Robert J. Snyder, MD
I’ve been an Orthopaedic physician for many years and have treated more patients for hip pain than I can count. There are the usual suspects that I see regularly, patients who have osteoarthritis, rheumatoid arthritis, avascular necrosis and those who have fractured their hip. Almost all of these patients will have to have their hip replaced, either sooner or later, it’s simply a matter of time.
However, there are another group of hip conditions that aren’t quite as flashy and don’t get as much attention, but they can be just as painful and may develop into chronic issues. In this article, I’m going to discuss these three hip problems, common causes and how they are treated.
Hip Bursitis – Hip bursitis involves inflammation of the bursae, small fluid-filled sacs that cushion the hip joint. Many people often think that bursitis is confined to the elbow or shoulder, but the hip is a common site for this malady, especially for women.
Common causes include repetitive activities that overwork or irritate the hip joint, direct trauma, and underlying conditions, like rheumatoid arthritis. Repetitive activities, overuse, and trauma can also cause bursitis. However, for some folks is a lack of stretching can be the instigator.
Symptoms – Sharp pain at the point of the hip, which may extend to the outside of the thigh, especially when touched. Worse with activity and when lying on the affected side, often worsening with prolonged standing or climbing stairs. Swelling and tenderness might also be seen.
Treatment: Pain and inflammation reduction with rest, intermittent ice, and NSAIDs. Physical therapy exercises can help improve hip strength and flexibility. Oral steroids are commonly ordered. Corticosteroid injections can be administered for stubborn cases. A bursectomy is rarely done but may be if needed for chronicity and severe pain.
Hip Tendinitis – Your hip has quite a few tendons and ligaments that help it move the way it should. Anyone of these can become irritated or inflamed. A few of the more well-known are the ilio-tibial band, the gluteus medius, the hip flexor, and the greater trochanter tendons.
Common causes of hip tendinitis are repetitive strain from overuse, particularly in competitive athletes. However, it can also be caused by connective tissue disorders and seen in those with auto-immune disease.
Symptoms: Tenderness to the touch, pain that increases with movement or activity, and sometimes swelling near the affected tendon.
Treatment: Activity modification and rest, training alteration for athletes, ice, NSAIDs and possibly bracing. Steroids, either oral or injected, especially for athletes who want to return to sport quickly. Physical therapy will be ordered to improve flexibility and strength and for reduction in inflammation. Severe cases might require surgical tendon release.
Hip Labral Tears – Like the shoulder joint, the hip has a rim of cartilage that goes around its socket. Typically, this cartilage rim in the hip is more hearty than the shoulder labrum, but it can be torn through high velocity or impact trauma or overuse.
Common causes include trauma from car accidents and sports injuries, structural abnormalities, or repetitive motions.
Symptoms -pain internally within the hip/groin, stiffness, a clicking or locking sensation, and limited range of motion.
Treatment – Rest, activity modification, NSAIDs, and physical therapy. Arthroscopic surgery may be necessary to repair severe tears or to get injured athletes back on the field competitively in less time. Post-operative physical therapy will be important to ensure recovery of full range-of-motion and strength.