Pain can be generated from structures that are within the hip joint or from structures surrounding the hip (Figure 1). The hip joint is a weight-bearing joint. The joint consists of two main parts: the ball (femoral head) and the socket (acetabulum of the pelvis).
Pain can be anterior in the groin, lateral, posterior, or far posterior, including the SI joint and lower spine (Figure 2).
Anterior hip pain is usually deep in the groin. It can result from arthritis of the hip (Figure 3). Arthritis of the hip is usually treated conservatively with physical therapy, anti-inflammatory medications and injections. Surgical treatment will be utilized in chronic cases, and is most commonly a total hip replacement.
A second condition is a Labral tear (Figure 4), which is best diagnosed by an MRI arthrogram. Conservative treatment of labral tears includes physical therapy, anti-inflammatory medication and injections. In cases that are refractor to non-operative treatment, surgical treatment is done by debridement or repair of the lesions, usually arthroscopically.
For stress fractures (Figure 5) diagnosis is usually done by an MRI or bone scan. Early diagnosis is important to prevent displacement of the fracture, which can lead to future problems. If nondisplaced, it can usually be treatment by screw fixation.
Avascular necrosis is due to death of a segment of bone, when the blood supply to the femoral head is interrupted (Figure 6). In early cases, diagnosis is by an MRI. Early stages of treatment include decompression or drilling. Stem cell injection has been tried, but there is no large series yet. Some surgeons prefer vascularized fibular graft, but it is complicated by long-term results of donor site problems. Severe cases are usually diagnosed by x-ray and treated with a total hip replacement.
Lateral hip pain is usually due to Trochanteric Bursitis (Figure 7). The treatment is usually conservative and includes physical therapy, anti-inflammatory medications and injections. Surgical treatment is extremely rare, with an excision of the bursa.
Posterior hip pain occurs due to Piriformis syndrome (Figure 8). Treatment for this includes physical therapy and stretching, anti-inflammatory medication and injections. In rare and severe cases, surgical treatment to release the piriformis tendon is performed. Piriformis syndrome can present with sciatic nerve irritation.
Far posterior pain is usually due to Sacroiliac joint and lower spine conditions (Figure 9). Injection of the SI joint is one method to diagnose and possibly treat pain of SI joint origin, especially with improvement of the pain level of the patient.
For more information on the hip, follow the links below:
https://www.youtube.com/watch?v=mAL-Szu7qAchttps://www.youtube.com/watch?v=8xA53i4CuW0https://www.youtube.com/watch?v=-W3o_WADI1M
https://www.youtube.com/watch?v=5A1o5Q8hGkg
https://www.youtube.com/watch?v=zjY14sjU8vc
https://www.youtube.com/watch?v=cq-iyFzHdPY
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