Pain can arise from the structures that are within the hip
joint or from the structures surrounding the hip joint. The most important
thing is to ask the patient to locate the site of pain. ask the patient to
point at the site of pain. When the patient states that their hip hurts, it
doesn’t mean that the pain is coming from the hip joint itself, so ask the
patient to point at the site of the pain. The pain can arise from structures
that are within the hip joint or from structures surrounding the hip. The hip
joint is a weight bearing joint. The joint consists of two main parts: femoral
head (ball) and acetabulum (socket). The hip pain can be anterior hip pain
(deep groin pain). The pain can be lateral hip pain. the pain can be posterior
hip pain. The pain can be far posterior hip pain, coming from the sacroiliac
joint and the lower spine. Anterior hip pain is usually deep within the groin,
and it can result due to arthritis of the hip. Conservative treatment is
physical therapy, anti-inflammatory medication, possible injections, and
surgery is done in late cases, usually by total hip replacement. It is usually
diagnosed by clinical examination with a provocative test of flexion,
adduction, and internal rotation. The diagnosis is confirmed by an MRI
arthrogram. Conservative treatment is therapy, anti-inflammatory medication,
and injections. Surgical treatment provides good result and is usually done by
arthroscopic debridement or repair of the tear. Stress fracture is usually
diagnosed by an MRI. The x-ray may be normal. Early diagnosis is important
before the fracture displaces and gives a bad result. Treatment of avascular
necrosis is usually surgical fixation of the fracture. Fixation of the fracture
is usually performed utilizing screws. Femoral head replacement is done in
rare, late cases. Avascular necrosis means death of a segment of the bone. When
the blood supply of the femoral head is interrupted, a segment of the bone dies
and becomes necrotic (femoral head will collapse). Treatment for early stages
of AVN without collapse of the femoral head include decompression by drilling
of this segment in the femoral head to bring a new blood supply to the area.
Vascularized fibular graft may be used also. In severe cases with collapse of
the femoral head (usually diagnosed by an x-ray), the treatment is usually
total hp replacement. Treatment of an inflamed bursa is usually conservative
treatment of physical therapy, anti-inflammatory medication, and injection.
Surgical treatment by excision of the bursa is rarely done. In case of chronic,
resilient trochanteric bursitis, try to get an MRI to exclude a tear of the
abductor muscles of the hip (gluteus medius and gluteus minimus muscle tear). Posterior
hip pain is usually due to piriformis syndrome. The sciatic nerve can be
irritated from the piriformis syndrome. Treatment is usually physical therapy,
stretching, anti-inflammatory medications, and injections. Surgical treatment
is usually rare. It is the last resort. It includes release of the piriformis
tendon and exploration of the sciatic nerve. It is done in cases that fail to
improve with conservative treatment. Far posterior pain may come from the
sacroiliac joint or from the lower spine conditions. Sacroiliac joint (SI)
problems is a challenging diagnostic and treatment entity. There are a lot of
clinical diagnostic examinations that can be used to diagnose sacroiliac joint
(SI) problems such as the Faber test and others. However, injection of the SI
joint is probably the method to diagnose pain originating from the SI joint. If
there is improvement of the condition of the patient after injection of the SI
Joint, then we will probably consider that the problem is in the SI joint. The
SI joint problems are usually under estimated and are unappreciated. Lower
spine conditions can cause referred pain to the buttock and hip area. In fact,
symptoms of hip and lower spine conditions can overlap or both of them can
coexist in the same patient. You have to separate pain from the hip from pain
that comes from the spine.
