Hips

Although the hip joint is durable, it isn't indestructible. Age, wear and tear, fractures and a number of medical conditions can cause hip pain. 

hip movement

The hip joint

The hip joint is ball and socket joint formed by the end of the femur bone (the ball) and the pelvic bones (the socket).

But the hip joint is much more than just bones. Your hips also have:

  • thick cartilage cushions covering the surfaces of the bones
  • joint fluid
  • muscles and tendons that help hold the joint together (and let you move)
  • tissue sacs (called bursae)
  • nerves and blood vessels.

Things can go wrong with any these parts of the hip and cause you to feel hip pain.

Where, when and how the pain occurs (pain patterns) points to the cause of your hip problem. So, expect to be asked 'Where does it hurt?' and 'When does it hurt the most?'

Once we know the cause of your pain, we can tailor the best solution for you.

 

Hip pain patterns

Pain at the front of the hip or in the groin

Pain here suggests a problem with the hip joint itself.

Osteoarthritis is the most common joint problem. It tends to have a gradual onset of pain. 

Pain that occurs suddenly suggests other causes. These include osteonecrosis, occult fracture (eg following trauma), acute synovitis or joint infection.

Pain over the outside of your upper thigh

Pain in this area that's worse with direct pressure (eg pressing with your hand or pressing against a mattress) is commonly due to trochanteric pain syndrome. This is caused by inflammation or injury to tissues over the bony prominence at the top of the thigh bone.

If you have pain of your outer thigh that would describe as burning, numbness, or tingling, you might have meralgia paresthetica. This is due to the nerve entrapment.

Pain at the back of the hip

This is the least common pain pattern affecting the hip.

It is most often a sign of sacroiliac joint disease, lumbar radiculopathy, herpes zoster, or an unusual presentation of the hip joint.

Because it is less common, you might need extensive examination and radiographic testing of the back and hip to find the cause.

Hip conditions

Click on the condition to read more.

+ Hip osteoathritis

This is a loss the cartilage cushion covering the surface of the hip joint bones. It's a progressive 'wear and tear' condition and usually affects people over 40 years of age. As the cartilage is worn away, you end up with a 'bone on bone' situation, which is very painful.

The key symptom is pain that is worse with activity and relieved by rest. As the disease progresses, pain may occur with less and less activity, and eventually occurring at rest and at night.

Other key clinical features suggestive of osteoarthritis include:

  • groin pain aggravated by movement rather than by direct pressure
  • pain on internal rotation
  • morning stiffness (less than 30 to 60 minutes)
  • reduced range of movement.

Replacing the worn away tissue with a synthetic prosthesis is the definitive treatment.

+ Trochanteric pain syndrome

This is caused by inflammation or injury to tissues over the bony prominence (greater trochanter) at the top of the thigh bone (femur). It is one of the most common causes of hip pain.

Sometimes it can occur after a fall/knock to the outside of the hip or after lying on the side of the hip for a long time.

It can also due to a gait abnormality (e.g. stiff low back, leg length discrepancy, knee arthritis, and ankle sprain). The change to gait may create an exaggerated movement of tendons and fascia over the outer femur. This increases friction and pressure over the trochanter.

Sometimes there is no obvious reason for the injury.

+ Osteonecrosis

Osteonecrosis is known by different names: aseptic necrosis, avascular necrosis, ischaemic necrosis and osteochondritis dissecans.

It's due to compromise of the blood supply to the hip, leading to the death of bone and marrow cells. Eventually, the bone crumbles away and the joint is destroyed.

Several conditions and treatments are associated with osteonecrosis. The two most commonly reported are excessive alcohol intake and corticosteroid medication. But how the disorder develops is not fully understood.

+ Occult hip fracture

An occult hip fracture is one where there is a break between the main thigh bone and the ball part of the hip joint but the bones are not separated (ie non-displaced). It can be surprisingly difficult to diagnose.

We suspect occult hip fracture in patients with:

  • severe tenderness at the front/side of the hip
  • severe pain with even partial weight bearing
  • intolerance to passive rotation of the hip.

Sometimes the fracture doesn't show up on X-ray and you might need a CT scan or MRI.

+ Meralgia paresthetica

The lateral femoral cutaneous nerve is susceptible to entrapment. It travels from abdominal cavity into the upper thigh through a small tunnel. There it can be squashed by things such as extra body fat, tight clothing, tool belts and even leaning against a table for long periods.

It's most common in middle age (40–60 years). Symptoms range from numbness and tingling (hypesthesia) to burning pain (paresthesia) over the upper outer thigh.

+ Labral tear

The labrum is part of the socket of the hip joint. It sits around the rim and acts as a fibrous seal of the ball and socket joint.

Tears to the labrum can occur:

  • suddenly (usually in younger people performing athletic activities)
  • slowly (usually in people over 35 years) where the labrum ages and becomes prone to small splits. These can degenerate into a significant tear over time.

The labrum has limited healing capacity, so when tears happen, they often don't repair on their own.

Where the tear is located tends to dicate where you feel the pain. Most tears happen at the front or top of the hip, and most people feel pain at the front of the hip. Occasionally tears can occur at the back and cause pain in the buttocks.

Tears can also cause clicking with some movements. This clicking is usually painful.