Hip Pain Diagnosis & Treatment in NYC

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Patients can experience “hip” pain in a variety of areas around the hip joint, including the upper thigh, inner leg (groin), outer buttock, or outside (“lateral” side) of the hip. Pain in these areas can occur for many reasons, some of which are related to the hip joint itself and some which are related to structures other than the hip, such as the lower back, tendons, ligaments, or nerves. Since the hip is located deep inside the body and surrounded by numerous muscles and nerves, it can be difficult for a patient to tell exactly where the pain is coming from. Patients with true hip joint pain usually have pain in the groin area, but hip joint pain can present anywhere around the hip. Sometimes hip pain may even radiate to the knee below.

If you are experiencing pain around the hip, it is important to consult a hip specialist to get an accurate diagnosis and the appropriate treatment.

What do I need to know about hip anatomy?

The hips are the body’s largest ball-and-socket joints. The ball, or “femoral head”, is the uppermost part of the thigh bone, or “femur”. The socket, or “acetabulum”, is formed from three fused bones that create half of the pelvis. Both the femoral head and the acetabulum are covered with cartilage surfaces that provide cushion within the joint and low friction motion. The hip is nourished and lubricated from a soft tissue lining around the hip called the “synovium”, which produces a lubricating “synovial fluid”.

illustration of hip bone with various parts labeled including joint capsule

Most people have a ball and socket that conform to each other well, meaning that the hip joint has high stability just from the shapes of the bones and how well they fit together. Additional soft tissues around the hip enhance the function and stability of the hip joint.

The “labrum” is a ring of cartilage attached to the edge of the acetabulum. This ring deepens the hip and creates a “suction seal” to improve hip stability. Ligaments crossing from the pelvis, outside of the socket, to the top of the femur create the “hip capsule” that further stabilizes the hip. Finally, numerous muscles cross the hip joint, and their tendons insert on various surfaces of the thigh bone to stabilize the hip joint and provide hip motion.

Nerves exit the spinal cord in the lower back and run both within the pelvis and outside of the pelvis to the bone, cartilages, muscles, and skin around the hip and down the leg. They give feedback to the brain about pain and also position of the joint (“proprioception”), and control and coordinate muscles to balance the body and power limb motion.

Learn more about the hip.

What causes hip pain?

When you walk, each hip joint experiences 2 to 3 times your body weight. Over time, repetitive use, particularly with excess load (for example, elevated body weight) can lead to cartilage breakdown and eventual damage to the underlying bone. Additionally, there are other predisposing factors that can accelerate hip joint damage and cause pain. Some of these are systemic (body-wide) conditions, like rheumatoid arthritis, while others are related to abnormal shape(s) of one or more bones contributing to the hip joint, as seen in hip impingement.

Some common causes of hip pain include:

  • Hip arthritis, including osteoarthritis, inflammatory arthritis and secondary arthritis
  • Hip impingement
  • Labral tear
  • Childhood hip disorders, including hip dysplasia, Legg–Calvé–Perthes disease (LCPD), and slipped capital femoral epiphysis (SCFE)
  • Hip fracture, including femoral neck fracture and stress fractures
  • Hip dislocation or hip instability
  • Hip tendinitis, snapping hip, or tendon tear
  • Hip bursitis
  • Pinched nerve around the hip
  • Hip infection

When should I see a doctor for hip pain?

If the hip pain is minor, nonsurgical treatments may be successful at relieving your symptoms. These include rest, and icing or heating the painful area to reduce discomfort. However, if hip pain persists or becomes more severe, patients should make an appointment with an orthopedic hip specialist. In particular, if hip pain interferes with your daily life, work or recreational activities, wakes you from sleep, or requires prescription pain medication, you should not delay seeing a hip surgeon.

In some situations, medical assistance may be required immediately. You should seek help right away if you have any of the following symptoms:

  • Inability to move the hip joint or leg
  • Inability to stand or put pressure on the hip
  • Signs of infection, such as fever along with pain in the hip
  • Extreme swelling around the hip or leg

How will Dr. McLawhorn diagnose my hip condition?

Dr. McLawhorn prefers to begin your evaluation by taking a detailed history, including your description of your hip pain along with your general health history. Next, he performs a physical exam, during which he will assess your walking, range of motion, and strength around the hip. X-rays are an important part of your evaluation to look at the status of your hip joint. X-rays of other relevant areas, such as the lumbar spine, may be ordered if necessary for an accurate diagnosis. MRI is useful when there are further questions about the health of the bone, cartilage, labrum, or muscles around the hip. CT is ordered selectively for patients requiring certain types of hip surgery. Blood work or injections into the hip or spine may be necessary for diagnosis in rare circumstances.

After Dr. McLawhorn makes the diagnosis, he will recommend the best hip and knee treatment option to suit your needs and expectations.

FAQ

What Is Hip Pain?

The hip area is the largest supporting structure in the human body as it is what holds up the entire torso. The hips are located near the femur and pelvic socket, which is surrounded by cartilage. If this protective cartilage sustains any damage or is worn down, it can cause pain to occur in the hip area.

What Are The Symptoms of Hip Pain?

There are other symptoms aside from experiencing pain in the hip area.

These symptoms can include the following:

  • You cannot bear heavy amounts of weight.
  • Your hip is constantly making a popping sound.
  • There is a noticeable deformity.
  • Your hip pain worsens over time.

Hip pain can also be a symptom of other conditions, such as bursitis and strain in your hamstrings.

How Is Hip Pain Diagnosed?

Hip pain can be diagnosed through a variety of methods. First, the doctor will go over your medical history and perform a physical examination to get a basic understanding of the problem. If the symptoms you have are severe enough, you may require a more extensive examination.

These examinations can include the following:

  • Radiography
  • Ultrasonography
  • Magnetic resonance imaging (MRI)

The examination needed is up to your preference, but it also depends on what is causing your hip pain.

What is Hip Necrosis?

Hip necrosis, also known as avascular necrosis, is a condition where the bone tissue of the hip joint loses its blood supply. If blood is not supplied to the hip joint, the tissue surrounding it starts to die. This can ultimately result in the collapse of the bone. Those with hip necrosis may feel pain, stiffness, and a limited range of motion.

What Causes Hip Necrosis?

Hip necrosis can be caused by a number of factors.

Below is a comprehensive list of causes for hip necrosis:

  • Traumatic injuries - Sustaining a traumatic injury, such as a fracture or dislocation, can impede the blood flow in the hip.
  • Excessive alcohol - Consuming heavy amounts of alcohol can greatly increase your risk of hip necrosis. This is because alcohol can create fatty deposits in your blood vessels, which can impair your blood flow.
  • Using corticosteroids - Corticosteroids are a type of anti-inflammatory medication that is meant to treat rheumatologic diseases, such as rheumatoid arthritis and inflammatory bowel disease. Although this medication can provide relief, it can affect the function of your blood vessels.
  • Certain medical conditions - Having certain medical conditions, such as blood clotting disorders, vasculitis, and HIV, can increase your risk of hip necrosis.
  • Radiation therapy - If you are receiving radiation therapy in the pelvic area, it can increase your risk of hip necrosis.

Understanding the potential causes can help you be more proactive in preventing hip necrosis from occurring.

What Are The Treatments For Hip Necrosis?

Hip necrosis can be treated through a variety of methods. The most appropriate treatment for hip necrosis varies from patient to patient. Several factors need to be considered, such as the severity, how damaged the hip bone is, the cause, and the patient's current health.

The following treatments for hip necrosis include the following:

  • Medication - Medication, such as non-steroidal anti-inflammatories or other potent pain medication, can be prescribed to treat hip necrosis.
  • Physical therapy - Physical therapy sessions can help patients suffering from hip necrosis can help strengthen the hip muscles, maintain the mobility of the hip joint, increase blood flow, and improve hip function.
  • Core decompression - Core decompression is a surgical procedure where holes are drilled into the hip bone as a way to relieve pressure and promote blood vessel growth. This is considered to be the most effective option for treating early signs of hip necrosis.
  • Bone grafting - Bone grafting is another surgical procedure that is performed if a large section of the hip bone is affected by necrosis. It is when bone is transplanted to help treat diseased bones.
  • Osteotomy - Osteotomy is a surgical procedure that realigns a patient’s hip joint as a way to redistribute weight. This is meant to help relieve pressure and stress on the affected area of your hip bone.

During your appointment with Dr. McLawhorn, he will explain more about these treatments in more detail. It is important to be transparent about your medical history so he can determine the best treatment option for your situation.

How will Dr. McLawhorn diagnose my hip condition?

Once the hip fracture surgery is completed, you will have to stay in the hospital for about three to five days. After you have spent a few days recovering in the hospital, you will be discharged, but you have to take it easy for a while. The average time it takes to fully recover from hip fracture surgery is about three to four months. However, it can potentially take up to a full year to recover, depending on the issue and the intensity of the surgery.

There are many possible causes for hip pain, which can lead to more serious medical problems if left untreated. It is important to seek advice from an orthopedic hip specialist to accurately diagnose and treat your hip pain. Dr. McLawhorn is an orthopedic surgeon at Hospital for Special Surgery, specializing in hip and knee reconstruction and replacement. He sees patients at locations in New York City, and Stamford, Connecticut. To learn more, call 212-606-1065 (NYC) or 203-705-2113 (CT) today or schedule an appointment by using the form on this page.

Learn more about hip pain, conditions, and treatments at hss.edu

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