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Anatomy
The hip joint is a ball and socket joint, where the femur (large thigh bone) connects to the pelvis. The top of the femur is a round ball, which
fits into the socket (acetabulum) formed by the pelvic bone. The ball is allowed to glide and rotate within the acetabulum because a group of
ligaments and muscles support the joint and inhibit over extension or malrotation from occurring. Also, within the joint is a synovial lining,
which provides lubricating fluid to decrease friction, produced when the joint is in motion.
Pathology
Hip dislocations and femur fractures are often acute injuries and can be acutely treated. There are other conditions that can produce chronic
progressive hip pain.
Diseases, besides trauma, that can cause chronic hip pain:
• Osteoarthritis (OA)- also known as degenerative arthritis or degenerative joint disease. OA is the most common cause of arthritis in the
United States. It is most common in women, people over the age of 55, obese people, and those with a history of previous joint trauma or
disease.
OA results from repetitive wear and tear of the joint. OA can cause a chronic, non-inflammatory arthritis of any moveable joint. The most
common joints involved in OA are the DIP joints (small joints closest to your fingernails) of the fingers and the knees. Typically the joint
involvement is one-sided and asymmetric. Patients typically experience crepitus, which is a crackling or popping sound and sensation. This
is created when the cartilage has broken down and two rough edges are coming into contact with each other. This can also cause a
decrease in range of motion, pain that worsens with activity, and improves with rest. There is typically no localized swelling or redness seen
with this cause of arthritis.
• Rheumatoid Arthritis (RA)- Unlike OA, RA is a chronic, systemic, destructive, inflammatory arthritis. It is commonly seen in younger aged
women 35-50, although can be seen in anyone. Infections by viruses, and bacteria and genetic factors (HLA-DR4) are thought to possibly
trigger the destructive inflammation.
RA is characterized by symmetric involvement of the large and small joints. The originating cause is by a nonspecific inflammation which
then produces T-cell activation (cell of your immune system) and a pannus (flap of tissue) is formed. The pannus erodes into the
surrounding cartilage, tendons, and even bones.
• Avascular Femoral Head Necrosis- Results from incomplete blood supply to the bone. The bone then typically develops necrosis or
destruction of normal tissue. A fracture of the femoral neck or dislocation of the femoral head may damage the blood vessels that supply the
femoral head. Other causes can be from arthritis syndromes, local or systemic steroids, infection, radiation, or unknown causes. When
there is necrosis in the femoral head, the bone typically cannot support the body weight and the femoral head can eventually collapse and
fracture causing pain and further complications.
• Labral Tears- The hip socket or acetabulum is lined by cartilage. This cartilage is called your labrum and allows for smooth movements of
the femur ball in your hip joint. A labral tear can result from injury or wear and tear arthritis. Labral tears can often be painful and those
affected often complain of a “catching” or “locking” sensation with certain movements. Treatment often involves medications, injections,
physical therapy, and sometimes surgery.
• Lumbar Radiculitis- Spinal nerve in the low back can become irritated and aggravated by various conditions. If a nerve root becomes
irritated it can cause painful radiation into the lower extremity. The pain is called referred because it is felt in the hip, but the pathology is in
the low back. Typically radiculitis can be diagnosed with a physical exam and relevant spinal imaging.
Diagnosis
Diagnosing patients with hip pain is never straight forward and is often difficult, as many of the symptoms are similar for different etiologies.
The first step in evaluating a patient with hip pain is a comprehensive history and physical exam. Several aspects will be covered in the
history and some of the most common questions asked are:
Where is the pain located?
How long has the pain been there?
What were you doing when you first noticed the pain?
Is there anything you can do that alleviates the pain?
Are you currently taking any medications for the pain? Do they work?
Is there any family history of arthritis or other autoimmune disease?
After conducting a full history and physical exam your physician may want additional studies, including radiological films and blood work.
Imaging techniques are useful because your physician is often able to see pathology inside the affected joint.
Common imaging techniques to evaluate arthritis include:
X-Ray - a diagnostic test which uses an electromagnetic energy ray to produce images of internal tissues. Bones are well visualized.
CT Scan - a diagnostic test that combines x-rays with computer technology to produce cross sectional views of the body. This is helpful
because it helps to visualize detailed images of the body, including the bones, muscles, and organs.
MRI Scan - a diagnostic image that uses large magnets and a computer to produce detailed images of the structures within the body. This is
even more detailed than the CT Scan and X-Ray.
Common laboratory tests that your physician may want to check are complete blood count (CBC), complement, antinuclear antibody (ANA),
creatinine, erythrocyte sedimentation rate, rheumatoid factor, urinalysis, and a white blood cell count (WBC). Another aspect that may
potentially need to be evaluated is the consistency of the fluid accumulation in the joint.
Your physician may want to perform an arthrocentesis to look at the components of the fluid in the joint. This is especially crucial when gouty
arthritis or a septic arthritis is suspected. Another method in evaluating the joint is performed by an orthopaedic surgeon and is called an
arthroscope. This procedure involves placing a small, optic tube (arthroscope) into the joint through. Images of the joint are projected onto a
screen and viewed by you and your physician. Your physician and pain specialist will decide which items are necessary to diagnose your
arthritis.
Treatment
There are many surgical and interventional options for severe causes of arthritis and joint pain. The most common and recommended
methods to treating arthritis are conservative alternative therapy provided by a pain specialist. Staying active and physical therapy as well as
NSAIDs and Acetaminophen (Tylenol), have also proven to be beneficial. Physical therapy has been noted to significantly improve the
postural stability in hip OA patients (Giemza 2007). Also, intra-articular joint injections are rapidly gaining popularity and use in the treatment
for arthritis because of their success, minimally invasive nature, and long-acting effects.
A joint injection may be considered for patients with symptoms suggesting arthritis. The injection can help relieve pain by reducing the
inflammation and numbing the joint and can also help diagnose the source of pain. The most important and greatest success achieved with
the use of joint injections is the rapid relief of symptoms that allows you to experience enough relief to become active again. With this you
regain the ability to resume your normal daily activities that was not achieved with oral medications and physical therapy.
There are many more treatments dependant on the cause of your specific pain. Each person suffering from pain is an individual and needs
an individualized pain plan. Contact Arizona Pain Specialists today to see what your pain relief options are available.
Articles
Arthritis burden and impact are greater among U.S. women than men: intervention opportunities. J Womens Health (Larchmt). 2007 May;16
(4):441-53 Theis KA, Helmick CG, Hootman JM.
The effect of physiotherapy training program on postural stability in men with hip osteoarthritis. Giemza C, Ostrowska B, Matczak-Giemza M.
Aging Male. 2007 Jun;10(2):67-70
The hip joint is a ball and socket joint, where the femur (large thigh bone) connects to the pelvis. The top of the femur is a round ball, which
fits into the socket (acetabulum) formed by the pelvic bone. The ball is allowed to glide and rotate within the acetabulum because a group of
ligaments and muscles support the joint and inhibit over extension or malrotation from occurring. Also, within the joint is a synovial lining,
which provides lubricating fluid to decrease friction, produced when the joint is in motion.
Pathology
Hip dislocations and femur fractures are often acute injuries and can be acutely treated. There are other conditions that can produce chronic
progressive hip pain.
Diseases, besides trauma, that can cause chronic hip pain:
• Osteoarthritis (OA)- also known as degenerative arthritis or degenerative joint disease. OA is the most common cause of arthritis in the
United States. It is most common in women, people over the age of 55, obese people, and those with a history of previous joint trauma or
disease.
OA results from repetitive wear and tear of the joint. OA can cause a chronic, non-inflammatory arthritis of any moveable joint. The most
common joints involved in OA are the DIP joints (small joints closest to your fingernails) of the fingers and the knees. Typically the joint
involvement is one-sided and asymmetric. Patients typically experience crepitus, which is a crackling or popping sound and sensation. This
is created when the cartilage has broken down and two rough edges are coming into contact with each other. This can also cause a
decrease in range of motion, pain that worsens with activity, and improves with rest. There is typically no localized swelling or redness seen
with this cause of arthritis.
• Rheumatoid Arthritis (RA)- Unlike OA, RA is a chronic, systemic, destructive, inflammatory arthritis. It is commonly seen in younger aged
women 35-50, although can be seen in anyone. Infections by viruses, and bacteria and genetic factors (HLA-DR4) are thought to possibly
trigger the destructive inflammation.
RA is characterized by symmetric involvement of the large and small joints. The originating cause is by a nonspecific inflammation which
then produces T-cell activation (cell of your immune system) and a pannus (flap of tissue) is formed. The pannus erodes into the
surrounding cartilage, tendons, and even bones.
• Avascular Femoral Head Necrosis- Results from incomplete blood supply to the bone. The bone then typically develops necrosis or
destruction of normal tissue. A fracture of the femoral neck or dislocation of the femoral head may damage the blood vessels that supply the
femoral head. Other causes can be from arthritis syndromes, local or systemic steroids, infection, radiation, or unknown causes. When
there is necrosis in the femoral head, the bone typically cannot support the body weight and the femoral head can eventually collapse and
fracture causing pain and further complications.
• Labral Tears- The hip socket or acetabulum is lined by cartilage. This cartilage is called your labrum and allows for smooth movements of
the femur ball in your hip joint. A labral tear can result from injury or wear and tear arthritis. Labral tears can often be painful and those
affected often complain of a “catching” or “locking” sensation with certain movements. Treatment often involves medications, injections,
physical therapy, and sometimes surgery.
• Lumbar Radiculitis- Spinal nerve in the low back can become irritated and aggravated by various conditions. If a nerve root becomes
irritated it can cause painful radiation into the lower extremity. The pain is called referred because it is felt in the hip, but the pathology is in
the low back. Typically radiculitis can be diagnosed with a physical exam and relevant spinal imaging.
Diagnosis
Diagnosing patients with hip pain is never straight forward and is often difficult, as many of the symptoms are similar for different etiologies.
The first step in evaluating a patient with hip pain is a comprehensive history and physical exam. Several aspects will be covered in the
history and some of the most common questions asked are:
Where is the pain located?
How long has the pain been there?
What were you doing when you first noticed the pain?
Is there anything you can do that alleviates the pain?
Are you currently taking any medications for the pain? Do they work?
Is there any family history of arthritis or other autoimmune disease?
After conducting a full history and physical exam your physician may want additional studies, including radiological films and blood work.
Imaging techniques are useful because your physician is often able to see pathology inside the affected joint.
Common imaging techniques to evaluate arthritis include:
X-Ray - a diagnostic test which uses an electromagnetic energy ray to produce images of internal tissues. Bones are well visualized.
CT Scan - a diagnostic test that combines x-rays with computer technology to produce cross sectional views of the body. This is helpful
because it helps to visualize detailed images of the body, including the bones, muscles, and organs.
MRI Scan - a diagnostic image that uses large magnets and a computer to produce detailed images of the structures within the body. This is
even more detailed than the CT Scan and X-Ray.
Common laboratory tests that your physician may want to check are complete blood count (CBC), complement, antinuclear antibody (ANA),
creatinine, erythrocyte sedimentation rate, rheumatoid factor, urinalysis, and a white blood cell count (WBC). Another aspect that may
potentially need to be evaluated is the consistency of the fluid accumulation in the joint.
Your physician may want to perform an arthrocentesis to look at the components of the fluid in the joint. This is especially crucial when gouty
arthritis or a septic arthritis is suspected. Another method in evaluating the joint is performed by an orthopaedic surgeon and is called an
arthroscope. This procedure involves placing a small, optic tube (arthroscope) into the joint through. Images of the joint are projected onto a
screen and viewed by you and your physician. Your physician and pain specialist will decide which items are necessary to diagnose your
arthritis.
Treatment
There are many surgical and interventional options for severe causes of arthritis and joint pain. The most common and recommended
methods to treating arthritis are conservative alternative therapy provided by a pain specialist. Staying active and physical therapy as well as
NSAIDs and Acetaminophen (Tylenol), have also proven to be beneficial. Physical therapy has been noted to significantly improve the
postural stability in hip OA patients (Giemza 2007). Also, intra-articular joint injections are rapidly gaining popularity and use in the treatment
for arthritis because of their success, minimally invasive nature, and long-acting effects.
A joint injection may be considered for patients with symptoms suggesting arthritis. The injection can help relieve pain by reducing the
inflammation and numbing the joint and can also help diagnose the source of pain. The most important and greatest success achieved with
the use of joint injections is the rapid relief of symptoms that allows you to experience enough relief to become active again. With this you
regain the ability to resume your normal daily activities that was not achieved with oral medications and physical therapy.
There are many more treatments dependant on the cause of your specific pain. Each person suffering from pain is an individual and needs
an individualized pain plan. Contact Arizona Pain Specialists today to see what your pain relief options are available.
Articles
Arthritis burden and impact are greater among U.S. women than men: intervention opportunities. J Womens Health (Larchmt). 2007 May;16
(4):441-53 Theis KA, Helmick CG, Hootman JM.
The effect of physiotherapy training program on postural stability in men with hip osteoarthritis. Giemza C, Ostrowska B, Matczak-Giemza M.
Aging Male. 2007 Jun;10(2):67-70
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Hip Pain
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin
M.D
The hip joint is a large weight bearing joint that attaches the leg bone
(femur) to the pelvis. It is an extremely important joint, as it allows the
body to walk, run, and sit. The hip is a very strong structure, but still can
be damaged. Sports-related injuries, motor vehicle accidents (MVA),
and falls in the elderly are subject to the most crucial hip injuries.
However, severe chronic hip pain is often due to arthritis.
In 2007 the Centers for Disease Control (CDC) published an article that
stated, “Arthritis continues to burden the U.S. population as the leading
cause of physical disability and affects women disproportionately:
women with arthritis report greater prevalence of activity and work
limitations, psychological distress, and severe joint pain than their male
counterparts” (Theiss 2007).
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin
M.D
The hip joint is a large weight bearing joint that attaches the leg bone
(femur) to the pelvis. It is an extremely important joint, as it allows the
body to walk, run, and sit. The hip is a very strong structure, but still can
be damaged. Sports-related injuries, motor vehicle accidents (MVA),
and falls in the elderly are subject to the most crucial hip injuries.
However, severe chronic hip pain is often due to arthritis.
In 2007 the Centers for Disease Control (CDC) published an article that
stated, “Arthritis continues to burden the U.S. population as the leading
cause of physical disability and affects women disproportionately:
women with arthritis report greater prevalence of activity and work
limitations, psychological distress, and severe joint pain than their male
counterparts” (Theiss 2007).
Book I - Pain Syndromes
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions