Hip pain | Causes | Diagnosis | Therapies | Consultation
HOW IS THE HIP CONSTRUCTED?
The hip is a ball and socket joint and the human body’s second largest. The hip socket (acetabulum) is shaped like a nutshell and the head of the femur has a diameter of around five centimetres. The hip socket and head of femur are coated in a layer of cartilage around five millimetres thick: this provides pain-free movement of the hip joint with little friction.Unfortunately, the joint cartilage stops growing in adults. When standing, the load on the hip joint is four times the body's weight. When walking down stairs, the hip joint is subjected to eight times the body’s weight. This is why so many patients in the initial stages of osteoarthritis of the hip first notice the pain when descending the stairs.
Hip pain and problems can differ greatly and depend on age and sporting activity. Frequent pain symptoms include pain and restrictions during certain movements or stresses, stabbing pains during certain movements, electrifying pains radiating into the thigh, pain on the exterior of the hip, a limping gait, a relieving posture in the hip and a bouncy tendon when moving. These hip problems can occur suddenly - e.g. from an accident or overexertion - and normally increase with time. Hip pains caused by osteoarthritis are particularly common, especially in the elderly. Arthrosis is an abrasion of the cartilage and also affects the hip joint. If the problems do not clearly improve within two weeks despite relieving the hip, the problems should be investigated more closely.
The causes of hip pain are as varied as the pain itself. The problems can come from the joint, muscles, their tendons and nerves. An accident, congenital malformation, overexertion, abrasion, metabolic disorder, impingement or infection can thus trigger acute or chronic hip pain with restricted movement:
- A broken bone, e.g. a fracture of the neck of the femur
- Traumatic hip luxation (dislocation of the hip joint caused by an accident)
- Arthritis of the hip (inflammation of the hip joint) caused by bacteria (septic coxitis, infection), rheumatism (rheumatoid arthritis) or an inflammatory flare of the (activated osteoarthritis)
- Hip dysplasia (congenital malformation of the hips)
- Advanced coxarthrosis (arthrosis in the hip joint)
- Hip impingement (a painful blockage of the hip joint by bone spurs: known as “pincer impingements” at the hip socket and “cam impingements” at the neck of the femur. These bony deformations at the hip socket and/or femoral head impact the movement of the hip joint painfully, especially when bending over.
- Labral tear (a tear to the labrum, an important O-ring of cartilage around the hip joint)
- Bursitis (inflammation of the synovial bursa), e.g. bursitis trochanterica (inflammation of the synovial bursa at the greater trochanter of the femur)
- Periarthritis of the hip: a disease of the insertion of the tendons of the stabilising hip muscles at the greater trochanter caused by wearing
- Snapping hip syndrome, or coxa saltans, is caused by a taut ligament (the iliotibial tract) which is snagged by the greater trochanter when bending over, then suddenly snaps over it.
- Meralgia paraesthetica: Nerve compression of the lateral femoral cutaneous sensory nerve beneath the inguinal ligament. The patients suffer from false sensations (paraesthesias) as well as burning pain and sensory disorders on the front and/or exterior of the thigh.
- Necrosis of the head of the femur: Dying off of the bone at the head of the femur. This can occur without a recognisable trigger (idiopathic) or owing to cortisone tablets or injections, alcohol abuse, metabolic disorders or an arterial occlusive disease.
- Perthes’ disease: Dying off of the femoral head occurring in childhood.
Juvenile epiphysiolosis of the head of the femur (epiphyseolysis capitis femoris): Slipping of the head of the femur along the growth plate during puberty.
If someone has hip problems, precise questioning and examination are required. How long has the pain existed? How is it triggered? Where exactly are the hip problems localised? How does the pain feel? Is it stabbing, wrenching, aching or electrifying?
This is followed by a close examination of the mobility of the hip. Can the hip pain be triggered by certain movements of the hip joint? How severely is the movement restricted? Are there specific pressure points? How is the muscle strength?
An X-ray shows the situation of the bones in the hips. Targeted injections of local anaesthetic into or around the hip joint can also help form a diagnosis. Further examinations include MRI (magnetic resonance imaging) or CT (computed tomography).
When all examinations have been performed, the results are discussed and explained in detail and potential conservative therapy methods presented.
Hip pain can be treated conservatively (without surgery) or with surgery.
The following measures are the focus of the conservative therapy:
- (ultrasound, shock-wave therapy, massage, muscle training, etc.)
- Anti-inflammatory medications and lubricants
- (hyaluronic acid, cortisone) injected into or around the hip joint (e.g. for bursitis)
- Cartilage-supporting medications or appropriate dietary supplements for the joint
In surgical treatment, we differentiate between joint-preserving surgery and joint replacement with an artificial hip:
- Joint-preserving surgeries:
- Fixation of breaks with plates, screws or nails
- Suturing of tendon tears
- Removal of the bursa and bone spurs
- Arthroscopy of the hip joint with sutures or removal of the labrum (cartilaginous ring) as well as the ablation of bone spurs for hip impingements
- Artificial hip replacement:
- If the abrasion caused by the osteoarthritis has destroyed the hip joint, it can be replaced with an artificial hip.
Your well-being and personalised treatment are the focus at the Pyramid Clinic.
As the Pyramid Clinic is a private clinic, supplemental insurance is required: Treatments in our clinic require private or semi-private insurance. Naturally, we can also treat patients with general insurance if they opt for an upgrade.
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