Hip Pain

Overview

Hip pain has numerous potential causes, ranging from musculoskeletal complaints such as hip arthritis, greater trochanteric bursitis and iliopsoas impingement to intra-abdominal problems such as sportsman’s hernia, inguinal hernia and athletic pubalgia, and even multifactorial conditions like complex regional pain syndrome and fibromyalgia. Each of the aforementioned conditions will cause a form of hip pain and the pain will be slightly different depending on the cause. These differences are key to helping your healthcare practitioner achieve a definitive diagnosis of the true cause of your hip pain.

X-ray showing hip anatomy.

Diagnosis

The first step in achieving a diagnosis for your hip pain is consulting a healthcare professional. Any hip pain that does not self-resolve or respond to over-the-counter-analgesia should be presented to an appropriate healthcare professional for diagnosis. As with most medical problems, a thorough medical history is important to obtain. This includes details about the pain itself and more general information about your medical history. A physical examination is also essential to achieving a diagnosis – this will involve movement of the painful hip as well as examination of your gait and potentially more specific tests designed to identify specific causes of hip pain. You will most likely also require medical imaging in some form – what type is up to your healthcare professional to determine.

Treatment

The first line treatment for any joint pain should be rest of the affected joint for a short period of time. Over-the-counter analgesics such as Tylenol or nonsteroidal anti-inflammatory medications are also appropriate. If neither of these prove effective at relieving your pain then you may require a full course of dedicated physical therapy. If this also proves ineffective then consultation with a healthcare professional in regards to your hip pain is warranted.

More invasive treatments for persistent and refractory hip pain range from injections of corticosteroid and/or local anaesthetic into the hip joint (usually done under imaging guidance by a specialist radiologist) to surgical procedures to address the cause of the hip pain. These can range from hip arthroscopy in younger patients to address abnormal anatomy that is causing damage to the soft tissues within the hip joint, to pelvic osteotomies to realign the hip joint to preserve the cartilage in the joint for as long as possible, to hip replacement surgery when the normal hip cartilage has worn away and arthritis is the principal cause of your hip pain. Your healthcare professional should be able to advise you on the most appropriate treatment for you based on your diagnosis, or refer you to another healthcare professional who can.

Summary

Hip pain has a potentially wide range of causes – some are less serious and self-limiting, others will require medical or surgical intervention to treat effectively. It is important to identify refractory hip pain early on and seek the advice of an appropriate healthcare professional as soon as possible to achieve a diagnosis and ensure you receive appropriate treatment in a timely manner.