Hip pain / hip pain diagnostic

Causes / forms

One distinguishes between pain in the hip joint on the one hand chronic acute pain, on the other hand, rest pain of mobility pain.
Furthermore, there are also combined complaints.
The pain character describes either pulling or biting pain, which can also radiate into the environment of the hip joint and oppressive, movement-impairing pain, which are located mainly at the joint without radiation.

  • Acute Pain: Acute hip pain occurs suddenly and unexpectedly. The cause is in many cases in trauma after quick carelessly performed movements in the hip joint.
    Harmless causes can be strains of the hip muscles. In this case, unphysiologically performed movements or rapid, unprepared movements without warming up the muscles lead to tensing of the muscles. Often, such strains occur in athletes when improperly warming up before performing the exercise. The pain in the hip joint is usually pulling and biting and let the affected person go into a protective posture. It also happens that it can come to movement restrictions in the joint.
    After accidents, it may happen that it does not come to a strain but to a crack or tear of the hip muscles. The pain is usually stronger than with the strain and in many cases also leads to a movement impairment.
    Also to the arrival or breakdown, it often comes after sports accidents, especially in duels in ball sports.
    Even with high-speed trauma, eg in car accidents, it can cause tearing of the muscles of the hip joint.
    After falls from a great height, fractures of the hip can occur. A distinction is made here between anterior to a posterior pelvic fracture and a stable from an unstable variant. In younger people, a stronger trauma is usually necessary to cause a pelvic ring fracture (fall from high altitude), in the elderly, often already falls from one to two steps of a staircase. The reason is the osteoporosis present in older people, which makes the bone break faster. In most cases it is the strongest pain that leads the patient to the doctor with a pelvic fracture. These patients also go into a posture immediately after the trauma. Usually movements can not be performed anymore.
  • In addition to the fractures of the hip, said falls can also lead to fractures of the femoral neck (usually in elderly patients) and also cause severe pain in the hip and movement impairments.
    Furthermore, it may also happen that in pain that has been present for some time and are stated in the hip, the actual cause much further down, namely in the knee. If no pain-causing cause is found in and around the hip joint, the knee on the corresponding side should definitely be examined, as knee joint injuries can lead to pain in the hip joint.
  • Chronic hip pain: chronic pain in the hip has existed for some time, they are by their character mostly in the course of becoming stronger and lead the patient only after a few months to the doctor.
    The main reason are usually signs of wear in the hip joint, which arise due to chronic stress and unilateral wear. This so-called coxarthrosis is a very common disease, especially of advanced age. The pain is described as pulling and pushing. The complaints are mostly accompanied by movement impairments in osteoarthritis of the hip joint. One differentiates once starting arthrosis of the hip joint from advanced arthrosis. While the incipient variant usually causes no or a few discomfort or only when a correspondingly heavy load on the hip joint, patients with advanced arthrosis complain at rest about pain and movement impairment.

Pain on the outside of the hip

There may be several causes of pain occurring on the outside of the hip, which may not always be in the hip joint itself.

Inflammation of the bursa (bursitis trochanterica) or of the tendinous tendon attachments is most common in the area of ​​the large hillock located in the lateral area of ​​the hip. Typical is a pressure pain in the area of ​​the outer hip / outer thigh, so that the patients often can not lie on the affected side.

In addition, pain when walking, running, sitting and climbing stairs can also occur. Furthermore, nerve stimulation ( neuralgia ) in the hip environment may be the cause of lateral hip pain. On the one hand small skin nerves in the area of ​​the outer hip may be affected ( Meralgia paraesthetica in case of irritation of the N. cutaneus femoris lateralis ), on the other hand there may also be pinching, bruising or damage of larger nerves arising from the spinal cord or the spine (N. sciatic nerve, femoral nerve, obturator nerve), which can lead to pain and disturbances in muscle control.

The irritation of cutaneous nerves can eg by constant pressure when wearing too tight clothing or by extreme weight gain on the stomach ( even in pregnancy !) Emerge, the entrapment of larger nerves, such as the sciatic nerve, may be due to muscle or caused by disc herniation of the lumbar spine become.

The irritation of cutaneous nerves is usually expressed by burning, stinging pain on the outside of the hip, often associated with tingling and numbness. Classical sciatic pain is characterized by perturbing pain in the lower back and the back of the leg, which in one case or another is accompanied by muscle weakness or sensory disturbances in the affected leg.

In addition to the nerve irritation also traumatic events in the hip area are possible, so that bruises, strains, muscle soreness, bruising or fractures can lead to pain on the outside of the hip.

The possible causes mentioned so far usually lead to unilateral hip pain in the outer area. If pain occurs on both outer sides, systemic joint diseases are more likely to be considered (hip osteoarthritis, rheumatism, gout, osteoporosis, vascular diseases such as peripheral arterial occlusive disease).

Hip pain in pregnancy

Hip pain can also occur during pregnancy. Pregnancy hormone secretion naturally occurs during pregnancy, making pelvic ligaments and joints more elastic and loose, facilitating childbirth.
This process can cause severe hip pain in some women. In addition, the increase in size of the child and the weight gain of the pregnant woman result in a heavy burden on the pelvis, which further promotes the development of hip pain. In addition, a number of different diseases can cause hip pain in pregnancy.
Hip pain that occurs during pregnancy is usually difficult to treat. Often, physiotherapy, pelvic floor exercises and orthopedic support belts are prescribed to strengthen the pelvic muscles and relieve the pelvis.

Also, the pregnant woman should take care not to lift too heavy objects and sufficiently long pauses to comply. Also, various medications, such as acetaminophen can in some cases relieve the hip pain during pregnancy. If the pregnant woman suffers greatly from hip pain, hormone therapy or even cesarean delivery may need to be considered.

Hip pain in children

In some cases an X-ray examination is required for the diagnosis.

In children, strains of the hip muscles, cracks or lacerations of the hip muscles as well as fractures of the pelvic ring and the femoral neck may be the reason for hip pain. However, there are also clinical pictures which typically cause hip pain only in childhood. These include, for example, the so-called coxitis fugax, which is popularly referred to as Hüftchnupfen . Hüftchnupfen (Coxitis fugax) is an inflammation of the hip joint, which affects especially children before the age of ten. In addition to the hip pain, which occur quite suddenly and can radiate to the legs, the children also come up with a restraint with limping and limited rotation in the hip joint. Usually, the hip fever is preceded by a banal infection, for example, cough or runny nose. However, the exact cause of the occurrence of hip dryness is not yet finally resolved. The hip flu can be detected by ultrasonic ultrasound examination. In some cases, an X-ray examination is also useful. While sparing the hip joint, the hip fever disappears by itself within one to two weeks.

Another disease in children, which is characterized by hip pain and a posture with limping and limited rotation in the hip joint, is the so-called Morbus Perthes. Morbus Perthes is a circulatory disorder of the femoral head of unknown cause. Due to the circulatory disorder, there is a lack of supply and eventually the death of the bone tissue in the femoral head, which can be associated with considerable hip pain. One can detect the Morbus Perthes by means of an x-ray examination. Treatment of Perthes's disease is either conservative using splints, plasters and walking aids to relieve and stabilize the femoral head, or surgically. The surgery will attempt to support the femoral head and provide optimal femoral head positioning in the acetabular cup. This is a very serious procedure that requires a comprehensive risk-benefit analysis. For some children, hip pain can occur during the growth phase. The pain, because they are associated with growth processes, referred to as growth pain. The cause of growing pains is ultimately unknown. Growth pains that typically occur in the legs, but also at any other part of the body, as can occur on the hip, are usually harmless and usually disappear by themselves.

In addition, congenital malformations of the femoral head and pelvis can cause hip pain in children. In addition, a recurrent hip pain should always consider a cancer of the thigh or pelvic bone.

Hip pain while walking

Hip pain, which increases when walking, when climbing stairs or when standing for a long time, often indicates inflammation of the bursa on the large rolling hill ( bursitis trochantericae, attachment tendinosis ). The cause of bursitis is often overuse of the joint, trauma, hip arthritis, back problems, different leg lengths or malpositioning of the hip.

But also signs of wear in the hip joint ( coxarthrosis ) can lead to hip pain while walking. In the process, the articular cartilage is broken down, causing the joint to rub more and more on the joint socket, which can cause severe pain when walking.

Also, hip joint inflammation ( coxitis ) can lead to the typical symptom of a swinging gait pattern (by bending the upper body and spreading the affected leg outwards), as the person concerned tries to minimize the pain when walking. In some cases, in the case of hip replacement, it may be necessary to puncture the joint to drain pus and infectious fluid. In addition, antibiotics and analgesics are administered.

Hip pain that occurs while walking should always be followed by a scan of the lumbar spine. Even a herniated disk of the lumbar spine or an entrapment of the sciatic nerve can lead to severe hip pain.

Another cause of hip pain in walking is peripheral arterial occlusive disease ( PAD ) of the aortic or pelvic type. The vascular disease is triggered by arteriosclerosis ( vascular calcification ) and leads to stinging muscle pain in the hip area, thighs and buttocks while walking. The strongest risk factor for the development of peripheral arterial disease is smoking. The therapy of hip pain depends on the underlying disease.

Hip pain while jogging

Pain while jogging

Hip pain while jogging can have a variety of causes. Already incorrect footwear while jogging can cause hip pain and even back pain due to a misalignment of the foot and lack of support of the footbed. In addition, the terrain that is jogged plays an important role in the development of hip pain. Particularly uneven floors can lead to an irregular distribution of weight and thus promote hip pain. Also, a shortened or insufficiently stretched hip and leg muscles can cause hip pain while jogging. Incorrect stress or exercise can also make sports injuries, such as hip muscle strains or hip muscle tears and bruises, and bursitis, which in turn can cause hip pain.

Of course, various diseases such as coxarthrosis, coxitis, rheumatism or gout can lead to hip pain while jogging. The best way to avoid hip pain while jogging with suitable shoes, sufficient warming up of the muscles before training, adjusted to the personal fitness level running speed and intensity of the respective training session. For the treatment of hip pain while jogging come physiotherapy, anti-inflammatory and analgesic drugs such as ibuprofen, and possibly surgery into consideration. If the hip pain is due to a disease while jogging, the treatment depends on this.

Hip pain while running

Hip pain, which is especially noticeable when walking, running or jogging or aggravating, can have different causes. Frequently, small things like a wrong footwear or unfavorable running surfaces already play an essential role in the development of hip pain.
But foot deformities, a malfunctioning running technique, shortened or imbalanced hip and leg muscles as well as overloads in the joint due to excessive training can be the cause.

Among the most common diseases of the hip joint, which become increasingly noticeable with pain during running, is the bursitis on the large hump of the hip (bursitis trochanterica) . This bursa works as a kind of buffering system and, while performing hip movements, reduces friction between the femur and the tendons that run above it.

An inflammation in this bursa is mainly caused by overuse and deformity in the joint (eg different leg lengths), but also by a previous trauma.

Furthermore, even simple signs of wear in the hip joint can lead to pain symptoms while walking. In hip osteoarthritis ( coxarthrosis ), the protective, cartilaginous joint cover is worn due to age or stress, so that movements of the joint cause a direct rubbing of the bony parts of the joint, which can sometimes be very painful.

Also a hip inflammation ( Coxarthritis ) by a bacterial inflammation can express itself with pain during the running.
Another typical overuse of the hip, which occurs mainly in runners, is the stress fracture ( fatigue failure ) in the head of the femur, which results in permanent stress on microfractures in the skeleton accompanied by inflammation of the surrounding periosteum.
The result is pain and movement restrictions while walking and running.

In addition to the diseases that originate from the hip joint itself, should be thought of in case of run-related pain in the hip area always to nervous or intervertebral disc problems. Spinal disc prolapse in the lumbar region of the lumbar region can lead to entrapment of spinal nerves (eg, sciatic nerve) that can cause uncomfortable hip pain. Likewise, trapping the sciatic nerve in its spinal column-distant course ( in the area of ​​the posterior buttock or thigh) can cause the same symptoms.

Hip pain after exercise

Sometimes the symptoms start only after the stress.

Hip pain, which occurs after exercise, may have different reasons.

Age tends to be less important, so any age group may be affected by post-sport pain. Rather, the level of stress is of great importance, since it is just the exceeding of the individual load limit that quickly becomes noticeable as a result of pain. Where the personal limit for hip strain is affected by many factors and can vary over the course of life. False footwear, hip joint, leg or foot deformities as well as shortened hip muscles ( muscle dysbalances ) can lower the individual load limit and lead to discomfort more quickly.

The type of sport is also crucial: running, football, handball, ballet, weightlifting and skiing are among the sports that require a heavy hip load. If pain already occurs during or after exercise in the hip area, bursitis may be present in many cases over the large hillock (bursitis trochanterica). This is mainly due to recharge ( unusual movements ) or chronic over- / Fehlbelastung and are characterized by direct pressure and depth pain in the lateral hip area.

Likewise, the permanent rubbing of the large tendon strip on the thigh outer side ( iliotibial tract ) on the rolling hill can lead to pain after exercise ( Coxa saltans ). Chronic overstressing of the hip joint can also lead to microfractures (fatigue fractures) in the bony joint system, which can often be accompanied by inflammation of the surrounding periosteum and bone marrow edema. Also, damage to joint structures ( cartilage, joint lip, joint capsule, joint ligaments ) or free, located in the joint cavity joint body ( eg, detached cartilage pieces) can make the sporting activity unpleasant.

If the cartilaginous part of the joint in the context of a hip joint degeneration (hip osteoarthritis) is so severely damaged that bare bone rubs each other during movements in the joint system, this may also be one of the more common causes of hip pain during sports.

Hip pain while sitting

Numerous diseases of the hip joint can lead to a painful sitting sensation, the reason being usually the spatial narrowness in the joint resulting in the sitting position or the changed pressure / tension conditions on certain joint structures.

Hip osteoarthritis, which is characterized by age-related or overload-related cartilage wear, can be painful both when sitting and walking. Also, the inflammation of the biceps of the hip joint (bursitis trochanterica) can be symptomatic especially when sitting, as this exerted increased pressure on the touch-sensitive, liquid-filled bag and this is particularly irritated.

If there is bone necrosis in various hip diseases, which reduces blood flow to the joint and causes the death of bone tissue, it causes pain that can be exacerbated in certain seating positions that further minimize the blood supply.

A common cause of hip pain in sitting is lumbo-sciatica, in which the sciatic nerve is pinched or narrowed in its course of the posterior vessel / leg. When sitting, unfavorable moments of pressure or toughening can occur, which lead to an increased irritation of the sciatic nerve.

At night

Many illnesses can cause hip pain, even at rest or when lying down, and thus occur especially at night, when you relax and calm down. Examples include coxarthrosis (a common condition that causes wear and tear in the hip joint due to improper stress), coxitis (an inflammation of the hip joint), rheumatoid rheumatism (symptoms characterized by fluid drawing pain in the musculoskeletal system), gout (painful deposition of uric acid crystals in various joints) or bursitis (bursitis in the joint due to infection or injury).
In addition, hip pain that occurs at night may also indicate involvement of nerves. Especially when the pain radiates from the spine to the hip, it should also be thought of a herniated disc of the lumbar spine or the ischial syndrome. In both cases, nerves are narrowed and irritated by various structures, which can cause dull, stinging or burning pain in the lower back, hip and thigh. Hip pain, which occurs at night, disturbs sleep and thus leads to an immense impairment of the quality of life. You should therefore be clarified by a doctor. The cause of the nocturnal hip pain can usually be found out by a detailed questioning of the person concerned, a physical examination and an X-ray examination. How the hip pain is treated ultimately depends on the underlying condition.

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Pain experienced by the affected patients as hip pain may, in some cases, have its origin in the area of ​​the post. Conversely, complaints that are apparently due to a problem of the buttocks can be caused by diseases of the hip. For this reason, extensive diagnostics are the key to the treatment of hip or post pain.

In this context, pain in the hip can be triggered by chronic malfunctioning and / or overloading of the buttocks musculature. The cause of these stress-induced complaints may be congenital postural defects. Especially patients who suffer from length differences of the legs or misalignments of the pelvis (so-called pelvic obliquity) often develop pains on the buttocks and on the hips. In the end, these symptoms are caused by the swelling of the butt muscles and a concomitant pressure on the sciatic nerve.

In the affected patients, the resulting pain in most cases is not limited to the hips and buttocks. Many patients also report pain in the lower back (lumbar spine) and thighs.

In addition, irritation of the sciatic nerve, originating directly at the nerve root, can lead to pain in the hip and buttocks. Possible reason for such irritation may be the classic herniated disc.

In addition, small spurs on the individual vertebral bodies can permanently damage the sciatic nerves and cause pain in the hips and buttocks.

In addition, in some patients suffering from hip and butt pain, overuse of the tendons and ligaments can be observed. Even in these cases, the symptoms are usually triggered by a malposition of the body axis. The pain felt by the patient may occur localized at one point of the body or affect the entire buttocks.

Furthermore, in people suffering from persistent or recurrent pain on the hip and buttocks, a disease in the area of ​​the sacroiliac joint should be excluded. In most cases, a simple dislocation of the joint can be detected in those affected. The treatment is therefore simple and characterized by a direct relief of the symptoms. Another cause of pain on the butt

The partially radiating to the hip is the presence of an abscess. Due to the pus in the abscess cavity, enormous pressure can be exerted on the surrounding tissue. Depending on the localization, the buttock musculature may be impaired and, indirectly, the sciatic nerve may be irritated. The result is often severe pain on the buttocks and around the hip.

strip

Hips pain can radiate to various other regions. In addition to low back (lumbar spine) or thigh radiography, many of the affected patients report an additional perception of discomfort in the groin. In addition, diseases of the inguinal region can cause the affected people to feel pain on the hip.

Pain that affects both the hip and the groin occur especially in active people and competitive athletes. Groin pain is generally one of the most common causes of training and competition failure.

The so-called " inguinal hernia " plays a special role in this context. In this disease, it comes to Hervorstülpen a bag filled with intestinal sections. The direct cause of inguinal hernia is in most cases a weak spot in the area of ​​the abdominal wall. With an increase in pressure within the abdomen (for example, during pressing or athletic activity), the intestine can no longer be kept inside the body. The most dreaded complication of inguinal hernia is pinching the hernia in the area of ​​the hernia. By this condition, there is the danger that the blood vessels supplying the intestine are compressed and therefore the oxygen supply comes to a standstill. The parts of the intestine in the hernia will die. The key symptom of inguinal hernia is a pain in the groin that in many cases can radiate to the hips.

Another cause of hip and groin pain is muscular dysbalance. Especially during exercise, the trunk-pelvic-leg region is subjected to high loads by swinging motions. The muscles and ligaments of the hip region act as static as well as dynamic structures on the groin. If it comes through postural damage and / or a Fehlbelastung, creates a dysbalance between the individual muscles. As a result, the stabilizing function of the hip muscles is disturbed and there is stress-induced pain in the hip and pelvis areas.

Diagnosis of hip pain

Computed Tomography (CT)

In the case of the causes of hip pain, the survey is particularly important.
It should show, since when the complaints are present, in which movements they are greatest and whether appropriate trauma and accidents have preceded.
Thereafter, the physical examination follows. The patient's posture and gait are closely examined to see if there are any malpositions, such as O-legs or X-legs (evidence of coxarthrosis). On lying patients, both passive and active movements of the leg are performed in the hip joint and paid particular attention to movements that cause the patient particularly severe pain.
After the physical examination, the diagnostic imaging follows, traditionally first the conventional radiograph of the thigh of the affected side and the hip. The recordings are then supplemented by a pelvic overview recording. Distinct fractures of the thigh or hip can be seen this way. Also, the common arthrosis can already be seen by an x-ray of the hip. If there are no abnormalities in the radiograph, a CT scan of the hip and pelvis can be performed as a supplement. In this recording again the smallest hairline cracks of the pelvis can be seen. Many pelvic fractures do not appear in the conventional radiograph and are only present in the CT scan. In addition, in a CT can still be paid attention to muscle approaches and appropriate on and tears are seen. If you want an even more detailed presentation, an MRI of the pelvis should be performed.

More information can be found under our topic:

  • MRI from the pelvis
  • MRI of the hip

exercises

The hip joint, the most stressed joint of the human body with the largest range of motion, is supported, moved and secured by about 18 different muscles in its guidance.
In addition to the gluteal muscles ( outer hip muscles ), these include the hip flexor muscles (inner hip muscles ), the low-lying hip muscles and the adductor muscle group ( muscles to pull the leg to the body ). Through targeted and balanced training of these muscle groups, large loads can be better buffered, the ligamentous apparatus preserved and the cartilage of the hip joint protected from excessive, uneven wear.

It is important, however, that the opponent of the currently trained muscle ( antagonists are eg hip flexor and -strecker ) is strengthened with the same extent and the same intensity, so that no imbalance ( dysbalance ) between the two, which in turn can lead to incorrect stress in the joint system, Genauso ist auch das Ausführen von Dehnungsübungen ( 5-10 Minuten/Tag ) von enormer Wichtigkeit, um die Hüftmuskulatur geschmeidig zu halten und vor Verkürzungen zu bewahren.

Bestehen bereits Vorerkrankungen des Hüftgelenks, wird die Stärkung der Hüftmuskulatur umso wichtiger, da durch sie das Gelenk entlastet und der Heilungsprozess unterstützt werden kann.

Empfehlenswert ist das Aufsuchen von Physiotherapeuten, die gezielt die richtigen Übungen für die jeweilige Fehlfunktion des Hüftgelenks ermitteln und helfen können, diese korrekt durchzuführen und später selbstständig in den Alltag zu integrieren. Zu diesen Kräftigungsübungen gehören beispielsweise Übungen im Stand (zB seitliches, horizontales Anheben des gestreckten Beines zur Stärkung der Abduktorenmuskeln der Hüfte ) oder im Liegen (zB Brücke bilden, seitlicher Stützstand mit Anheben des schmerzhaften Beines ), die täglich mit mindestens 10 Wiederholungen durchgeführt werden sollten.
Daneben kann auch Schwimmtraining oder Aquagymnastik zur schonenden Kräftigung der Hüftmuskulatur angewandt werden, da durch den Wasserauftrieb das Gelenk entlastet und durch den Wasserwiderstand die Muskulatur gestärkt wird. Kraul- und Rückenschwimmen ist dabei eher zu empfehlen, als Brustschwimmen.

therapy

Die Therapie richtet sich ganz nach der die Schmerzen auslösenden Ursache.
Während Frakturen des Beckens (stabile Beckenringfrakturen) meistens außer Schmerzbehandlung nicht weiter behandelt werden müssen, muss eine instabile Beckenringfraktur meistens operativ versorgt werden.
Anrisse der Muskeln des Beckens werden ebenfalls meistens konservativ versorgt. Die Arthrose des Hüftgelenks wird in frühen Stadien auch nur mit Schmerzmitteln und Physiotherapie behandelt.
In fortgeschrittenen Stadien ist die Implantation eines künstlichen Hüftgelenks (Hüft-TEP) indiziert.

Summary

Bei Hüftschmerzen unterscheidet man chronische von akuten Schmerzen.
Akute Schmerzen treten plötzlich und unerwartet auf, die Ursache liegt meistens in einem Trauma, in Form einer Muskelzerrung, eines Muskelrisses oder in einer Fraktur des Beckenknochens oder des Oberschenkelhalses (ebenfalls nach Trauma).
Die Ursachen von chronischen Schmerzen der Hüfte liegen in den allermeisten Fällen in Verschleißerscheinungen im Hüftgelenk aufgrund jahrelanger Fehlbelastung. Diese sogenannte Hüftarthrose ( Coxarthrose ) ist die häufigste Ursache von Hüftschmerzen, vor allem bei älteren Menschen. In frühen Stadien kommt es zu wenigen Beschwerden, meistens nur bei Vollbelastung des Hüftgelenks. Bei fortgeschrittener Arthrose klagen die Patienten bereits schon in Ruhe über ziehende und beißende Schmerzen, die sie in eine Schonhaltung bringen und verhindern, gewohnte Bewegungsabläufe in der Hüfte weiter durchzuführen.
Zur Diagnostik von Hüftschmerzen gehört neben der ausführlichen Befragung des Patienten auch die körperliche Untersuchung sowie die bildgebende Untersuchung, in Form eines Röntgenbildes, wo Frakturen oder Arthrosen gesehen werden können. Noch deutlicher können Frakturen in einem CT oder MRT gesehen werden.
Die Behandlung wird bei stabilen Frakturen des Beckens meistens konservativ durchgeführt, bei vorhandenen Instabilitäten muss operativ behandelt werden. Ergänzend zu den Behandlungsformen sollten bei allen Schmerzen der Hüfte physiotherapeutische Übungen durchgeführt werden.

When to See a Doctor about Chronic Hip Pain (February 2020).


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