What can hurt in the hip area?
The joint is surrounded by powerful muscles and tendons, each of which can become a source of pain. Coxarthrosis is manifested by pain in the groin and limited inward rotation of the hip. Trochanteric bursitis and tendinitis of the gluteus medius muscle give point pain along the outer surface, which makes it difficult to lie on your side. Aseptic necrosis of the femoral head causes rapidly increasing pain in relatively young people. In children and adolescents, hip pain requires special attention.
- Coxarthrosis - osteoarthritis of the hip joint
- Trochanteric bursitis and gluteal tendinopathy
- Aseptic necrosis of the femoral head
- Impingement syndrome and damage to the acetabular labrum
- Hip fracture after a fall
- Referred pain from lumbar disc herniation
- Infectious and reactive arthritis
Risk factors
Coxarthrosis develops faster if the joint is initially formed incorrectly: with dysplasia, previous Perthes disease or after injury. Excess weight and heavy physical labor with lifting loads play a role. Aseptic necrosis most often occurs in people who take glucocorticoids for a long time, abuse alcohol, and have suffered a joint injury. In older people, the most important risk factor for hip fracture is osteoporosis, so identifying and treating it reduces the likelihood of severe consequences of a fall.
- Age over 50
- History of hip dysplasia
- Excess body weight
- Hip injuries and fractures
- Long-term use of glucocorticoids
- Osteoporosis
- Hard physical labor
Symptoms to watch out for
With arthrosis, pain appears at the beginning of movement, subsides when walking and intensifies in the evening. The range of movements is gradually limited: at first it is difficult to turn the leg inward, then to put on a sock and tie the laces. Lameness and shortening of the step appear. With trochanteric bursitis, the pain is strictly local, and the patient accurately shows the painful point. Pain radiating below the knee with numbness is usually associated not with the joint, but with the lumbar spine.
- Pain in the groin extending to the knee
- Starting pain after sitting
- Difficulty putting on shoes and socks
- Lameness and decreased stride length
- Pain on the outer thigh when lying on your side
- Clicking noise when moving the hip
- Limiting inward rotation of the leg
Surveys
The examination includes assessment of gait, leg length and range of motion in the joint. The main method is an x-ray of the pelvis in a direct projection: it shows narrowing of the joint space, osteophytes, dysplasia and changes in the femoral head. Ultrasound clearly shows the trochanteric bursa, tendons and effusion. MRI is necessary if avascular necrosis, acetabular labral injury is suspected, and if x-rays are normal with persistent pain. Blood tests are prescribed if an inflammatory or infectious lesion is suspected.
- Examination with assessment of range of motion
- X-ray of the pelvic bones in direct projection
- Ultrasound of the hip joint and soft tissues
- MRI of the hip joints
- Complete blood count and C-reactive protein
- Densitometry for suspected osteoporosis
- MRI of the lumbar spine for referred pain
Treatment and prevention
For arthrosis, proven benefits include weight loss, regular exercises on the muscles of the thigh and buttocks, and walking with a cane in the opposite hand when pain is severe. Painkillers are used in courses as prescribed by a doctor. Physical therapy and manual techniques relieve symptoms but do not restore cartilage. For trochanteric bursitis, offloading, abductor muscle exercises and sometimes injections help. When the pain persists at rest and at night, and x-rays show severe changes, endoprosthetics is discussed - an operation that reliably restores mobility.
- Weight loss
- Exercises for the gluteal and thigh muscles
- Cane in the hand opposite the affected leg
- Anti-inflammatory drugs as prescribed by a doctor
- Physiotherapy and therapeutic massage
- Prevention of falls and treatment of osteoporosis
- Hip replacement