Hip pain can be due to a number of conditions, including gluteus medius tendonitis, trochanteritis, hip arthrosis (or coxarthrosis) and hip fracture.
Hip pain may be felt in the groin or just below the side on the outside of the thigh; moreover, coxalgia is often accompanied by other symptoms, including, for example, lameness, a sense of joint stiffness, soreness, local redness and swelling.
Identifying the precise origin of hip pain through a scrupulous diagnostic investigation is very important, because the most appropriate treatment is based on the causes.
, the hip is the important equal joint of the human body that joins the lower limb to the trunk.
In fact, it has as protagonists the head of the femur, the femur which is the bone of the thigh, and the acetabulum, which instead is a deep bone cavity belonging to the iliac bone (of the pelvis).
The head of the femur is an almost spherical bony protuberance, with a medial and slightly anterior orientation, which fits perfectly inside the acetabulum, which, as anticipated, is a cavity of the iliac bone.
Thanks to the combination of the femoral head and the acetabulum, the hip is a mobile and, at the same time, stable joint.
Elements such as the joint capsule, synovium, synovial bags, ligaments and the complex of muscles and tendons that contribute to joint mobility complete the anatomy of the hip.
;Tendonitis of the gluteus medius muscle
Tendonitis of the gluteus medius is often a functional overload disease related to excess exercise.
Tendonitis of the gluteus medius mainly affects people engaged in sports in which the involvement of the lower limbs is high, such as running, cycling and swimming.
Tendonitis of the gluteus medius muscle is associated with coxalgia because the tendon of insertion of this muscle passes near the hip joint, hooking itself to the greater trochanter, just below the head of the femur.
Osteoarthritis of the Hip
Also known as coxarthrosis, hip osteoarthritis is a chronic inflammatory condition characterized by the progressive degeneration of the articular cartilages that cover the femoral head and acetabulum.
Articular cartilage degeneration means thinning of the cartilage layer that protects the underlying bone; with the thinning of this cartilage, the underlying bone is more affected by the intimate relationship between the joint surfaces, until it becomes inflamed and painful.
In the long term, then, coxarthrosis could induce, around the joint, the growth of osteophytes, that is small bone growths; osteophytes compromise joint functionality and could damage other components of the joint itself.
Numerous factors may favor hip arthrosis, including: aging, sedentary lifestyle, a past fracture or bone infection, congenital joint abnormalities, overweight or obesity, and osteonecrosis.
For further information: Coxarthrosis or Arthrosis of the HipTrochanteritis
Also known as trochanteric bursitis, trochanteritis is inflammation of the synovial bursa over the greater trochanter of the femur; the greater trochanter is a lateral bony prominence of the femur, located just below the head (of the femur), on which they insert the tendons of some muscles involved in the movement of the hip and thigh.
Responsible for hip pain at night, trochanteritis can be the result of:
- Trauma from a fall or impact;
- Bruises in sports;
- Sports activities, such as running, cycling or swimming, which repeatedly strain the muscles with tendon insertions on the greater trochanter (ex: gluteus minimus, gluteus medius, piriformis).
Furthermore, trochanteritis can also be observed in those who spend a lot of time lying on their side on a rigid surface.
For further information: Trochanteritis: Causes, Symptoms and TherapyFracture of the Hip
The hip fracture is a serious injury that can occur as a result of falls to the ground, traffic accidents, direct hits to the side or sports injuries.
The hip fracture mainly affects people with osteoporosis, which means that it mostly affects older people.
Other Causes of Hip Pain
Other causes of hip pain are:
- Rheumatoid arthritis. An example of a systemic pathology that can cause coxalgia, rheumatoid arthritis is a chronic autoimmune disease, which mainly affects the joints, first inflaming the synovial membrane and subsequently affecting the surfaces and articular cartilages.
- Septic arthritis. It is an inflammatory process affecting a "joint, supported by a" generally bacterial infection.
- The lesion of the acetabular labrum. The acetabular labrum is a ring of fibrocartilage that surrounds the circular perimeter of the acetabulum, favoring the relationship between the latter and the head of the femur.
A lesion of the acetabular labrum can be traumatic injuries, structural alterations, degenerative processes, etc. - The femoroacetabular conflict. Also known as impingement femoro-acetabular, is a painful syndrome due to a "structural anomaly of one between the acetabulum and the head of the femur, or both; this anomaly causes an anomalous contact between the same parts, which end up being damaged or to damage other joint components ( ex: acetabular lip).
In addition, other other causes of hip pain are also:
- L "osteonecrosis;
- L "osteomyelitis;
- Ileo-psoas bursitis;
- Sciatica
- The paresthetic meralgia.
Causes of Hip Pain in Young People
In younger people, hip pain is generally related to two conditions: hip dysplasia, which is a congenital disease, or juvenile idiopathic arthritis, which is also known as juvenile rheumatoid arthritis.
Hip dysplasia
Hip dysplasia is a congenital condition characterized by a malformation of the acetabulum, which cannot keep the head of the femur firmly inside.
Hip dysplasia is the result of an anomaly in fetal development.
This condition increases the risk of hip dislocation.
Hip pain: who is most at risk
Hip pain risk factors include:
- The advanced age;
- Excess weight (overweight or obesity);
- The sedentary lifestyle;
- L "osteoporosis;
- Contact sports (eg rugby, football, etc.);
- Sports activities such as running, swimming or cycling without adequate preparation.
Complications
When the cause is a clinically relevant condition (eg: osteoarthritis or fracture) or when treatment is not appropriate, hip pain can become an extremely debilitating symptom, which prevents the patient from carrying out the most mundane daily activities (eg: climbing stairs).
Hip pain: when to see a doctor?
Hip pain is a symptom that should worry and lead sufferers to see a doctor when:
- It has been running for several days;
- Despite the rest and the application of ice, it persists and shows no signs of improving;
- It follows a fall or a collision at the level of the side;
- It is associated with symptoms such as joint stiffness, reduced joint mobility and / or local swelling;
- It causes difficulty walking, climbing stairs, or leaning forward from a seated position.
Physical examination and anamnesis
The physical examination and anamnesis provide important information on the characteristics of the painful sensation (location, intensity, etc.), on the modalities of onset (what triggered it) and on the risk factors (the patient is elderly; suffers from osteoporosis; practice) sporting activity etc.).
The physical examination, in particular, could include a series of diagnostic maneuvers on the painful limb, which help to establish whether the symptoms are related to joint dysfunction.
Diagnostic for Images
Diagnostic imaging, on the other hand, allows to evaluate the state of health of the hip joint and of the muscle-tendon elements that interact with it.
From the information provided by diagnostic imaging, it is possible to precisely identify the causes of hip pain.
Imaging tests commonly used in hip pain assessment include:
- X-ray;
- Magnetic resonance;
- Ultrasound;
- CT scan.
Blood tests
Blood tests are part of the diagnostic process when the doctor believes that the pain in the hip may be due to a bone or joint infection, or to rheumatoid arthritis.
hip varies according to the triggering cause; from this it is easy to deduce how important it is to trace the origin of the disorder through an accurate diagnosis and the consultation of an expert.
For some conditions responsible for hip pain, a combined conservative therapeutic approach is sufficient; for others, surgery is essential; for still others, depending on the severity of the symptoms, there is a choice between conservative treatment and surgical therapy.
Hip pains due to infections or systemic pathologies (eg rheumatoid arthritis) have been deliberately excluded from the previous series; for these conditions a specific causal intervention is required, which this article will not discuss, except however, to indicate to the reader more details about it.
Conservative Therapies for Hip Pain
The most classic conservative treatments for hip pain include:
- Rest from all those activities that evoke pain;
- Physiotherapy based on joint mobility exercises and strengthening exercises e stretching of the hip muscles;
- Taking a non-steroidal anti-inflammatory drug (NSAID) to counter pain and relieve inflammation;
- Applying ice to the painful area.
To these remedies, depending on the triggering cause, the doctor may add others.
For example, in the presence of mild to moderate "osteoarthritis of the hip", weight control is also indicated, as conditions such as overweight and obesity could fuel the painful sensation as well as worsen the disease.
Conservative Treatment: When is it needed?
Causes of hip pain that also benefit from a conservative therapeutic approach are:
- The trochanteritis;
- The mild to moderate arthrosis of the hip;
- The femoroacetabular impingement at an early stage;
- Tendonitis of the gluteus medius.
Hip Pain Surgery
Generally speaking, surgical treatment is essential when the hip joint has severe structural damage, which compromises its correct functionality.
In reality, however, surgery could also be useful in the presence of conditions that are not particularly serious, but which have proved resistant to conservative remedies (in such circumstances, to resort to surgery, it is necessary that the symptoms have been in place for a long time and that no others remain alternatives).
The exploitable surgical techniques are arthroscopy and open arthroplasty; these techniques have different indications and differ in the degree of invasiveness (the second is much more invasive than the first).
Surgery: When is it needed?
Conditions such as:
- Advanced femoroacetabular conflict, characterized by lesions to the acetabular labrum and / or articular cartilage;
- Advanced arthrosis of the hip;
- Lesion of the acetabular labrum;
- Fracture of the hip.
It should be noted that, if persistent, trochanteritis may also require surgery, in this case a bursectomy (removal of the synovial bursa).
