Brief overview
- Description: Pain in the area of the hip joint, mostly in the groin or in the area of the large rolling hill (bone protrusion at the top outside of the thigh)
- Causes: e.g. osteoarthritis (hip joint arthrosis = coxarthrosis), fracture of the neck of the femur, “dislocation” (luxation) of the hip joint, inflammations, growing pains, leg length discrepancy, bursitis, arthritis, “snapping hip”, etc.
- Diagnostics: Patient interview (anamnesis), physical examination (e.g. testing of leg axis and pelvic position, mobility), blood test, imaging procedures (such as X-ray, computer tomography, magnetic resonance imaging).
- Therapy: Depending on the cause, e.g., medication (such as anti-inflammatory drugs, cortisone), heat therapy, exercise therapy, electrotherapy, surgical procedures (such as removal of a persistently inflamed bursa or insertion of an artificial hip joint).
Hip pain: description
The characteristics of the complaints can vary greatly: For example, in some patients the hip pain is unilateral with radiation into the leg, in others there is no radiation of pain, and in a third group both hip joints are affected. Some patients complain particularly of hip pain when walking, while in others the pain in the hip is most noticeable when getting up in the morning. In some cases, there is also persistent hip pain.
Hip pain: causes and possible diseases
Hip pain can be acute or chronic.
Acute hip pain: causes
The main causes of sudden (acute) hip pain are:
- Femoral neck fracture: sudden hip pain in the groin area after a fall, less often with no apparent cause (in osteoporosis); movement of the affected leg is very painful
- septic coxitis: bacterial inflammation of the hip joint; usually the hip pain is unilateral, increases rapidly and is accompanied by high fever and a strong feeling of illness
- Coxitis fugax (“hip flare”): Inflammation of the hip joint in young children; sudden leg and hip pain in the groin area; the children limp and no longer want to walk
Chronic hip pain: causes
In other cases, hip pain develops more slowly and can last for a long time. The main causes are:
Leg length discrepancy (BLD).
Osteoarthritis of the hip joint (coxarthrosis)
Doctors call osteoarthritis of the hip joint (coxarthrosis). It occurs mainly in older age, but sometimes also affects younger people. Patients suffer from chronic hip pain with increasing restriction of movement. The complaints become noticeable, for example, when getting out of a car or climbing stairs. In later stages of the disease, hip pain also occurs at night and at rest.
Sufferers complain of hip pain, more specifically pain in the area of the large rolling mound. This is the strong bony prominence at the lateral hip joint. The pain radiates along the outside of the thigh to the knee. It is most noticeable when bending or severely abducting the hip joint.
Periarthropathia coxae may occur alone or as a concomitant of other conditions such as coxarthrosis or leg length discrepancy.
Bursitis (inflammation of the bursa)
Arthritis of the hip joint (coxitis).
Generally, hip pain in coxitis occurs in the groin area and often extends to the knee. The hip has limited mobility, and patients usually adopt a protective posture (with slight flexion and outward rotation of the thigh).
“Rapid hip” (coxa saltans).
Subsequently, coxa saltans often leads to inflammation of the bursa in the trochanteric region (bursitis trochanterica).
Idiopathic femoral head necrosis
In idiopathic femoral head necrosis, patients report increasing, load-dependent hip pain in the groin area; knee pain may also occur. Internal rotation and spreading (abduction) of the thigh are increasingly limited.
Osteonecrosis of the femoral head in children is called Perthes disease. At first, it is usually only noticeable by a limp. Hip pain in the groin or knee pain usually follow later.
Narrowing syndrome (impingement) of the hip
Meralgia paraesthetica
Initially, the hip pain appears only when standing and improves when the leg is bent at the hip joint. Later, permanent pain occurs.
The complaints in this clinical picture are due to nerve compression under the inguinal ligament. Patients suffer from paraesthesia, burning pain and sensory disturbances on the front or outer side of the thigh.
Epiphysis capitis femoris
This is the chronic variant of femoral head slippage (see above). It is much more common, but also occurs during puberty.
Hip pain: pregnancy
Affected women report sometimes severe pelvic, low back or hip pain. Early pregnancy may already be accompanied by such complaints. The increasing weight of the growing child can intensify them in the course.
Hip pain: What to do?
In case of hip pain, you should always go to the doctor to have the cause clarified. This diagnosis and individual factors will then determine how hip pain can be treated. Some examples:
Treatment options for coxarthrosis include:
- Exercise therapy
- Heat treatment
- Electrotherapy
- Artificial hip joint: If conservative measures do not help sufficiently against the restricted movement and pain in the hip, many patients receive an artificial hip joint.
Hip pain: what you can do yourself
In the case of coxarthrosis can help:
- Relieve the hip: The therapy of a coxarthrosis includes first of all a change of lifestyle: In case of obesity (adiposity) a weight loss, various aids for everyday life (walking stick, putting on aids for shoes and stockings etc.) are recommended.
These exercises, which you should never do without consulting or being guided by a doctor or physiotherapist, could include:
- Hip mobilization: Stand facing the wall on a low step or thick book, stabilize with hands on the wall. First let the right leg swing back and forth, then switch legs.
- Stretch hip muscles: Stand hip-width apart. Lunge forward with your right leg, push your hips forward, you can place the knee of the back leg on the floor for a secure stance (place towel/mat underneath). Return to starting position. Switch legs. Alternatively, place one leg on the seat of a chair and lean forward.
In the case of “hip rhinitis” (coxitis fugax), which usually occurs in children and only rarely in adults, the pain can generally be relieved with a few days of bed rest and the administration of the painkiller paracetamol. However, as long as the leg and hip pain in the groin persists, the affected child should not participate in school sports.
Hip pain: When do you need to see a doctor?
In children and adolescents, hip pain should always be evaluated by a doctor, because in this age group it is usually caused by a serious condition that can leave permanent damage.
Hip pain: diagnosis
To get to the bottom of the cause of your hip pain, the doctor will first talk to you in detail. Possible questions to ask during this history-taking interview include:
- Where exactly do you feel the hip pain?
- Does the hip pain only occur during exertion or is it also noticeable at rest or at night?
- How far can you walk on level ground without experiencing hip pain?
- Is there any unsteadiness in your gait? Do you use a walking stick?
- Do your joints feel stiff for more than half an hour in the morning (morning stiffness)?
- Do you have pain in other joints as well?
- Do you notice any paraesthesia in your legs?
- Do you take any medication (painkillers, cortisone preparations, etc.)?
- What is your profession? Do you do any sports?
Physical examination
This is followed by the physical examination. The doctor will always examine both sides equally, even if the hip pain only occurs on one side.
In the next step, the doctor palpates and taps the groin area and the area around the trochanter on the outside of the pelvis. He looks for signs of inflammation such as local redness, hyperthermia and swelling. These symptoms could indicate bursitis as the cause of the hip pain.
Blood test
Imaging procedures
An X-ray examination of the pelvis is primarily used to detect any signs of osteoarthritis as a cause of hip joint pain. Even more detailed images are obtained with the aid of computed tomography (CT). It can better show the severity of joint destruction (for example, in the case of femoral head necrosis).
Magnetic resonance imaging (MRI) is well suited to diagnosing soft tissue changes caused by inflammation and the early stages of osteonecrosis or a fatigue fracture.
If the hip pain is due to inflammation or tumors in the joint area, this can be determined with the help of a nuclear medicine examination (joint scintigraphy).
