The hip is another joint in the body that is commonly injured. This can occur at different locations around the hip and from various different causes.
Hip arthritis is a common condition that develops as we age. The hip is a ball-and-socket joint that is important for both weight-bearing and movement. The wear and tear of this joint over decades can ultimately result in the development of arthritis. The pain from arthritis of the hip is normally felt in the groin area. It is usually worth with activity such as walking or standing. The bony osteophytes that develop to protect the joint end up causing pain and reduce the range of motion at the hip. These symptoms will result in decreased function so that you may be limited in your normal activities.
Hip arthritis can be diagnosed with x-ray. X-ray is excellent at evaluating the bones in our bodies. The various stages of arthritis including joint space narrowing (cartilage wearing out), bony osteophytes (new bone), and subcondral cysts (destruction of bone) can all be visualized with x-ray in order to help determine the severity.
Conservative treatment may include physical therapy to help strengthen the muscles that support the joint, ice and medications to reduce pain, and bracing to help stabilize the joint during activity. If these treatments fail to improve the symptoms of arthritis, then steroid injections can be performed for pain relief. Regenerative Medicine using platelet-rich plasma (PRP) and stem cell therapy are newer treatment options that can help heal the arthritis and prevent the need for surgery. If all else fails, surgery may still be required. Knee or hip replacement surgeries are commonly performed for severe, end-stage arthritis that has failed all other treatments.
Greater Trochanteric Bursitis
If your hip pain is located on the outside of your hip, then greater trochanteric bursitis (GTB) is most likely the cause. GTB is caused by inflammation of the bursa and tendons of the muscles of the hip joint. These include the gluteus minimus and medius tendons where they attach onto the bone at the outside of the hip. There will be localized tenderness and pain at this spot on the outside of the hip where the bone can be felt. This pain may also move down into the thigh or leg. Any pressure on this spot will result in pain, so sleeping on the affected side may be difficult.
Normally, there is no imaging required to diagnosis GTB. Sometimes, MRI may be useful to determine if there is any tearing of the tendons that may be causing symptoms beyond just inflammation of the bursa.
Conservative therapy includes physical therapy, ice, and NSAIDs. A steroid injection may also be useful to reduce the pain from the inflamed bursa. If the injury lasts for a long time or comes back on more than one occasion over time, then Regenerative Medicine using platelet-rich plasma (PRP) and stem cell therapy can help to heal the damaged tendons that are the underlying cause of GTB.
The labrum is a ring or band of cartilage that is part of the hip joint. The hip joint has a ball-and-socket structure to it. The labrum fits around the ball like a tight sleeve where it meets the socket of the joint. This helps to stabilize the joint so it does not dislocate out of place.
Injury to the hip joint can result in damage to the labrum. This will result in an unstable joint that can cause pain, especially with movement. The labrum can tear from a traumatic injury or it can wear out over time from overuse and cause degenerative tearing.
A labral tear requires an MRI to diagnose it. Often, a special type of MRI called an arthrogram is even necessary. The arthrogram includes contrast in order to help see deeper into the joint where the labrum is located. Ultrasound is not as useful for diagnosing labral tears due to the depth of the injury.
If conservative treatment fails with physical therapy and NSAIDs, then arthroscopic surgery should be considered. If you are a more active individual, you may also want to consider surgery sooner. In cases where you would like to avoid surgery or surgery has failed then you can try Regenerative Medicine with either Platelet-Rich Plasma (PRP) or Stem Cell Therapy to help heal the damaged labrum.
Sacroiliac Joint Dysfunction
Pain in the back of the hip is commonly caused by sacroiliac joint (SIJ) dysfunction. This joint is located on each side of our lower back where our sacrum (also known as tailbone or sit bone), meets the back of our hip bone, or ileium. The joint that forms here can become irritated due to instability of the ligaments that surround the joint which can lead to inflammation and pain. Sometimes the joint can also get locked into or stuck in place which will lead to pain. In rare cases, the joint can become severely arthritic. Typically this type of hip pain presents as pain on the back side of your hip in your lower back area. In this case, the pain can also move all the way down your thigh to your knee and mimic “sciatica”. Normally this condition can be diagnosed without any imaging. It is often treated with physical therapy and NSAIDs initially, but if these treatments aren’t helpful then a steroid injection at the site of the SIJ on the affected side can be very useful in reducing your pain and getting you moving like normal again.