HIP PAIN AND COMMON HIP PROBLEMS

Athletes tend to have fairly specific types of injuries to the hip itself. It’s important to diagnose a hip injury accurately, to maximize outcomes and to decrease time of recovery.  Many issues can be resolved without surgery, however if these become persistent or refractory to non-operative management, occasionally surgeries are necessary.

Tendon Injuries (Avulsion Fractures):

Sometimes, with very ballistic motions in and around the hip, occasionally the tendon can pull off of the bone, taking a small piece of bone with it.  These are called a avulsion fractures.  When this occurs, many times this will heal with a period of rest, rehabilitation, and observation.  If the tendon has pulled far enough away from its origin on the bone, occasionally we will have to repair this.  Younger athletes, those who are still growing, are more at risk for this particular type of injury, because of the relatively softer bone that they have compared to the tendon.  This is very common in ballistic athletes, those who are sprinters or perform a very quick and short motion.

Labral Tears:

The labrum is a structure within the hip joint itself, this is a soft tissue structure which helps to deepen the socket, making it more stable.  At times, in the setting of trauma or wear and tear, this can become damaged or torn.  This can become painful scenario, which can lead to the inability to perform certain activities, or require treatment beyond simply conservative means.

While we are still learning about the labrum and the effects of a labral tear, this can be a very painful scenario, and it can require surgical fixation.  To fix the labrum can require either an arthroscopic or a small open incision to repair the labrum, this can be performed on an outpatient basis, and although the recovery phase will require several weeks of limited weightbearing and therapy, it has been shown to be consistently helpful in terms of returning someone to their previous level of pain-free activity.

Bursitis (Peritrochanteric Pain Syndrome):

Many people have already heard about bursitis.  This is an inflammation of a small sac of fluid, which normally is meant to decrease pain and discomfort around the hip area.  Occasionally, this can become inflamed and painful.  What we have learned, is that bursitis is actually less likely than injury to the gluteus muscles, the muscles on the lateral aspect of the hip.  These muscles are not necessarily torn, however they can be injured, strained, causing pain within the hip area.  Oftentimes this is pain on the lateral aspect of the hip, it becomes painful when you are going from a sitting to a standing position.  It is also painful to sit or lie on that side.  There are also other structures that can become irritated in this setting, including the iliotibial band.  It is important to differentiate which structure is either injured, tight, or otherwise having issues.  Happily, this particular syndrome, is very amenable to physical therapy as well as injections of a steroid (cortisone) to decrease inflammation, and return you to your previous level of function.

Iliopsoas Tendon Injuries:

One of the major tendons that runs across the front of the hip is the iliopsoas tendon.  This is a large muscle which is classified as a hip flexor.  This can be injured in the setting of athletics.  Less commonly, this can be injured in the setting of a total hip arthroplasty, and may require treatment.  This can cause even a loud snapping sound, if injured.  Many times, we can treat this nonoperatively, and the use of physical therapy and anti-inflammatories as essential in the treatment of this.  There are advanced surgical options should this become a persistent issue, will make that determination based on the origin of your injury.

Sacroiliitis:

Injury or irritation of the sacroiliac joint (the joint that joins the pelvis to the sacrum) can be called sacroiliitis.  There can be an injury that initiates this, or there can be arthritis of that joint itself.  This is amenable to many forms of nonoperative management, including injections very specifically into that joint and other modalities.  If this becomes severe or unmanageable by nonoperative means, there are surgeries which can be performed that we will decrease motion to that area (fusion) to decrease pain.

Piriformis Syndrome:

One of the small muscles in the back of the hip, the piriformis, has been known to cause issues within the hip area, and can secondarily cause issues with the sciatic nerve.  It is important to differentiate this, versus a low back issue which can also injure the sciatic nerve.  The symptoms of this are buttock pain, pain with sitting or certain activities.  This can cause symptoms which radiate down the leg.  It will be important to perform a physical exam to differentiate this versus other forms of muscular or nerve injury

Certain injuries or conditions can cause hip pain.

Inflamed tendons

The most common cause of acute hip pain is inflamed tendons, or tendonitis. This is often due to too much exercise. This condition can be very painful, but it usually heals within a few days.

Arthritis

The most common cause of long-term hip pain is arthritis. Arthritis can cause pain, stiff and tender joints, and difficulty walking. There are various types of arthritis:

• Osteoarthritis (OA) can be the result of age-related wearing down of the cartilage that surrounds the joints.
• Trauma to a joint, like a fracture, may cause traumatic arthritis like osteoarthritis.
• Infectious arthritis is due to an infection in the joint causing the destruction of cartilage.
• Rheumatoid arthritis (RA) is due to the body’s immune system launching an attack on the joints. This type of arthritis may eventually destroy joint cartilage and bones.

Osteoarthritis is much more common than rheumatoid arthritis.

Trochanteric bursitis

Another possible cause of hip pain is trochanteric bursitis. This condition occurs when the bursa, which is a liquid-filled sac near the hip joint, becomes inflamed.

A number of factors can cause trochanteric bursitis, including hip injury, overuse of the joints or posture problems.

Other conditions such as RA can also cause hip pain. This condition is much more common in women than in men.

Hip fractures

Hip fractures are common in older adults and in those who have osteoporosis, which is a weakening of the bones due to age or other factors.

Hip fractures cause very sudden, severe hip pain, and they require immediate medical attention. There are complications that can arise from a fractured hip, such as a blood clot in the leg.

A hip fracture usually requires surgery to be corrected. You’ll most likely need to have physical therapy to recover.

There are other, less common conditions that can cause hip pain. These include snapping hip syndrome and osteonecrosis, or avascular necrosis.

Snapping hip syndrome

Snapping hip syndrome, which most commonly occurs in dancers or athletes, is characterized by a snapping sound or feeling in the hip.

This snapping may occur when you’re walking or getting up out of a chair, for example. The condition is usually painless, but can cause pain in some cases.

Snapping hip with pain is usually a sign of cartilage tear or fragments of material in the hip.

Osteonecrosis

Osteonecrosis, or avascular necrosis, occurs when blood doesn’t reach the bones, either temporarily or permanently. This can lead to the loss of the supporting bone.

In this condition, the cartilage is normal initially but will eventually collapse as it progresses. Eventually, bones may break or crumple. It’s not always clear what causes osteonecrosis.

Joint injury, heavy use of steroid medications or alcohol, and cancer treatments may put you at greater risk for this condition. But in many cases, the cause is never determined.

Contact Dr. Collins if you have hip pain that lasts longer than a few days. They can come up with a plan to manage pain and treat your condition.

However, you should seek immediate medical attention the hip is bleeding or you can see exposed bone or muscle, a popping noise occurs, or you can’t bear weight.

Also, seek immediate help if your hip joint appears deformed or is swollen, or if you have severe pain.

Prompt medical attention is necessary for hip pain accompanied by any of the following:

• swelling
• tenderness
• soreness
• warmth
• redness

These may be signs of serious conditions, including septic arthritis, which is a joint infection. If it’s left untreated, septic arthritis can lead to deformed joints and osteoarthritis.

For pain that could be related to a condition such as arthritis, Dr. Collins will ask you a range of questions, including:

• Is the pain worse at a time of day?
• Does it affect your ability to walk?
• When did your symptoms first appear?

You may need to walk around to let Dr. Collins observe the joint in motion. They’ll measure the motion in the normal and abnormal hip and compare the two.

To diagnose arthritis, Dr. Collins will perform fluid and imaging tests. Fluid tests involve taking samples of blood, urine, and joint fluid for testing in a laboratory. Imaging tests may include:

• X-rays
• CT scans
• MRI scans
• ultrasounds

Imaging tests will provide Dr. Collins with detailed views of your bones, cartilage, and other tissues.