The hip is the body’s second largest weight-bearing joint after the knee. It is a ball and socket joint at the juncture of the leg and pelvis. The rounded head of the femur (thighbone) forms the ball, which fits into the acetabulum (a cup-shaped socket in the pelvis). Ligaments connect the ball to the socket and usually provide tremendous stability to the joint. The hip joint is normally very sturdy because of the fit between the femoral head and acetabulum as well as strong ligaments and muscles at the joint.
All of the various components of the hip mechanism assist in the mobility of the joint. Damage to any single component can negatively affect range of motion and ability to bear weight on the joint. Orthopedic degeneration or trauma – those conditions affecting the bones in the hip joint – can necessitate total hip replacement, partial hip replacement or hip resurfacing.
A hamstring strain can be a pull, a partial tear, or a complete tear.
Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily; a grade 3 strain is a complete tear of the muscle that may take months to heal.
Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibers join tendon fibers.
In the most severe hamstring injuries, the tendon tears completely away from the bone. It may even pull a piece of bone away with it. This is called an avulsion injury.
If you strain your hamstring while sprinting in full stride, you will notice a sudden, sharp pain in the back of your thigh. It will cause you to come to a quick stop, and either hop on your good leg or fall.
Additional symptoms may include:
- Swelling during the first few hours after injury
- Bruising or discoloration of the back of your leg below the knee over the first few days
- Weakness in your hamstring that can persist for weeks
Femoroacetabular impingement (FAI) is a condition where there is too much friction in the hip joint from bony irregularities causing pain and decreased range of hip motion. The femoral head and acetabulum rub against each other creating damage and pain to the hip joint. The damage can occur to the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket) during normal movement of the hip. The articular cartilage or labral tissue can fray or tear after repeated friction. Over time, more cartilage and labrum is lost until eventually the femur bone and acetabulum bone impact on one other. Bone on bone friction is commonly referred to as osteoarthritis.
Femoroacetabular impingement generally occurs as two forms: Cam and Pincer.
CAM Impingement: The cam form of impingement is when the femoral head and neck are not perfectly round, most commonly due to excess bone that has formed. This lack of roundness and excess bone causes abnormal contact between the surfaces.
PINCER Impingement: The pincer form of impingement is when the socket or acetabulum rim has overgrown and is too deep. It covers too much of the femoral head resulting in the labral cartilage being pinched. The pincer form of impingement may also be caused when the hip socket is abnormally angled backwards causing abnormal impact between the femoral head and the rim of the acetabulum.
Most diagnoses of FAI include a combination of the cam and pincer forms.
Symptoms of FAI
Symptoms of femoroacetabular impingement can include the following:
- Groin pain associated with hip activity
- Complaints of pain in the front, side or back of the hip
- Pain may be described as a dull ache or sharp pain
- Patients may complain of a locking, clicking, or catching sensation in the hip
- Pain often occurs to the inner hip or groin area after prolonged sitting or walking
- Difficulty walking uphill
- Restricted hip movement
- Low back pain
- Pain in the buttocks or outer thigh area
A hip labral tear involves the ring of cartilage, called the labrum, that follows the outside rim of the socket of your hip joint. The labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket.
Athletes who participate in such sports as ice hockey, soccer, football, golfing and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also can lead to a hip labral tear.
Many hip labral tears cause no signs or symptoms. Occasionally, however, you may experience one or more of the following:
- A locking, clicking or catching sensation in your hip joint
- Pain in your hip or groin
- Stiffness or limited range of motion in your hip joint
If you have arthritis which has not responded to conservative treatment, you may be a candidate for total hip replacement surgery.
Hip replacement has become necessary for your arthritic hip: this is one of the most effective operations known and should give you many years of freedom from pain.
Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons. When the articular cartilage wears out, the bone ends rub on one another and cause pain. In general, but not always, it affects people as they get older (osteoarthritis).
Other causes include
- Childhood disorders such as congenital dislocation of the hip, Perthe’s disease, slipped epiphysis, etc.
- Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis
- Trauma or fractures
- Increased stress such as overuse, obesity, etc.
- Avascular necrosis (loss of blood supply)
- Connective tissue disorders
- Obesity, since additional weight puts extra force through your joints which can lead to arthritis over a period of time
- Inflammation such as rheumatoid arthritis
In an Arthritic Hip
- The cartilage lining is thinner than normal or completely absent
- The degree of cartilage damage and inflammation varies with the type and stage of arthritis
- The capsule of the arthritic hip is swollen
- The joint space is narrowed and irregular in outline; this can be seen in an X-ray image
- Bone spurs or excessive bone can also build up around the edges of the joint
- The combinations of these factors make the arthritic hip stiff and can limit activities due to pain or fatigue
The diagnosis of osteoarthritis is made on history, physical examination, and X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).
Total hip replacement is indicated for arthritis of the hip that has failed to respond to conservative (non-operative) treatment.
You should consider a total hip replacement when you have
- Arthritis confirmed by X-ray
- Pain which does not respond to analgesics or anti-inflammatories
- Limitations of activities of daily living including your leisure activities, sport or work
- Pain keeping you awake at night
- Stiffness in the hip making mobility difficult
Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the outside (lateral) point of the hip known as the greater trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain.
What are the symptoms of trochanteric bursitis?
Trochanteric bursitis typically causes the following symptoms:
- Pain on the outside of the hip and thigh or in the buttock.
- Pain when lying on the affected side.
- Pain when you press in on the outside of the hip.
- Pain that gets worse during activities such as getting up from a deep chair or getting out of a car.
- Pain with walking up stairs.
Snapping hip is a condition in which you feel a snapping sensation or hear a popping sound in your hip when you walk, get up from a chair, or swing your leg around. The snapping sensation occurs when a muscle or tendon (the strong tissue that connects muscle to bone) moves over a bony protrusion in your hip. Although snapping hip is usually painless and harmless, the sensation can be annoying. In some cases, snapping hip leads to bursitis, a painful swelling of the fluid-filled sacs that cushion the hip joint.
Snapping hip can occur in different areas of the hip where tendons and muscles slide over knobs in the hip bones.
- Outside of the hip. The most common site of snapping hip is at the outer side where the iliotibial band passes over the portion of the thighbone known as the greater trochanter. When the hip is straight, the iliotibial band is behind the trochanter. When the hip bends, the band moves over the trochanter so that it is in front of it. The iliotibial band is always tight, like a stretched rubber band. Because the trochanter juts out slightly, the movement of the band across it creates the snap you hear. Eventually, snapping hip may lead to hip bursitis. Bursitis is thickening and inflammation of the bursa, a fluid-filled sac that allows the muscle to move smoothly over bone.
- Front of the hip. Another tendon that could cause a snapping hip runs from the front of the thigh up to the pelvis (rectus femoris tendon). Snapping of the rectus femoris tendon is felt in the front of the hip. As you bend the hip, the tendon shifts across the head of the thighbone, and when you straighten the hip, the tendon moves back to the side of the thighbone. This back-and-forth motion across the head of the thighbone causes the snapping.
- Back of the hip. Snapping in the back of the hip can involve the hamstring tendon. This tendon attaches to the sitting bone, called the ischial tuberosity. When it moves across the ischial tuberosity, the tendon may catch, causing a snapping sensation in the buttock region.
- Cartilage problems. The labrum that lines the socket of the hip can tear and cause a snapping sensation. Damaged cartilage can loosen and float in the joint causing the hip to catch or “lock up.” This type of snapping hip usually causes pain and may be disabling.
The iliotibial band is a band of fibrous tissue that runs down the outside of the thigh. It provides stability to the knee and hip and helps prevent dislocation of those joints. The band may overdevelop, tighten, and rub across the hipbone or the outer part of the knee. Each time the knee is bent or the hip flexed, the band rubs against bone. This is particularly common in runners, cyclists, and people who participate in other aerobic activities.
Symptoms of iliotibial band syndrome include:
- Pain on the outside of the knee or hip.
- Snapping hip pain as the iliotibial band snaps back and forth over the point of the hip (greater trochanter).
- Pain that generally disappears as the band is stretched out and becomes more flexible.
- Pain that improves with rest.
Iliotibial band syndrome is treated with rest, medicines to relieve swelling and pain, and stretching exercises as instructed by a physical therapist or sports medicine doctor. Steroid injections at the most tender spot are sometimes helpful.
Gluteus medius tears can be the result of traumatic injury or a degenerative condition. With both partial- or full- thickness tears of the gluteus medius that are the result of acute trauma to the muscle or tendon, localized bleeding and scar tissue formation and calcification of the tendon may occur. Cases of degenerative conditions such as tendinopathy are more common and can result in a complete tearing of the gluteus medius tendon over time.
One of the major symptoms of a gluteus medius tear is a condition referred to as a trendelenburg sign, which manifests itself as an abnormal gait cycle and causes a dipping of the hip that is swinging rather than the normal raising. A secondary indicator of a trendelenburg sign is the increased degrees of knee flexion as the individual attempts to clear the ground their foot. You may also feel pain or irritation in the buttocks that varies with severity of injury.