What Are Causes of Traumatic Hip Pain?

DR. SUNIL RAJAN Head of Department Apollo Institute of Orthopaedics, Apollo Hospitals, Indore M.S Orthopedics, Specialization: Joint Replacement Surgery

What Are Causes of Traumatic Hip Pain?

Hip Fracture Falls are the most common reason that elderly people break a hip. The fracture is due to a combination of two effects of aging, osteoporosis (thinning of bones), and a loss of balance.

These two risk factors are the potential cause of many falls. Occasionally, the bone may spontaneously break due to osteoporosis and become the cause of the fall.

Bones may also weaken because of other diseases that have affected the hipbones. A pathologic hip fracture describes this situation, and osteoporosis is but one cause. Other potential causes of bone weakening are cancer within the bones, benign tumors and cysts, Paget's disease, and inherited diseases of bone.

When health care professionals talk about a hip fracture, they really mean a fracture of the proximal or upper part of the femur. Fractures of the acetabulum are less common and usually are due to major trauma like a motor-vehicle collision or a fall down a flight of stairs.

The precise location of the fracture is important, because it guides the decision of the orthopedic surgeon as to which type of operation is needed to repair the injury.

Aside from a fall, any trauma can potentially cause a hip fracture. Depending upon the mechanism of injury, the femur may not break; rather, a portion of the pelvis (often the pubic ramus) may be fractured. The initial pain may be in the hip area, but examination and X-rays may reveal a source different than the hip joint as a cause of hip pain. Trauma can also cause a hip dislocation in which the femoral head loses its relationship with the acetabulum. This usually is associated with an acetabular (pelvic bone) fracture; however, in patients with hip replacements, the artificial hip may dislocate spontaneously.

Contusions (Bruises) Contusions (bruises), sprains, and strains may occur because of trauma, and even though there is no broken bone, these injuries can still be very painful.

Sprains are due to ligament injuries, while strains occur because of damage and inflammation to muscles and tendons (tendinitis: tendon + itis = inflammation). Because of the amount of force required to walk or jump, the hip joint is required to support many times the weight of the body.

The muscles, tendons, bursas, and ligaments are designed to shield the joint from these forces. When these structures are inflamed, the hip cannot function and pain will occur.

Overuse Injuries Hip pain may also arise from overuse injuries in which muscles, tendons, and ligaments can become inflamed. These injuries may be due to routine daily activities that may cause undue stress on the hip joint or because of one specific strenuous event. Overuse may also cause gradual wearing away of the cartilage in the hip joint, causing arthritis (arth = joint + itis = inflammation).

Other structures should be mentioned as a cause of hip pain because they become inflamed.

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Hip tendonitis is a common cause of pain, especially with involvement of the hip flexor tendons.

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The iliotibial band stretches from the crest of the pelvis down the outside part of the thigh to the knee. This band of tissue may become inflamed and cause hip pain, knee pain, or both. This is a type of overuse injury that has a gradual onset associated with tightness of the muscle groups that surround the knee and hip.

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Piriformis syndrome, in which the piriformis muscle irritates the sciatic nerve in the buttock, can also cause significant posterior hip pain. This pain often occurs when sitting, squatting, straining to have a bowel movement, or when trying to get out of bed. Because the sciatic nerve may be irritated, pain may radiate down the leg.

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