Video Transcript
There are a few most common causes of hip pain. The first thing really to distinguish is to identify which pain is coming from the hip, as opposed to some other source. So four causes of hip pain, and the pain can come from muscles, ligaments, tendons, the pain can come from within the joint itself. But those types of pain present in a different way. So that’s the most important distinguishing factor is to find out is the hip actually the cause of the pain to begin with.
Hip pain can come from, when it’s coming from muscles, tendons, and ligament injuries, typically come from overuse syndromes. This can come from overusing the strongest hip muscles in the body such as iliopsoas tendinitis; it can come from tendon and ligament irritations, which typically are involved in snapping hip syndrome, it can come from within the joint which is more characteristic of hip osteoarthritis. Each of these types of pain present in slightly different ways, which is then the most important part really in diagnosing and sifting through what the cause is by doing a good physical examination and making a correct diagnosis.
In terms of diagnosing hip pain, typically a patient will expect when they come in to be asked about their symptoms, and it’s very important to find out when did these symptoms start, how long have they been going on for, how frequent are they, do they come on in the morning or in the evening, do they come on with any certain activity, is there something that makes them better or makes them worse. The intensity of the pain also is important. And describing does it have any associated radiating symptoms? Is it just localized to one spot or does it move? After getting a history and finding out what the type of pain the patient is having, that also includes whether the pain is dull, aching, or sharp, or intense, then it’s important to do a good physical exam. And the physical examination involves testing the muscle strength, testing for sensation, testing, doing specific provocative maneuvers which might help us rule out one type of injury from another.
In diagnosing the causes of hip pain, it’s important to understand what the hip anatomy is. The hip is basically a ball-and-socket joint similar to the shoulder joint in the arms. The hip joint is impressive in that it serves two factors, it’s a support structure as well as being very flexible. Because it’s a strong support structure, it’s also tends — it also tends to get injured. Because it’s very flexible, it similarly can be susceptible to different types of injuries.
The bones of the hip are supported by specific muscles. The strongest muscle in the body actually is one of the main flexors of the hip, it’s called the iliopsoas muscle. And it has two attachments to the inner part of the hip as well as to the lower part of the back. This muscle is involved in iliopsoas tendinitis, iliopsoas bursitis, and is one of the common causes of muscle pain that causes hip pain. The tendons attach the muscles to the bones and the ligaments connect bones to bone. So, an area that is often susceptible to increased pressure are the tendons themselves or the muscles attached to the bone, so that is another source of pain, more specifically in iliopsoas tendinitis. The bursa are pockets of fluid that also protect the top part of the bone to prevent pressure from being placed on the bone. There are about 160 different bursa in the body, and when they get irritated, this can develop into bursitis.