Hip problems are very common in older people but may appear already in childhood. In children, the problem may be a congenital dislocation of the hip, ossification disorder at the end of the hip or a temporary hip inflammation. Pediatricians are familiar with these disorders.
The most common reason for hip pain in older people is arthritis. There are two types of arthritis of the hip. The most common is osteoarthritis, wear-and-tear arthritis or degenerative joint disease. With it the cartilage of the joint is wearing off with age. After this, a bare bone is exposed in the joint and the joint becomes painful and stiff. The cause is truly rarely a developmental disorder. Generally no explanation is found for arthritis. Hereditary causes may play a role. Also overweight, injuries and fractures in this area predispose to this ailment.
In the cartilaginous tissue degradation and repair takes place all the time. Osteoarthritis is considered to arise when the normal repair mechanism fails due to the mechanical and biochemical changes in the joints. Cartilage has no blood vessels, so the supply of the nutritive substances and oxygen is restricted. However, cells have to maintain the wide external support structure.
At an early stage when an attempt is made to correct the damaged cartilage, cells accumulate in the damaged area and the growth factor concentration in the region increases. If this first attempt fails, it will disrupt the balance of repair and degradation of the cartilage matrix and degradation will achieve a more commanding position. This leads to increased deaths of the cartilage cells, and to formation of tissue, which cannot withstand the normal stress. Because cartilage does not have nerves, the early-stage changes are painless, and the symptoms occur only after other tissues are damaged.
Recent evidence shows that synovial tissue and bone also play a role in the pathogenesis of osteoarthritis. Synovial local inflammatory symptoms such as swelling and pain are often seen in the course of the disease. These symptoms are considered to be secondary and occur when the cartilage degradation products and neurotransmitters get in contact with the synovial cavity. Inflammatory changes, on the other hand, are also adversely affecting the balance of repair and degradation of the cartilage, which further adds to the inflammatory changes. The vicious circle is ready and may get worse.
Synovial inflammation in osteoarthritis occurs in the very beginning of the disease process as well as at later stages. It is of a lower degree than in rheumatoid arthritis but may be a factor in the vicious cycle that leads to worsening of osteoarthritis, and changes in the bone under the cartilage such as bone spurs, remodeling, sclerosis and attrition.
The second type is inflammatory arthritis. It can be caused for example by rheumatoid arthritis, ankylosing spondylitis or systemic lupus erythematosus along with other systematic diseases.
In these cases, there is usually also pain in other joints and other symptoms as well. The diagnosis can be confirmed by doctor´s examination and laboratory tests. With rheumatoid arthritis, it is vital to start appropriate medication soon after diagnosis. Treatment of rheumatoid arthritis should be left to a specialist.
Hip stiffness may be the first symptom of arthritis. It is usually more pronounced in the morning or after a break and eases after some movement. Hip flexion and internal or toward the groin rotation are usually the first movements of the hip to be limited.
An early symptom of arthritis is also a dull pain during exertion. The pain feels in the groin area or on the outside of the hip or in buttocks and may radiate to the thigh, sometimes as far down as the knee. It may be felt in the morning and disappear with movement.
When the complaint advances, pain and stiffness during the rest in the joints may be present, and there may be a limp with walking. At its worst, this degenerative condition may cause severe nighttime pain. There may be good and bad periods with the pains and they can change also with weather conditions.
During the examination, a doctor will find that the hip’s range of motion is limited and that movements are painful. An x-ray, CT, or MRI scan will confirm the diagnosis. More complicated tests are usually not needed, and treatment planning can be started. It's good to know that in about half of the cases, when X-ray changes of osteoarthritis are seen, there are however no symptoms. Thus, if by chance X-ray signs of degeneration are noted in the hip or in other joints, this usually does not require any action.
There is no curing medication for this condition, so treatment concentrates on alleviating the symptoms, which of course is of paramount importance. An appropriate anti-inflammatory without many side effects would be useful. In most severe cases, medication has to be used continuously, and in milder cases medication on demand will be sufficient.
One useful form of physical therapy is traction of the hip joint. This may alleviate the pain for long periods of time. Before the traction, the hip joint capsule should be prepared with deep heat treatment and massage. Electric therapy can be used in alleviating pain. It is necessary to maintain mobility of the hip and leg muscles with gymnastics or physiotherapy. Moderate use of the hip is recommended despite pain.
If these treatments do not provide sufficient help, surgery becomes an option. The worn joint is then replaced with an artificial one. This type of surgery usually works well to reduce pain. However, it should be pointed out that the artificial joint is made of material that wears out as well, so exertion levels should be planned accordingly. It is necessary to be cautious about muscular activity and practicing walking after surgery if problems exist in those areas.
If an artificial joint has to be inserted in a young patient, there is a danger that it will dislodge sometime during the patient’s life. Each additional surgery is more complex than an earlier one. This is why the first operation is postponed as long as possible in young people. If the artificial joint causes symptoms after having functioned well, it may be necessary to check its status with an x-ray.
Self-treatment of the early stages includes anti-inflammatory medication in short treatments lasting a few days. Because the structures that cause pain are deeply embedded, ointments are not particularly useful. Cold compresses may be used several times a day in the beginning and heat treatment later.
The most valuable thing is not to put a lot of weight on the degenerated joint. If one is overweight, losing weight may offer some relief. It is easier said than done, but is well worth the effort. A cane can be used to reduce the pressure on the joint if possible.
Carrying heavy objects should be seriously limited. A bag with wheels for grocery shopping might be used, or the grocer might be asked to deliver your groceries or they might be ordered via the Internet. Unfortunately, using a cane is generally considered a sign of such poor condition that it is impossible to walk otherwise. This is not so, and the cane does lend dignity to its user.
Even though weight should not be carried on the hip, it does not mean that one should stop moving altogether. It is particularly beneficial to exercise the hip muscles despite the pain. Water exercises are the best way to do this, as they put less stress on the hip joint but keep the muscles around the hip working.
The mucous bursa in the hip may become inflamed and cause pain that radiates downward, which is why this problem is often confused with sciatica. During an examination, a strong local tenderness on the outside of the hip is often present in this case.
Ultrasound or MRI can be used to confirm the diagnosis and to exclude other reasons if this is considered necessary. At this same place the tendons attached to the bone may become irritated and provide clinical picture similar to the bursitis without the actual inflammation of the bursa. A cortisone shot or two usually takes care of both of these problems if pain medication and the rest do not solve it.
Sometimes the lateral femoral cutaneous nerve along the frontal and side surface of the thigh may entrapp in the inguinal flexure causing the condition called meralgia paresthetica. This causes nerve pain on the front, outer portion of the thigh. The area may also become numb. Usually the area is clearly delineated. The reason often remains unclear; a trauma is often considered a possibility.
Examination shows reduced sense of touch in the typical region and possible tenderness at the irritated area of the inguinal flexure. Diagnosis can be confirmed with the nerve conduction studies and EMG. Treatment options include stretching of the muscles and posture alignment, decreasing the inward curve of the lower back, which help reduce the pressure on the nerve. Surgery can be considered if no other treatments work and the problem makes everyday life difficult.
Degenerated and bulged intervertebral disks in the lower back may cause radiating pain in the hip region. A nerve pinched by the gluteus muscles may also cause pain in the hip area. In case of these problems, examination usually shows stronger symptoms in the back or buttock. Treatment will then focus on the underlying problem. Please see the back pain page.
A snapping sound from the hip is usually harmless. It is often caused by a muscle on the side of the thigh flipping over the outmost part of the hip. In most cases, no treatment is necessary.
See a Doctor
Prolonged hip pain that does not get better with home remedies.
Hip exercise videos Tv-gym.com.
Kidshealth.org about developmental dysplasia of the hip.
Wikipedia page about developmental dysplasia of the hip.
American Academy of Orthopedic Surgeons on arthritis of the hip.
About.com pages about hip replacement surgery.
Ezinearticles.com about hip fractures.
Emedicine pages on bursitis.
Mayoclinic.com meralgia paresthetica.
American Academy of Orthopedic Surgeons on inflammatory arthritis of the hip.
Portlandhiparthroscopy.com on loose bodies.
Mayoclinic.com pages on hip labral tear.
Hipfai.com about femoroacetabular impingement.
webMD about snapping hip.