Pain in the hip is the experience of pain in the muscles or joints in the hip/ pelvic region, a condition commonly arising from any of a number of factors. Sometimes it is closely associated with lower back pain.
Causes Causes of pain around the hip joint may be intra-articular, extra-articular, or referred pain from neighboring structures, such as sacroiliac joint, spine, symphysis pubis, or the inguinal canal. Common etiologies include:
Trochanteric bursitis, caused by inflammation of the trochanteric bursa of the outer hip, often affecting both hips Arthritis of the hip, degeneration of the hip joint from osteonecrosis, trauma, sepsis, rheumatoid arthritis, or anatomic anomalies Meralgia paresthetica, a chronic neurological disorder of the lateral femoral cutaneous nerve, most common among those who are pregnant or have diabetes Hip avascular necrosis, cell death of bone tissue in the hip joint brought on by vascular occlusion or coagulation which is the result of old age, alcoholism, trauma, decompression sickness, or several other possible causes; the treatment is often total hip replacement Occult hip fracture, a fine crack somewhere in the hip socket, common in elderly women and those with osteoporosis, usually only in one hip Snapping hip, a condition caused by iliotibial band snap, iliopsoas tendon snap, and hip labral tear, usually only in one hip; may be accompanied by an audible "snap" when the hip joint is moved Paget's disease, enlarged or deformed bones of the hip, a genetic disorder; pain is usually in both hips simultaneously Malignancy, as cancer in the pelvis or proximal femur may cause pain; usually only one hip is affected Primary septic arthritis caused by an infection within the synovial fluid of the hip, a condition rare in adults except for those who are already immunocompromised as well as those who have artificial hips; only one side of the pelvis is affected, onset of pain is rapid Transient or acute synovitis or "irritable hip", a condition most common in children, more often in boys than girls, and clearing up on its own within 7–10 days; pain is only on one side Sciatica, a condition most often brought on by damage to the L4 or L5 nerve roots but sometimes caused by inflammation or tension in the piriformis muscle of the pelvis (which rests on the sciatic nerve), in which case the condition is called piriformis syndrome; pain usually only occurs in one side but may occur in the other side at other times or (rarely) both sides simultaneously Sacroiliac joint dysfunction, an uncommon neurological condition of the mostly-immobile sacroiliac joint of the hip brought on by previous trauma to the joint such as an automobile accident; pain will usually be in only one side Radiculopathy, a nerve disorder brought on by pressure or irritation of a nerve at its root (i.e., near the spine) often resulting from degeneration of a spinal disc, joint degeneration, or osteoarthritis, among other causes Pain in the groin, called anterior hip pain, is most often the result of osteoarthritis, osteonecrosis, occult fracture, acute synovitis, and septic arthritis; pain on the sides of the hip, called lateral hip pain, is usually caused by bursitis; pain in the buttock, called posterior or gluteal hip pain, which is the least common type of hip pain, is most often caused by sacroiliac joint dysfunction as well as sciatica (whether from a hemorrhaged spinal disk or a tense piriformis muscle). Herpes zoster (shingles) may also cause posterior hip pain.
Clinical examination
Clinical tests are adapted to identify the source of pain as intra-articular or extra-articular. The flexion-abduction-external rotation (FABER), internal range of motion with overpressure (IROP), and scour tests show sensitivity values in identifying individuals with intra-articular pathology ranging from 0.62 to 0.91.
Medical imaging Projectional radiography ("X-ray") is the first imaging technique of choice in hip pain, not only in older people with suspected osteoarthritis but also in young people without any such suspicion. In this case plain radiography allows categorization as normal hip or dysplastic hip, or with impingement signs, pincer, cam, or a combination of both.
Need for clinical correlation Imaging of the hip needs to be complementary to the clinical history and physical examination because it is well known that imaging findings do not always correlate with the presence of pain and vice versa.
X-Ray Projectional radiography ("X-ray") is currently useful not only in older people in whom osteoarthritis of the hip is suspected but also in younger people without osteoarthritis, who are being evaluated for femoroacetabular impingement (FAI) or hip dysplasia. Plain radiography allows us to categorize the hip as normal or dysplastic or with impingement signs (pincer, cam, or a combination of both). Besides these, pathologic processes like osteoarthritis, inflammatory diseases, infection, or tumors can also be identified (Figure 1). Figure 1.
X-ray in pediatrics X-ray of infants should be obtained with the pelvis in neutral position with the lower limbs held in neutral rotation and slight flexion.
Hip dysplasia
Despite the widespread of ultrasound, pelvis X-ray is still frequently used to diagnose and/or monitor hip dysplasia or for assessing other congenital conditions or bone tumors. The most useful lines and angles that can be drawn in the pediatric pelvis assessing DDH are as follows:
Joint effusion
Legg-Calvé-Perthes disease (LCPD) Most cases of Legg-Calvé-Perthes disease (LCPD) develop between the ages of 4 and 10 years (Figure 3). Classification of its severity can be assessed by radiographs. Herring or lateral pillar classifications and the patient’s age strongly correlate with the outcome.
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