Hip pain, also described as “groin pain,” “groin pull,” “fork in my groin” “aching ovaries,” or a deep aching pain in one’s hip, can occur from injury to the hip brought on by mechanical dysfunctions in the joint, or the result of trauma from the high impact and deep flexion occurring in sports such as football, downhill skiing, martial arts and wrestling. It also can arise as the result of repetitive motion from certain movements such as golf or soccer. Or, pain can result from a congenital condition that causes wear and tear on the joint. Sometimes the pain is noticed after sitting through a movie or getting in and out of a car.
If you find yourself with hip pain, it’s important to consult a physician. An examination will help to determine what’s causing the soreness, since hip pain can actually come from the hip as well as the spine, pelvis or leg. While waiting to see your physician, there are activity modifications and exercises that may help to relieve some of the discomfort. View activities and exercises.
Femoro-acetabular impingement (FAI) occurs when the ball (head of the femur) does not have its full range of motion within the socket (acetabulum of the pelvis). This causes a decreased range of hip joint motion, in addition to pain. Most commonly, FAI is a result of excess bone that has formed around the head and/or neck of the femur, otherwise known as “cam”-type impingement. FAI also commonly occurs due to overgrowth of the acetabular (socket) rim, otherwise known as “pincer”-type impingement, when the socket is angled in such a way that abnormal impact occurs between the femur and the rim of the acetabulum.
When the extra bone on the femoral head and/or neck hits the rim of the acetabulum, the cartilage and labrum that line the acetabulum can be damaged. The extra bone can appear on x-rays as a seemingly very small “bump.” However, when the bump repeatedly rubs against the cartilage and labrum (which serve to cushion the impact between the ball and socket), the cartilage and labrum can fray or tear, resulting in pain. As more cartilage and labrum is lost, the bone of the femur will impact with the bone of the pelvis. This “bone on bone” motion is most commonly known as arthritis.
Non-surgical treatment should always be considered first when treating hip pain. The discomfort can often be resolved with rest, modifying one’s behavior, and a physical therapy and/or anti-inflammatory regimen. Such conservative treatments have been successful in reducing the pain and swelling in the joint.
If pain persists, it is sometimes necessary to differentiate between pain radiating from the hip joint and pain radiating from the lower back or abdomen. A proven method for differentiating between the two is by injecting the hip with a steroid and analgesic. The injection accomplishes two things:
The hip is a ball and socket joint with the femur, or thigh bone (ball) inserting into the acetabulum, or pelvic bone (socket). Both the ball and socket are covered with smooth articular cartilage. The labrum is an additional, specialized piece of cartilage that runs along the rim of the socket to provide a suction seal and stability to the hip joint. The labrum can be torn with a sudden, specific injury or with repetitive motions that cause “wear and tear.”
Labral tears often cause what feels like “groin pain.” Most patients describe the injury as a sharp pain that feels very deep. The pain level usually rises with increased activity and is easy to reproduce with high degrees of flexion and internal rotation of the hip joint. Sometimes an athlete will believe that the pain that he or she is experiencing is a groin pull. If, after treatment and rest, the patient resumes sports only to feel the pain recur, a labral tear or hip impingement should be considered.
The occasional “snapping” that can be heard when walking or swinging one’s leg around, results from the movement of a muscle or tendon (the tough, fibrous tissue that connects muscle to bone) over a bony structure. In the hip, the most common site is at the outer side where a band of connective tissue (the iliotibial band) passes over the broad, flat portion of the thighbone known as the greater trochanter (tro-KAN-ter). The snapping can also occur from the back-and-forth motion that takes place when the tendon, running from the inside of the thighbone up through the pelvis, shifts across the head of the thighbone. A tear in the cartilage or some bone debris in the hip joint can also cause a snapping or clicking sensation.
Recently, more and more athletes are being diagnosed with labral tears or impingement of the hip. This is especially common in athletes who perform repeated hip flexion such as runners, hockey players, soccer players, and football players. It is hard to remember players being diagnosed as having labral tears of the hip 10 years ago, as these were often misdiagnosed as common groin pulls. The use of MRI has greatly improved our ability to diagnose labral injuries.
Many labral tears may become asymptomatic, and these do not need specific treatment. However, for athletes with persistent pain from labral tears, there are many treatment options. Physical therapy is used to improve hip range of motion and strengthen the muscles around the hip joint. Pain medications such as anti-inflammatories (ibuprofen, Advil, Motrin, Aleve, etc.) can be used to decrease inflammation around the labrum and provide pain relief.
For those with continued pain from a labral tear, surgery is often indicated. Arthroscopic surgery can be performed through small incisions (1/2 cm) around the hip with specialized instruments to either debride (clean) or remove the injured labrum, or repair it to the socket.
After the surgery, the patient will be on crutches for two to six weeks; this is determined on a case by case basis. Physical therapy is used to improve the hip range of motion and muscle strength around the hip. Once a patient is free of symptoms and has regained his or her strength, he or she can return to play, which occurs within two and six months, depending on the extent of the injury.
The labrum contains nerve endings that can stimulate pain fibers, which can cause pain in the hip region.
It is possible to gain relief from the pain associated with a labral tear through appropriate muscle training and activity modification and therefore not feel the need for surgery. However, physical therapy will not fix a labral tear.
Recently, more and more athletes are being diagnosed with labral tears or impingement of the hip. This is especially common in athletes who perform repeated hip flexion such as runners, hockey players, soccer players, martial arts competitors, wrestlers, skiers and football players.
For the hip to last a lifetime, the anatomy must be normal and there needs to be the absence of catastrophic problems such as trauma or infection. Hip "dysplasia" refers to a hip that does not develop properly because of congenital dislocation, where the femoral head is not fully seated in the acetabulum. Degenerative changes, as a result of these irregularities, can occur very early in life; the greater the abnormalities, the sooner symptoms may occur.
Dysplasia can cause arthritis (loss of cartilage) because the shallow socket creates inadequate contact between the ball and socket. The overloaded cartilage can wear away if this situation is not corrected. In addition, the labrum (rim) is often torn, because of the high loads to which it is subjected in trying to maintain coverage of the head.
If you have been treated for groin pain and it keeps coming back, it may be your hips. You may want to consult a specialist or seek the opinion of another medical professional.
There are cases when a sports hernia has been diagnosed when it is really a hip condition. If you have been treated for a sports hernia and don’t seem to be improving, you may want to consult a specialist or seek the opinion of another medical professional.
If you have been treated for athletic pubalgia and don’t seem to be improving, there are cases where athletic pubalgia has been diagnosed when it is really a hip impingement. You may want to consult a specialist or seek the opinion of another medical professional.
Sometimes patients are treated for Gilmore’s Groin when it is really a hip problem. You may want to consult a specialist or seek the opinion of another medical professional to rule out a hip problem.
Non-surgical treatment should always be considered first when treating hip pain. In the case of hip impingement, it is possible to resolve the pain with rest, by modifying one’s behavior, and with a physical therapy and/or anti-inflammatory regimen. Such conservative treatments have been successful in reducing the pain and swelling in the joint.
Impingement can present at any time between the teen years and middle age. Patients often complain of discomfort in the front of their hip (groin) after prolonged sitting or walking (especially up hill). The pain can be a constant dull ache and/or a catching and or sharp, popping sensation. Sometimes it feels as though one’s hips are always tight. Pain can also be felt along the side of the thigh and in the buttocks.
Medical imaging including x-rays and magnetic resonance imaging (MRI) are crucial in diagnosing impingement. An x-ray can reveal an excess of bone on the femoral head or neck and the acetabular rim. An MRI can reveal fraying or tears of the cartilage and labrum.
Sometimes it is necessary to find a way to differentiate pain radiating from the hip joint and pain radiating from the lower back or abdomen. To accomplish this, the hip can be injected with a steroid and analgesic. If the pain is coming from the hip joint, the injection provides the patient with pain relief and confirms the diagnosis of hip pain. Once this is established, proper imaging can be performed to better understand how to provide relief. If the pain is not relieved, then the pain is coming from outside the hip joint, most likely the back muscles.
An ultrasound-guided cortisone injection made directly into the hip joint can provide relief. Ultrasound-guided cortisone injections using dedicated high-resolution ultrasound equipment are very precise and allow a radiologist to target the injections directly into an area, maximizing therapeutic outcomes. Following the injection, pain relief varies from patient to patient. Some may feel relief from pain within two to five days. If a patient feels no relief within ten days following the injection, the patient is unlikely to gain any additional improvement and further diagnostic testing may be needed to accurately identify the source of a patient’s pain.
Recent advances in the development of surgical equipment have allowed orthopaedic surgeons to treat conditions that were traditionally either ignored or treated with an open procedure. The procedure has been popular in Europe for the past 15-20 years, but has only recently gained popularity in the United States over the past 5-10 years.
Hip arthroscopy, or a “hip scope,” is a minimally-invasive procedure. The use of an arthroscope means that the procedure is done using 2-3 small incisions (approximately 1/4-1/2 inch long) rather than a more invasive “open” surgery that would require a much larger incision. These small incisions, or “portals", are used to insert the surgical instruments into the joint.
Hip arthroscopy is a safe and effective alternative to open surgery of the hip, a tremendous advantage in treating early hip conditions that may advance one day to end-stage arthritis.
Patients who respond best to hip arthroscopy are active individuals with hip pain, where there exists an opportunity to preserve the amount of cartilage they still have. Patients who have already suffered significant cartilage loss in the joint may be better suited to have a more extensive operation, which may include a hip replacement.
Following a combination of physical and diagnostic exams, patients are deemed suitable for arthroscopy on a case-by-case basis. Patients who respond best to hip arthroscopy are active individuals with hip pain, where there exists an opportunity to preserve the amount of cartilage they still have. Patients who have already suffered significant cartilage loss in the joint may be better suited to have a more extensive operation.
Studies have shown that 85-90 percent of hip arthroscopy patients return to sports and other physical activities at the level they were at before the onset of hip pain. The majority of patients get better, but it is not yet clear to what extent the procedure stops the course of arthritis. Patients who have underlying skeletal deformities or degenerative conditions may not experience as much relief from the procedure as would a patient with simple impingement.
As with all surgical procedures, there remains a small likelihood of complications associated with hip arthroscopy. Some of the risks are related to the use of traction. Traction is required to distract and open up the hip joint to allow for the insertion of surgical instruments. This can lead to post-surgery muscle and soft tissue pain, particularly around the hip and thigh. Temporary numbness in the groin and/or thigh can also result from prolonged traction. Additionally, there are certain neurovascular structures around the hip joint that can be injured during surgery. As with any surgery, there is also a chance of a poor reaction to the anesthesia.
For the hip to last a lifetime, the anatomy must be normal along with the absence of catastrophic problems such as trauma or infection. Hip problems can develop from congenital irregularities in the hip, trauma or wear and tear. Degenerative changes may appear early in life with symptoms (pain). This may signal that an individual may benefit from early intervention rather than leaving overloaded cartilage to wear away, leaving the patient open to the possibility of arthritis later in life.
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