HIP INJURIES

Hip Injuries:

The Hip Joint

The hip joint is a “ball and socket” joint located where the thigh bone (femur) meets the pelvic bone. The upper segment (“head”) of the femur is a round ball that fits inside the cavity in the pelvic bone that forms the socket, also known as the acetabulum. The ends of the bone are covered with a smooth, cushioning layer called articular cartilage. The articular cartilage is what allows the bones to glide smoothly. While the cartilage covers the entire head of the femur, the acetabulum cartilage is in the shape of a horseshoe with a depression (fossa) in the center of the socket. This fossa contains soft tissue and a ligament connecting the femoral head to the socket.

 

The socket has a rim of rubbery fibrocartilage called the labrum. The labrum acts as a gasket, sealing in joint fluid and maintaining lubrication and nutrition. In addition, numerous tendons surround the hip, as well as bursae, which are lubrication "cushions" where soft tissues glide over bony prominences.

Many factors can cause hip pain or hip problems that would lead someone to seek medical treatment from an orthopedist. These include abnormal anatomy that a person is born with and conditions that develop during the growth and development of the bones grow in childhood or adolescence. Trauma, as well as the wear and tear that occurs with aging can all lead to progressive arthritic changes. Hip pain in athletes is commonly the result of a muscle strain or tendinitis. The diagnosis and management of hip injuries has evolved substantially with the advancement in diagnostic tools such as magnetic resonance imaging and with new minimally invasive techniques

Arthritis of the Hip

Arthritis is one of the most common causes of pain in the hip. Arthritis is a progressive disorder, which means that it typically starts gradually and gets worse with time. The term arthritis literally means “inflammation of the joint.”

There are different types of arthritis that can affect the hip. The type of arthritis you have may affect your treatment options.

Types of Arthritis

There are five main types of arthritis that can affect the hip joint. They are:

• Osteoarthritis

• Rheumatoid arthritis

• Ankylosing spondylitis

• Systemic lupus erythematosus

• Psoriatic arthritis

 There is no cure for any type of arthritis, but there are ways to treat the pain and other associated symptoms.

 Osteoarthritis

Osteoarthritis means “arthritis of the bone” and is the most common form of arthritis. It is often described as the result of wear and tear on the joints, which explains why it is more common in older than younger people.

 The hip joint consists of the ball-shaped end of the thigh bone (femoral head) which fits into the hip socket (acetabular socket). The inside of this ball-and-socket joint is lined with smooth cartilage to help the joint move easily. If this smooth cartilage wears away, the remaining rough surfaces of the ball-and-socket grind against each other, causing pain. Over time, osteoarthritis can degenerate or permanently damage the joint.

Osteoarthritis of the hip (and other parts of the body) has been associated with the following:

• Structural problems with the hip joint (hip dysplasia, femoroacetabular impingement)

• Advancing age

• Obesity

• Previous damage or injury to the hip

 However, osteoarthritis may develop in people without these risk factors.

 

Figure a

 

  

Figure b

Two radiographs of a female patient showing acetabular dysplasia (a shallow hip socket). The patient started to have hip pain when she was 20 years-old (a). This hip dysplasia was not treated and 15 years later she had end-stage osteoarthritis of the hip (b). Note the complete loss of cartilage joint space between the ball and the socket over this 15-year interval.

Rheumatoid Arthritis

Rheumatoid arthritis is a systemic disorder, that is, it affects your entire body and not just the hip joint. The inflammation is related to an immune system response rather than wear and tear.

The hip joint, like other joints in the body, is protected by a special capsule that completely surrounds the joint. This capsule has a special lining (the synovial lining) and is filled with lubricant (joint fluid) that helps the joint move smoothly. Rheumatoid arthritis typically causes a swelling of the synovial lining. This causes pain and swelling, but eventually, rheumatoid arthritis can cause the bone and cartilage of the joint itself to deteriorate.

Rheumatoid arthritis can occur in people of all ages, including children (where it is known as juvenile rheumatoid arthritis), and is more common in women than men. Unlike osteoarthritis of the hip, which may occur only in one hip, rheumatoid arthritis typically occurs in both hips at the same time (and possibly other joints). Rheumatoid arthritis is also associated with overall weakness and fatigue. Medications to treat rheumatoid arthritis continue to improve.

Ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammation of the spine and sacroiliac joint (the joint where the spine meets the pelvis) which can sometimes cause inflammation of the hip joint. Ankylosing spondylitis can occur in people of all ages, including children, and typically starts in a person between the ages of 17 and 35. It is more common in men than women.

It is typical for people with ankylosing spondylitis to experience flares, when the condition is worse, followed by periods of remission with mild to no symptoms.

Systemic Lupus Erythematosus

Systemic lupus erythematosus or lupus is a systemic autoimmune disorder that can affect any part of the body, including the hip joint. If lupus strikes the hip, inflammation and damage to the joint can occur. Lupus can occur in people of all ages but it is most common in women aged 15 to 35.

Psoriatic Arthritis

As the name sounds, this type of arthritis is related to the skin condition psoriasis. Psoriatic arthritis causes joint pain, swelling, and stiffness and can affect any joint in the body, including the hip. Most people with psoriatic arthritis have the skin condition first (scaly red patches of skin) but it is possible to develop psoriatic arthritis before the skin condition occurs.

Arthritis Symptoms

Regardless of the type of arthritis, symptoms of hip arthritis include:

• Pain in the hip joint that may include pain in the groin, outer thigh, or buttocks

• Pain that is typically worse in the morning and lessens with activity

• Difficulty walking or walking with a limp

• Pain that worsens with vigorous or extended activity

• Stiffness in the hip or limited range of motion

In patients with rheumatoid arthritis or lupus, fatigue and weakness may also occur. Arthritis often occurs in flares with remission, but some people experience a relatively stable level of pain without flares.

Any type of arthritis can involve more than one joint in the body, so a person with osteoarthritis of the hands may develop the condition in the hip as well. Rheumatoid arthritis and lupus typically affect both hips at the same time, while osteoarthritis and psoriatic arthritis may occur in one hip but not the other.

Bursitis

What is bursitis?

A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. "Bursae" is the plural form of "bursa." The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees. When a bursa becomes inflamed, the condition is known as "bursitis."

There are two major bursae of the hip, the trochanteric bursa and the ischial bursa. These are located adjacent to the edges of the femur (thighbone) and pelvic bone, respectively. Inflammation of either can be associated with stiffness and pain around the hip joint. The trochanteric bursa is located on the side of the hip. It is separated significantly from the actual hip joint by tissue and bone. Bursitis is not arthritis and, therefore, is not a cause of true joint pain.

 

What causes hip bursitis?

Most commonly, bursitis is a noninfectious condition (aseptic bursitis) caused by inflammation that results from local soft-tissue trauma or strain injury. On rare occasions, the hip bursa can become infected with bacteria. This condition is called septic bursitis. Although uncommon, the hip bursa can become inflamed by crystals that deposit there from gout or pseudogout, or from calcinosis as a result of scleroderma.

Trochanteric bursitis

Trochanteric bursitis frequently causes pain and tenderness of the outer hip and thigh, making it difficult for those affected to lie on the involved side, frequently causing difficult sleep. Trochanteric bursitis also causes a dull, burning pain on the outer hip and thigh that is often made worse with excessive walking, exercise, or stair climbing. Iliotibial band syndrome can sometimes mimic or be associated with trochanteric bursitis.

Ischial bursitis

The ischial bursa is located in the upper buttock area. Ischial bursitis can cause dull pain in this area that is most noticeable when climbing uphill. The pain sometimes occurs after prolonged sitting on hard surfaces, hence the names "weaver's bottom" and "tailor's bottom."

Symptoms:

Pain that is worse after prolonged inactivity
Most patients describe that the pain is worse after sleeping or after being seated for a while.

Pain that is worse with repetitive activity
The pain may intensify after prolonged repetitive hip movements, such as with walking, jogging, or stair climbing.

Hip tenderness
Patients with hip bursitis have tenderness and pain over the side of the hip. Lying down on the affected side of the hip may cause a sudden and sharp increase in pain.

Radiating pain
Initially, the pain may be located primarily at the outside of the lower hip. Over time the pain may radiate down the outside of the thigh or to other points in the body, such as the lower back, buttock or groin.

Pain at extreme range of motion
Some patients may experience pain during extreme rotation, hip adduction (using the hip to move the leg past the center midline of the body), or hip abduction (using the hip to move the leg away from the body).

Fever and hip swelling, redness, and warmth
People with septic hip bursitis, in which the bursa is infected, will experience the same symptoms described above and may also feel tired, feverish, and sick. They may also notice that the skin is warm to touch and red at the hip. Septic hip bursitis requires prompt medical attention, including treatment with antibiotics to prevent the spread of infection to other points in the body or into the bloodstream.

With hip bursitis, swelling is not as apparent as it is in other common types of bursitis, such as knee bursitis and elbow bursitis, which affect bursae located just beneath the skin. Likewise, skin redness and inflammation are not usually seen with hip bursitis.

• Dislocation
• Cause
• Motor vehicle collisions are the most common cause of traumatic hip dislocations. The dislocation often occurs when the knee hits the dashboard in a collision. This force drives the thigh backwards, which drives the ball head of the femur out of the hip socket. Wearing a seatbelt can greatly reduce your risk of hip dislocation during a collision.
• A fall from a significant height (such as from a ladder) or an industrial accident can also generate enough force to dislocate a hip.
• With hip dislocations, there are often other related injuries, such as fractures in the pelvis and legs, and back, abdominal, knee, and head injuries. Perhaps the most common fracture occurs when the head of the femur hits and breaks off the back part of the hip socket during the injury. This is called a posterior wall acetabular fracture-dislocation.
• Symptoms
• A hip dislocation is very painful. Patients are unable to move the leg and, if there is nerve damage, may not have any feeling in the foot or ankle area.
• Sprains and strains A hip strain is an injury to the muscles or tendons surrounding or affecting hip movement, while a hip sprain is an injury to the ligaments around the hip. Strains typically cause pain with movement. The pain gets worse the more a person uses the muscles around the hip and is exacerbated when heavy amounts of activity are performed by that muscle group. A sprain usually causes pain with any movement of the hip, especially with flexion and internal rotation.
• Tendinitis

What is Hip Tendonitis?

Tendonitis is a condition where the tendon gets over strained, such as while performing high potential activities, performing unusual movements for the body, or due to biomechanical problems. Tendonitis is also called as tendinopathy or tendinitis.

Hip tendonitis is a condition in which single or many of the tendons that connect various muscles to the hip bone suffer damage. The hip and pelvis joints are responsible for taking strain by supporting the load of the body's weight in an upright position not only when it is stable, but also during movements. The muscles present in this region are strong and bulky having full-fledged capacity to undertake powerful movements whereas tendons are very much prone to injuries.

Hip tendonitis is a condition which results in inflammation, pain and degeneration in any of the tendons present in the hip area including groin, hip flexors, glute tendons and hamstrings. Excessive tension resulting from high force or over repetition of activities may cause a severe damage to the tendons of the hip. Hip tendonitis is a state where there is damage along with subsequent degeneration and inflammation of single or multiple tendons of the hip. Hip tendonitis generally occurs because of the wear and tear related to overuse injuries such as in sports injuries, but it also can occur due to trauma as a result of some accident.

Causes and Risk Factors of Hip Tendonitis

Hip tendonitis is generally caused by repetitive strain related to overuse. This generally happens in individuals performing heavy physical work that involves hip, which includes activities such as performing exercises that are beyond the capacity of the body's tolerance. When an individual begins a new type of exercise or sport, the muscles and tendons may not be accustomed to the movements required and hence injury can occur. Similarly, increasing the duration and intensity of exercise may result in injury leading to Hip Tendonitis. Sudden progression in exercise without appropriate preparation may also cause hip tendonitis. Individuals who are engaged in sports such as cycling and running when associated with over straining also have the higher chances for developing hip tendonitis.

Signs and Symptoms of Hip Tendonitis

• One of the symptoms of Hip tendonitis is gradual development of pain around the hip joint without a particular incident.
• Tenderness is felt when firmly touching the affected tendons of the hip.
• Feeling discomfort while stretching the muscle of the affected hip tendon can be a sign and symptoms of hip tendonitis.
• Another symptom of Hip Tendonitis is feeling of discomfort during contraction of the muscle of the affected hip tendon.
• Hip Joint Stiffness is often experienced in the morning time and after rest.
• Decrease in hip pain with activity, which may increase again after some time can also be a symptom of hip tendonitis.

Pinched nerves

• Meralgia paresthetica

• 

Meralgia paresthetica

Meralgia paresthetica is a condition characterized by tingling, numbness and burning pain in your outer thigh. The cause of meralgia paresthetica is compression of the nerve that supplies sensation to the skin surface of your thigh.

Tight clothing, obesity or weight gain, and pregnancy are common causes of meralgia paresthetica. However, meralgia paresthetica can also be due to local trauma or a disease, such as diabetes.

In most cases, you can relieve meralgia paresthetica with conservative measures, such as wearing looser clothing. In severe cases, treatment may include medications to relieve discomfort or, rarely, surgery.

Symptoms

Pressure on the lateral femoral cutaneous nerve, which supplies sensation to your upper thigh, might cause these symptoms of meralgia paresthetica:

• Tingling and numbness in the outer (lateral) part of your thigh
• Burning pain on the surface of the outer part of your thigh

These symptoms commonly occur on one side of your body and might intensify after walking or standing.

When to see your doctor

See your doctor if you have symptoms of meralgia paresthetica.

Causes

Meralgia paresthetica occurs when the lateral femoral cutaneous nerve — which supplies sensation to the surface of your outer thigh — becomes compressed, or pinched. The lateral femoral cutaneous nerve is purely a sensory nerve and doesn't affect your ability to use your leg muscles.

In most people, this nerve passes through the groin to the upper thigh without trouble. But in meralgia paresthetica, the lateral femoral cutaneous nerve becomes trapped — often under the inguinal ligament, which runs along your groin from your abdomen to your upper thigh.

Common causes of this compression include any condition that increases pressure on the groin, including:

• Tight clothing, such as belts, corsets and tight pants
• Obesity or weight gain
• Wearing a heavy tool belt
• Pregnancy
• Scar tissue near the inguinal ligament due to injury or past surgery

Nerve injury, which can be due to diabetes or seat belt injury after a motor vehicle accident, for example, also can cause meralgia paresthetica.

Risk factors

The following might increase your risk of meralgia paresthetica:

• Extra weight. Being overweight or obese can increase the pressure on your lateral femoral cutaneous nerve.
• Pregnancy. A growing belly puts added pressure on your groin, through which the lateral femoral cutaneous nerve passes.
• Diabetes. Diabetes-related nerve injury can lead to meralgia paresthetica.

• Age. People between the ages of 30 and 60 are at a higher risk.

• Sacroiliitis

 

The term sacroiliitis is used to describe any inflammation in the sacroiliac joint, which is located on either side of the sacrum (lower spine) that connects to the iliac bone in the hip.

 

Sacroiliitis is often found as part of a feature of inflammatory conditions of the spinal column. As a group, these conditions and diseases are termed a "spondyloarthropathy" and include conditions such as ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, among others.

Sacroiliitis may also be a component of other types of arthritis, such as ulcerative colitis, Crohn’s disease, or osteoarthritis.

 

 

Sacroiliitis is also a term that is sometimes used interchangeably with the term sacroiliac joint dysfunction, as technically either term can be used to describe pain that stems from the sacroiliac joint (or SI joint).

Sacroiliitis vs. Sacroiliac Joint Dysfunction

Both sacroiliitis and sacroiliac joint dysfunction are a common cause of sacroiliac pain, low back pain, and leg pain.

However, there are differences between the two conditions:

• Sacroiliitis. In medicine, the term "itis" refers to inflammation, and sacroiliitis describes inflammation of the sacroiliac joint. The inflammation may or may not be caused by sacroiliac joint dysfunction.
• Sacroiliac Joint Dysfunction. This condition generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much motion or too little motion. It typically results in inflammation of the SI joint, or sacroiliitis.

 

Sacroiliitis Symptoms

The most common symptoms of sacroiliitis include some combination of the following:

• Fever
• Pain, usually low back pain, leg pain (may be in the front of the thigh), hip pain, and/or buttock pain
• Pain that is worse when sitting for a long time, and worse when rolling over in bed
• Stiffness felt in the hips and low back, especially after getting out of bed in the morning or after sitting still for a prolonged period.

 

Sacroiliitis Causes

A wide range of factors may cause sacroiliitis or predispose one to developing sacroiliitis:

• Any form of spondyloarthropathy, which includes ankylosing spondylitis, arthritis associated with psoriasis, and other rheumatologic diseases, such as lupus
• Degenerative arthritis, or osteoarthritis of the spine, causing degeneration of the sacroiliac joints and in turn leading to inflammation and SI joint pain
• A trauma that affects the lower back, hip or buttocks, such as a car accident or fall
• Pregnancy and childbirth, as a result of the pelvis widening and stretching the sacroiliac joints during childbirth
• Infection of the sacroiliac joint
• Osteomyelitis
• Urinary tract infection
• Endocarditis
• IV drug use/drug addition

If a patient has pain in the sacroiliac area and any of the above conditions, he or she may have sacroiliitis or sacroiliac joint dysfunction.

 

• Sciatica

 

Sciatica is a common type of pain affecting the sciatic nerve, a large nerve extending from the lower back down the back of each leg

What Are the Symptoms of Sciatica?

Common symptoms of sciatica include:

• Lower back pain
• Pain in the rear or leg that is worse when sitting
• Hip pain
• Burning or tingling down the leg
• Weakness, numbness, or difficulty moving the leg or foot
• A constant pain on one side of the rear
• A shooting pain that makes it difficult to stand up

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes.

For some people, the pain from sciatica can be severe and debilitating. For others, the sciatica pain might be infrequent and irritating, but has the potential to get worse.

Seek immediate medical attention if you have lower extremity weakness, numbness in the upper thighs, and/or loss of bladder or bowel control.

What Causes Sciatica?

Sciatica is caused by irritation of the root(s) of the lower lumbar and lumbosacral spine.

Additional common causes of sciatica include:

• Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
• Degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae)
• Spondylolisthesis (a condition in which one vertebra slips forward over another one)
• Pregnancy
• Muscle spasm in the back or buttocks

Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too hard or too soft.

 

• Labrum Tears (Joint Socket Lining)

 

Overview

• 

Hip labral tear

A hip labral tear involves the ring of cartilage (labrum) that follows the outside rim of the socket of your hip joint. In addition to cushioning the hip joint, the labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket.

Athletes who participate in such sports as ice hockey, soccer, football, golf and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also can lead to a hip labral tear.

 

Symptoms

Many hip labral tears cause no signs or symptoms. Occasionally, however, you may experience one or more of the following:

• A locking, clicking or catching sensation in your hip joint
• Pain in your hip or groin
• Stiffness or limited range of motion in your hip joint

When to see a doctor

Seek medical attention if symptoms worsen or don't improve within six weeks.

Causes

The cause of a hip labral tear may be:

• Trauma. Injury to or dislocation of the hip joint — which can occur during car accidents or from playing contact sports such as football or hockey — can cause a hip labral tear.
• Structural abnormalities. Some people are born with hip problems that can accelerate wear and tear of the joint and eventually cause a hip labral tear.
• Repetitive motions. Sports-related and other physical activities — including the sudden twisting or pivoting motions common in golf or softball — can lead to joint wear and tear that ultimately results in a hip labral tear.

Complications

A hip labral tear may predispose you to develop osteoarthritis in that joint in the future.

Prevention

Hip labral tears are often associated with sports participation. If your sport puts a lot of strain on your hips, condition the surrounding muscles with strength and flexibility exercises. Try to avoid loading your hip with your full body weight when your legs are in positions at the extreme ends of your hip's normal range of motion.

 

What is transient synovitis of the hip?

Transient synovitis of the hip, also called toxic synovitis, is an inflammation and swelling of the tissues around the hip joint. Usually only one hip is affected. This condition is called “transient” because it lasts only a short time. Transient synovitis of the hip is the most common cause of sudden hip pain in children.

Transient synovitis of the hip usually occurs in children between 3 and 10 years of age. Sometimes it occurs in children younger than 3 years of age. It is more common in boys than in girls.

What are the symptoms of transient synovitis of the hip?

The main symptom is pain in the hip. In some children, the hip pain gets worse very quickly. In other children, the hip pain gets worse slowly. At first, the hip pain may be so mild that they don’t know there is something wrong.

When the pain gets bad enough, children who have transient synovitis have a hard time walking. If your child has transient synovitis of the hip, he or she may have pain whenever the hip is moved. Your child may walk with a limp. Because of the pain, your child may have trouble standing. Some children may have pain of the inner thigh or knee area, instead of around the hip. Many children who have this condition want to lie on their back with the knee on the side that hurts bent and turned out with their foot pointed away from their body. This position may lessen the pain.

Causes & Risk Factors

What is the cause of transient synovitis of the hip?

Doctors don’t know the exact cause of transient synovitis of the hip. It might be caused by a virus or it might be from an allergic reaction to an infection somewhere else in the body.