerves or Nerve Injuries
The nerves carry messages between the brain and the rest of the body. There are motor nerves, which make the body move, and sensory nerves, which are responsible for sensations like temperature, pressure, and pain. If a nerve becomes stretched, broken, pinched, or cut, the result can be pain, inflammation, numbness, and decreased mobility. A serious hip nerve injury may require surgical treatment.8
A common source of nerve pain in the hip is sciatica, which causes pain from the lower back through the hip and down the leg. Sacroiliitis and meralgia paresthetica (damage to a nerve in the thigh) are also nerve injuries that may cause hip pain. These conditions are usually treated non-surgically.
Cancers
Bone cancers such as chondrosarcoma, Ewing sarcoma, and osteosarcoma may cause pain, swelling, tenderness, weakness, fractures, and other symptoms. Other forms of cancer that may impact the hip include cancers of the bone marrow, soft tissue, and cartilage. Depending on the type and extent of cancer impacting a patient’s hip, our doctors can recommend a range of treatments.
Hip Fractures
There are a number of fractures that can affect the hip and cause hip pain. An acetabular fracture is the most rare; it is a break in the socket part of the ball-and-socket joint. This type of fracture is usually caused by a more violent injury source, like a car accident, and usually requires surgical treatment. Breaks of the femur or the femoral head (the “ball” in the joint) are more common and often happen as a result of a fall. Stress fractures, which are thin cracks in the bone, often affect people who engage in regular, high-impact activities such as dancing or distance running.9
Dislocation
Hip dislocation is a painful injury that happens when the end of the hip bone is forced from its normal position in the ball-and-socket joint. This injury sometimes happens during contact sports and sports where falling is common, like skiing and gymnastics. Hip dislocation may also result from car accidents or falls.10
Find Relief from Hip Pain
If a hip injury or condition has caused you to suffer pain or decreased mobility, the orthopaedic surgeons and sports medicine specialists at Beacon Orthopaedics are here to help. Please contact us to schedule a consultation with a specialist who has dedicated his or her career to treating hip patients like you.
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1 The American Academy of Orthopaedic Surgeons. Inflammatory arthritis of the hip. Available: https://orthoinfo.aaos.org/en/diseases–conditions/inflammatory-arthritis-of-the-hip/. Accessed April 21, 2021.
2 The American Academy of Orthopaedic Surgeons. Femoroacetabular impingement. Available: https://orthoinfo.aaos.org/en/diseases–conditions/femoroacetabular-impingement/. Accessed April 21, 2021.
3The American Academy of Orthopaedic Surgeons. Hip bursitis. Available: https://orthoinfo.aaos.org/en/diseases–conditions/hip-bursitis/. Accessed April 21, 2021.
4The American Academy of Orthopaedic Surgeons. Sprains, strains, and other soft-tissue injuries. Available: https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/. Accessed April 21, 2021.
5 The American Academy of Orthopaedic Surgeons. Osteonecrosis of the hip. Available: https://orthoinfo.aaos.org/en/diseases–conditions/osteonecrosis-of-the-hip/. Accessed April 21, 2021.
6 The American Academy of Orthopaedic Surgeons. Hip strains. Available: https://orthoinfo.aaos.org/en/diseases–conditions/hip-strains/. Accessed April 21, 2021.
7The American Academy of Orthopaedic Surgeons. Developmental dislocation (dysplasia) of the hip (DDH). Available: https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/. Accessed April 21, 2021.
8 The American Academy of Orthopaedic Surgeons. Nerve injuries. Available: https://orthoinfo.aaos.org/en/diseases–conditions/nerve-injuries/. Accessed April 21, 2021.
9 The American Academy of Orthopaedic Surgeons. Acetabular fractures. Available: https://orthoinfo.aaos.org/en/diseases–conditions/acetabular-fractures/. Accessed April 21, 2021.
10The American Academy of Orthopaedic Surgeons. Hip dislocation. Available: https://orthoinfo.aaos.org/en/diseases–conditions/hip-dislocation/. Accessed April 21, 2021.