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”. 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.
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.
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
