Hip pain is a nonspecific complaint that requires the health-care professional to find the underlying cause from the many potential injuries or illnesses. The approach to the diagnosis of hip pain requires an open mind because the source of trauma or the cause of illness may not be readily apparent.
Symptoms and Signs of Hip Pain
Hip pain is often difficult to describe, and patients may complain that the hip just hurts. The location, description, intensity of pain, what makes it better, and what makes it worse depend upon what structure is involved and the exact cause of the inflammation and injury.
Pain from the hip joint may be felt anteriorly (in front of the hip) as groin pain, laterally over the greater trochanter, or posteriorly in the buttock. Sometimes the patient may complain of knee pain that has been referred from the hip. This is especially true in children.
Trauma to the hip: With a fall, direct blow, twist, or stretch, the pain is felt almost immediately.
Overuse injury: The onset of pain may be delayed by minutes or hours as inflamed muscles surrounding the hip joint go into spasm or joint surfaces become inflamed, causing fluid accumulation. Overuse injuries may also cause cartilage, labrum, or capsule damage, resulting in inflammation, pain, and limping.
Pain: Most often, pain is felt in the front of the hip, but the joint is three-dimensional. Pain may be also felt along the outside part of the hip or even in the buttock area.
Limp: Limping is the body’s way of compensating for pain by trying to minimize the amount of weight the hip has to support while walking. Limping is never normal. Limping produces abnormal stresses on other joints, including the back, knees, and ankles, and if the limp persists, these areas may also become inflamed and cause further symptoms.
Fracture: With a hip fracture, there is an acute onset of constant pain after the injury that usually is made worse with almost any movement. The muscles that attach to the hip cause the fracture to displace, or move, and the leg may appear shortened and rotated outward. If no displacement occurs, the leg may appear normal but there is pain with any range of motion of the hip joint. Pelvic fractures may have pain similar to a hip fracture, but the leg appears normal.
Sciatica pain: Pain from the sciatic nerve tends to start in the lower back and radiate to the buttocks and to the front or side of the hip. It may be described in different ways because of nerve inflammation. Some typical descriptive terms used for the pain of sciatica include sharp, stabbing, or burning. The pain of sciatica may be made worse with straightening the knee, which stretches the sciatic nerve and may make it difficult to stand from a sitting position, or walk with a full stride. There may be associated numbness and tingling in the leg or foot. Physical examination may be able to map out which nerve root from the spine is involved.
Loss of bowel and bladder function associated with the pain may signal a neurosurgical emergency and the presence of cauda equina syndrome. If not recognized and treated with immediate surgery, there is risk for permanent damage to the spinal cord.
Arthritis: If arthritis narrows the hip joint and impinges the femoral head’s gliding motion within the acetabulum or if there is a tear in cartilage or labrum, the patient may describe a click, catch, or feeling that range of motion is somehow impeded. Usually, there is pain almost immediately that does not get better as activity continues.
Pain from arthritis tends to be worse after a period of inactivity and gets better as the joint “warms up” with use. But as activity increases, the pain will return.
Bone cancer: Cancer that arises primarily in bone or is metastatic, having spread from another site in the body, can cause intense, constant pain. It is often not related to activity and not made better with rest. Its location and radiation (where the pain spreads) may depend upon the location of the cancer within the hip or pelvis and what neighboring structures are involved or irritated.