So When Your Hip Hurts, What's Going on and What Do You Do?

There are many different causes of hip pain. And among the various problems requiring arthritis treatment, this ranks near the top.

This article will discuss the three most common types.

Osteoarthritis... the major culprit

The first is osteoarthritis. Osteoarthritis is a disease of cartilage, the gristle that caps the ends of long bones, and which cushions joints to allow gliding. When cartilage wears away, in other words, deteriorates, it causes the bones in the hip to rub against each other.

The pain of osteoarthritis is generally felt in the groin. It also may be felt in the buttocks. Patients may have difficulty getting their shoes and socks on and off the affected foot. Getting in and out of a chair may be difficult. Going up and down stairs may also be a problem.

On examination range of motion of the hip is abnormal. In particular, internal rotation tends to be affected early.

If osteoarthritis of the hip is suspected, the doctor will often order x-rays. The x-rays will show narrowing of the joint space as well as bone spurs and cysts in the bones next to the joint.

The treatment will vary depending on the extent of symptoms. Patients may respond to non-steroidal anti-inflammatory drugs, physical therapy, intra-articular steroid injections, and stretching exercises.

While patients may eventually require total joint replacement, if the arthritis is not that severe, a stem cell procedure may be considered.

Hip tendonitis... a major player

Another cause of hip pain is tendinitis. Tendinitis causes inflammation in the tough fibrous band that connects bones to muscles. The most common cause of tendinitis is overuse.

There are many different tendons in the hip region. The tendons in the front of the hip, if affected, will cause pain in the groin. This is particularly evident when a patient climbs stairs or gets up from the chair.

Tendinitis on the outside of the hip will cause pain with stair climbing. Also, the patient may experience discomfort at night if they try to lie on the affected hip.

Tendinitis involving the hamstring tendons in the hip may cause pain in the buttocks with walking or running.

The diagnosis is suspected by history and confirmed by physical examination. Magnetic resonance imaging (MRI) may be needed to confirm the extent of damage.

The treatment of choice is rest, anti-inflammatory medications, and physical therapy, early on.
Sometimes, steroid injections are required for acute problems.

For more chronic tendon problems, a percutaneous needle tenotomy using ultrasound guidance followed by platelet rich plasma (PRP) is generally advised. Surgery is rarely required.

Last... but not least

The final common problem that may affect the hip is bursitis. Bursitis is inflammation of the bursae, the small sacks of fluid that cushion bones and tendons.

The pain is felt along the outside of the hip. It is extremely painful when examined.

Treatment involves anti-inflammatory medications, ice, physical therapy, and stretching.

If non-steroidal anti-inflammatory drugs are ineffective, steroid injection may be required.

Again, this is a situation where percutaneous needle tenotomy with platelet rich plasma (PRP) may be needed.

There are obviously other causes of hip pain, but these are the three most common problems requiring specific arthritis treatment.