Causes of hip pain

What are the most common causes of hip pain?

In older adults, hip joint degenerative changes (known as hip osteoarthritis) cause the majority of hip pain. Osteoarthritis is a gradual process which leads to the thinning and eventual loss of the smooth joint surfaces (known as the cartilage). It also has other effects such as creating scarring and adhesions to the soft tissue joint capsule as well as weakness to the muscles and tendons supporting the joint. The hips are one of the most common joints to suffer with disabling osteoarthritis.

Although the disease process is usually gradual, in many cases individuals suffer with a rapid onset of groin pain and significant stiffness which does not often coincide with any changes in activity. Pain from hip osteoarthritis is normally primarily felt with prolonged sitting or initial rising from a seated position, squatting movements and getting in and out of a vehicle.

Hip pain in younger adults

Although degenerative osteoarthritis of the hip is normally seen in those over sixty, this condition can be seen in younger and middle-aged individuals. In these cases there will often be a strong genetic predisposition, previous hip joint trauma, other medical problems such as inflammatory arthritis or a developmental defect to the hip/s such as Perthes disease or hip dysplasia.

Hip pain in younger adults may also be the result of a bony prominence to the ball part of the hip joint (femoral neck/ head) or a hip socket (acetabulum) which becomes too deep. This has become known as hip impingement, or femoroacetabular impingement syndrome. Evidence suggests there may also be an increasing number of younger adults suffering with this condition which may be related to a lifestyle involving longer durations sitting or performing heavy twisting and turning movements during sports as the hip joints develop.

Another cause of hip pain in middle-aged adults is a condition known as greater trochanteric pain syndrome. This condition causes pain on the outside of the hip and is due to a combination of inflammation in a protective fluid filled sac (called a bursa) as well as pain from the tendons of the gluteal muscles. Other tendon problems which manifest disproportionality in younger and middle-aged adults include ischial and hamstring tendon pain. Both, greater trochanteric pain syndrome and ischial and hamstring tendon pain may result from a combination of degenerative changes within the tendons and/ or stiffness in some of the adjacent soft tissue. This problem may be compounded in those who still attempt to push past their limits with regular sporting activity.

Hip problems in children

When hip pain is suspected or felt in babies and children this should always be assessed by a qualified healthcare clinician. This will allow for the screening of certain hip conditions which, if left untreated, may cause problems with the hip joints in later life.

One such hip joint problem is termed developmental dysplasia of the hip. This condition refers to when the ball (femoral head) part of the hip joint does not sit properly in the hip socket (acetabulum). In some cases, it may be entirely dislocated from the joint. This condition is caused by childbirth and is more common with breech births. Although this condition will be routinely screened for with a physical examination after birth it is recommended that you seek a professional opinion for a confirmatory ultrasound scan if you suspect one of your baby’s hips moves differently or is being used differently to the other.

In later childhood, a condition known as Perthes disease may develop. It is not known exactly why this condition develops but it involves an interruption of the blood supply to the ball (femoral head) part of the hip joint. In many cases this is temporary and with monitoring will resolve. However, in some cases a specialist may recommend a brace, or in rare cases surgery, to encourage healing.

Far rarer are cases when children get a hip joint infection. In the event of a suspected hip joint infection then medical treatment will be required. Often this will involve a small operation to wash out the infection with sterile fluid and several days of intravenous antibiotics.

Unfortunately, it is not always easy to separate a hip infection from a more common hip problem known as transient synovitis of the hip in children. Transient synovitis, or irritable hip syndrome, is thought to be a viral problem and may also lead to characteristic inflammation of the hip on scans. Doctors may attempt to distinguish these conditions on the basis of whether there are systemic signs or blood test abnormalities which may indicate an infection.

In spite of these more serious causes of hip pain in children, the majority of hip pain in children will be related to mechanical problems such as small rotational abnormalities in the lower limbs as they develop. These are often referred to as torsions and may relate to the lower leg ankle and foot, lower leg bone, knee or hip. Strength deficits and stiff muscle groups may compound these problems and with a supervised program of physiotherapy a child will normally have no ongoing problems as their joints and soft tissue adapt. In rare circumstances a specialist may offer an orthopaedic operation to correct more severe cases of torsional abnormalities of the lower limbs.

Symptoms of hip pain Hip pain at night

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