Most cases of hip pain in adults are due to osteoarthritis (see separate section), however there are other conditions that may cause pain in the hip.
A bursa is a small fluid-filled sac found under the skin, over joints and between tendons and bones. This can become inflamed after repetitive use. The most common bursitis of the hip is trochanteric bursitis (on the outside of the hip). This may also be inflamed with a fall onto the hip. Symptoms are worse on walking upstairs and hills. The pain is also worse with lying on the affected side.
Treatment involves rest, icing the area and massage to relieve the surrounding muscles. For chronic bursitis a cortisone injection or shock-wave therapy may be recommended.
These are often due to overuse of the gluteus medius muscle in the buttock. They can occur after injury or with long term wear and tear. Pain is felt on the outside of the hip and weakness of the affected side will be noticed. Pain may be mild to severe depending on the grade of injury.
Treatment involves ice and anti-inflammatory medication and rest from sports. Occasionally surgery is needed. Strengthening exercises are needed when symptoms have reduced to aid hip stability.
The labrum is a ring of cartilage around the hip socket. It can be torn during sports or due to structural abnormalities. Pain can be felt in the hip or groin and may be accompanied by a locking, clicking or catching sensation.
Treatment includes rest, ice, massage and anti-inflammatory medication. Injections of cortisone can be helpful in reducing inflammation around the tear.
Hip dysplasia (congenital hip dislocation)
This is due to a birth abnormality where the top of the femur (thighbone) does not fit securely into the hip socket. It should be diagnosed when the baby is very young, although it does not produce symptoms in babies less than a year old. As the child starts walking, there may be a limp or the leg may be longer than the other.
Mild instability may resolve without treatment or bracing of the hip may be all that is required. In more severe cases, surgery and casting may be needed. In adults who have had hip dysplasia as a child, hip replacements are more common.
Hip Impingement Syndrome
Hip impingement syndrome, also known as femoral acetabular impingement syndrome (FAIS) usually affects young and middle-aged adults. Pain is caused because two areas are contacting or impinging on each other resulting in pain. The femoral head rotates in the socket (acetabulum). During impingement, the neck of the femur contacts the lip of the hip socket.
It is characterized by hip pain felt mainly in the groin and can result in chronic pain and decreased range of motion. FAIS has been reported to be associated with progressive osteoarthritis of the hip.
Activities that cause problems with hip impingement are those that involve hip flexion, such as: squash, tennis or any activity that involves repetitive deep lunging/hip flexion.
The two basic mechanisms of FAI are cam impingement (most common in young athletic males) and pincer impingement (most common in middle-aged women). This classification is based on the type of anatomical variation contributing to the impingement process. Cam impingement is the result of abnormal shape of the femoral head-neck junction; while pincer impingement is the result of an abnormal shape of the hip socket (acetabulum). In this situation the socket “pinches” the neck during hip movement.
Sometimes the symptoms can be eased with osteopathic treatment but the cause of the pain often requires surgical intervention.