Hip
There are numerous injuries and joint conditions of the hip. Although Dr. Dedhia does not perform hip replacements, he does treat other issues related to the hip joint. Please select a condition below to learn more. If you do not see a specific condition listed, please feel free to discuss your concerns during your visit.
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Anatomy
Hamstring muscle injuries — such as a “pulled hamstring” — occur frequently in athletes, but can also occur in those not involves in sports. They are especially common in athletes who participate in sports that require sprinting, such as track, soccer, and basketball.
A pulled hamstring or strain is an injury to one or more of the muscles at the back of the thigh. Most hamstring injuries respond well to simple, nonsurgical treatments.
The hamstring muscles run down the back of the thigh. There are three hamstring muscles:
- Semitendinosus
- Semimembranosus
- Biceps femoris
They start at the bottom of the pelvis at a place called the ischial tuberosity. They cross the knee joint and end at the lower leg. Hamstring muscle fibers join with the tough, connective tissue of the hamstring tendons near the points where the tendons attach to bones.
The hamstring muscle group helps you extend your leg straight back and bend your knee.
The following image shows the normal hamstring anatomy. The three hamstring muscles start at the bottom of the pelvis and end near the top of the lower leg.
Description
A hamstring strain can be a pull, a partial tear, or a complete tear.Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily; a grade 3 strain is a complete tear of the muscle that may take months to heal.
Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibers join tendon fibers.
In the most severe hamstring injuries, the tendon tears completely away from the bone. It may even pull a piece of bone away with it. This is called an avulsion injury.
Causes
Muscle overload is the main cause of hamstring muscle strain. This can happen when the muscle is stretched beyond its capacity or challenged with a sudden load.Hamstring muscle strains often occur when the muscle lengthens as it contracts, or shortens. Although it sounds contradictory, this happens when you extend a muscle while it is weighted, or loaded. This is called an “eccentric contraction.”
During sprinting, the hamstring muscles contract eccentrically as the back leg is straightened and the toes are used to push off and move forward. The hamstring muscles are not only lengthened at this point in the stride, but they are also loaded — with body weight as well as the force required for forward motion.
Like strains, hamstring tendon avulsions are also caused by large, sudden loads.
Risk Factors
Several factors can make it more likely you will have a muscle strain, including:Muscle tightness. Tight muscles are vulnerable to strain. Athletes should follow a year-round program of daily stretching exercises.Muscle imbalance. When one muscle group is much stronger than its opposing muscle group, the imbalance can lead to a strain. This frequently happens with the hamstring muscles. The quadriceps muscles at the front of the thigh are usually more powerful. During high-speed activities, the hamstring may become fatigued faster than the quadriceps. This fatigue can lead to a strain.
Poor conditioning. If your muscles are weak, they are less able to cope with the stress of exercise and are more likely to be injured.
Muscle fatigue. Fatigue reduces the energy-absorbing capabilities of muscle, making them more susceptible to injury.
Choice of activity. Anyone can experience hamstring strain, but those especially at risk are:
- Athletes who participate in sports like football, soccer, basketball
- Runners or sprinters
- Dancers
- Older athletes whose exercise program is primarily walking
- Adolescent athletes who are still growing
Hamstring strains occur more often in adolescents because bones and muscles do not grow at the same rate. During a growth spurt, a child’s bones may grow faster than the muscles. The growing bone pulls the muscle tight. A sudden jump, stretch, or impact can tear the muscle away from its connection to the bone.
Symptoms
If you strain your hamstring while sprinting in full stride, you will notice a sudden, sharp pain in the back of your thigh. It will cause you to come to a quick stop, and either hop on your good leg or fall.
Additional symptoms may include:
- Swelling during the first few hours after injury
- Bruising or discoloration of the back of your leg below the knee over the first few days
- Weakness in your hamstring that can persist for weeks
Imaging Tests
Imaging tests that may help your doctor confirm your diagnosis include:X-rays. An X-ray can show your doctor whether you have a hamstring tendon avulsion. This is when the injured tendon has pulled away a small piece of bone.Magnetic Resonance Imaging (MRI). This study can create better images of soft tissues like the hamstring muscles. It can help your doctor determine the degree of your injury.
Treatment
Treatment of hamstring strains will vary depending on the type of injury you have, its severity, and your own needs and expectations.The goal of any treatment — nonsurgical or surgical — is to help you return to all the activities you enjoy. Following your doctor’s treatment plan will restore your abilities faster, and help you prevent further problems in the future.
Nonsurgical Treatment
Most hamstring strains heal very well with simple, nonsurgical treatment.RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.
- Rest. Take a break from the activity that caused the strain. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
- Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
- Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
- Elevation. To reduce swelling, recline and put your leg up higher than your heart while resting.
Immobilization. Your doctor may recommend you wear a knee splint for a brief time. This will keep your leg in a neutral position to help it heal.
Physical therapy. Once the initial pain and swelling has settled down, physical therapy can begin. Specific exercises can restore range of motion and strength.
A therapy program focuses first on flexibility. Gentle stretches will improve your range of motion. As healing progresses, strengthening exercises will gradually be added to your program. Your doctor will discuss with you when it is safe to return to sports activity.
Surgical Treatment
Surgery is most often performed for tendon avulsion injuries, where the tendon has pulled completely away from the bone. Tears from the pelvis (proximal tendon avulsions) are more common than tears from the shinbone (distal tendon avulsions).Surgery may also be needed to repair a complete tear within the muscle.
Procedure. To repair a tendon avulsion, your surgeon must pull the hamstring muscle back into place and remove any scar tissue. Then the tendon is reattached to the bone using large stitches or staples.A complete tear within the muscle is sewn back together using stitches.
Rehabilitation. After surgery, you will need to keep weight off of your leg to protect the repair. In addition to using crutches, you may need a brace that keeps your hamstring in a relaxed position. How long you will need these aids will depend on the type of injury you have.
Your physical therapy program will begin with gentle stretches to improve flexibility and range of motion. Strengthening exercises will gradually be added to your plan.
Rehabilitation for a proximal hamstring reattachment typically takes at least 6 months, due to the severity of the injury. Distal hamstring reattachments require approximately 3 months of rehabilitation before returning to athletic activities. Your doctor will tell you when it is safe to return to sports.
Recovery
Most people who injure their hamstrings will recover full function after completing a rehabilitation plan. Early treatment with a plan that includes the RICE protocol and physical therapy has been shown to result in better function and quicker return to sports.To prevent reinjuring your hamstring, be sure to follow your doctor’s treatment plan. Return to sports only after your doctor has given you the go-ahead. Reinjuring your hamstring increases your risk of permanent damage. This can result in a chronic condition.
New Developments
Platelet-rich plasma (PRP) is currently being investigated for its effectiveness in speeding the healing of hamstring muscle injuries. PRP is a preparation developed from a patient’s own blood. It contains a high concentration of proteins called growth factors that are very important in the healing of injuries.A few treatment centers across the country are incorporating PRP injections into the nonsurgical treatment regimen for some hamstring muscle injuries. However, this method is still under investigation and more research is necessary to prove PRP’s effectiveness.
Anatomy
The hip is one of the body’s largest joints. It is a “ball-and-socket” joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).
The bone surfaces of the ball and socket are covered with articular cartilage, a smooth, slippery substance that protects and cushions the bones and enables them to move easily.
The surface of the joint is covered by a thin lining called the synovium. In a healthy hip, the synovium produces a small amount of fluid that lubricates the cartilage and aids in movement.
Description
Osteoarthritis is a degenerative type of arthritis that occurs most often in people 50 years of age and older, though it may occur in younger people, too.
In osteoarthritis, the cartilage in the hip joint gradually wears away over time. As the cartilage wears away, it becomes frayed and rough, and the protective joint space between the bones decreases. This can result in bone rubbing on bone. To make up for the lost cartilage, the damaged bones may start to grow outward and form bone spurs (osteophytes).
Osteoarthritis develops slowly and the pain it causes worsens over time.
Causes
Osteoarthritis has no single specific cause, but there are certain factors that may make you more likely to develop the disease, including:
- Increasing age
- Family history of osteoarthritis
- Previous injury to the hip joint
- Obesity
- Improper formation of the hip joint at birth, a condition known as developmental dysplasia of the hip
Even if you do not have any of the risk factors listed above, you can still develop osteoarthritis.
Symptoms
The most common symptom of hip osteoarthritis is pain around the hip joint. Usually, the pain develops slowly and worsens over time, although sudden onset is also possible. Pain and stiffness may be worse in the morning, or after sitting or resting for a while. Over time, painful symptoms may occur more frequently, including during rest or at night. Additional symptoms may include:
- Pain in your groin or thigh that radiates to your buttocks or your knee
- Pain that flares up with vigorous activity
- Stiffness in the hip joint that makes it difficult to walk or bend
- “Locking” or “sticking” of the joint, and a grinding noise (crepitus) during movement caused by loose fragments of cartilage and other tissue interfering with the smooth motion of the hip
- Decreased range of motion in the hip that affects the ability to walk and may cause a limp
- Increased joint pain with rainy weather
Doctor Examination
Physical Examination
During the physical examination, your doctor will look for:
- Tenderness about the hip
- Range of passive (assisted) and active (self-directed) motion
- Crepitus (a grating sensation inside the joint) with movement
- Pain when pressure is placed on the hip
- Problems with your gait (the way you walk)
- Any signs of injury to the muscles, tendons, and ligaments surrounding the hip
Imaging Tests
X-rays. These imaging tests create detailed pictures of dense structures, like bones. X-rays of an arthritic hip may show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).
(Left) In this x-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This x-ray of an arthritic hip shows severe loss of joint space and bone spurs.
Other imaging tests. Occasionally, a magnetic resonance imaging (MRI) scan, a computed tomography (CT) scan, or a bone scan may be needed to better determine the condition of the bone and soft tissues of your hip.
Treatment
Although there is no cure for osteoarthritis, there are a number of treatment options that will help relieve pain and improve mobility.
Nonsurgical Treatment
As with other arthritic conditions, early treatment of osteoarthritis of the hip is nonsurgical. Your doctor may recommend a range of treatment options.Lifestyle modifications. Some changes in your daily life can protect your hip joint and slow the progress of osteoarthritis.
- Minimizing activities that aggravate the condition, such as climbing stairs.
- Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) will put less stress on your hip.
- Losing weight can reduce stress on the hip joint, resulting in less pain and increased function.
Physical therapy. Specific exercises can help increase range of motion and flexibility, as well as strengthen the muscles in your hip and leg. Your doctor or physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.
Assistive devices. Using walking supports like a cane, crutches, or a walker can improve mobility and independence. Using assistive aids like a long-handled reacher to pick up low-lying things will help you avoid movements that may cause pain.
Medications. If your pain affects your daily routine, or is not relieved by other nonsurgical methods, your doctor may add medication to your treatment plan.
- Acetaminophen is an over-the-counter pain reliever that can be effective in reducing mild arthritis pain. Like all medications, however, over-the-counter pain relievers can cause side effects and interact with other medications you are taking. Be sure to discuss potential side effects with your doctor.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and reduce inflammation. Over-the-counter NSAIDs include naproxen and ibuprofen. Other NSAIDs are available by prescription.
- Corticosteroids (also known as cortisone) are powerful anti-inflammatory agents that can be taken by mouth or injected into the painful joint.
Surgical Treatment
Your doctor may recommend surgery if your pain from arthritis causes disability and is not relieved with nonsurgical treatment.
Osteotomy. Either the head of the thighbone or the socket is cut and realigned to take pressure off of the hip joint. This procedure is used only rarely to treat osteoarthritis of the hip.
Hip resurfacing. In this hip replacement procedure, the damaged bone and cartilage in the acetabulum (hip socket) is removed and replaced with a metal shell. The head of the femur, however, is not removed, but instead capped with a smooth metal covering.
Total hip replacement. Your doctor will remove both the damaged acetabulum and femoral head, and then position new metal, plastic or ceramic joint surfaces to restore the function of your hip.
In total hip replacement, both the head of the femur and the socket are replaced with an artificial device.
Information coming soon!
Overview
Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.Bursitis is inflammation of the bursa. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis.
Hip bursitis most often involves the bursa that covers the greater trochanter of the femur.
Symptoms
The main symptom of trochanteric bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip.
Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting.
Risk Factors
Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.
The following risk factors have been associated with the development of hip bursitis.
- Repetitive stress (overuse) injury. This can occur when running, stair climbing, bicycling, or standing for long periods of time.
- Hip injury. An injury to the point of your hip can occur when you fall onto your hip, bump your hip, or lie on one side of your body for an extended period of time.
- Spine disease. This includes scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
- Leg-length inequality. When one leg is significantly shorter than the other, it affects the way you walk, and can lead to irritation of a hip bursa.
- Rheumatoid arthritis. This makes the bursa more likely to become inflamed.
- Previous surgery. Surgery around the hip or prosthetic implants in the hip can irritate the bursa and cause bursitis.
- Bone spurs or calcium deposits. These can develop within the tendons that attach muscles to the trochanter. They can irritate the bursa and cause inflammation.
Doctor Examination
To diagnose hip bursitis, the doctor will perform a comprehensive physical examination, looking for tenderness in the area of the point of the hip. He or she may also perform additional tests to rule out other possible injuries or conditions. These tests can include imaging studies, such as x-rays, bone scanning, and magnetic resonance imaging (MRI).
Treatment
Nonsurgical Treatment
The initial treatment for hip bursitis does not involve surgery. Many people with hip bursitis can experience relief with simple lifestyle changes, including:
- Activity modification. Avoid the activities that worsen symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen, naproxen, piroxicam, celecoxib, and others, may relieve pain and control inflammation. Use NSAIDs cautiously and for limited periods. Talk with your doctor about the NSAIDs you use. NSAIDs may have adverse side effects if you have certain medical conditions or take certain medications.
- Assistive devices. Use of a walking cane or crutches for a week or more when needed.
- Physical therapy. Your doctor may prescribe exercises to increase hip strength and flexibility. You may do these exercises on your own, or a physical therapist may teach you how to stretch your hip muscles and use other treatments such as rolling therapy (massage), ice, heat, or ultrasound.
- Steroid injection. Injection of a corticosteroid along with a local anesthetic may also be helpful in relieving symptoms of hip bursitis. This is a simple and effective treatment that can be done in the doctor’s office. It involves a single injection into the bursa. The injection may provide temporary (months) or permanent relief. If pain and inflammation return, another injection or two, given a few months apart, may be needed. It is important to limit the number of injections, as prolonged corticosteroid injections may damage the surrounding tissues.
Surgical Treatment
Surgery is rarely needed for hip bursitis. If the bursa remains inflamed and painful after all nonsurgical treatments have been tried, your doctor may recommend surgical removal of the bursa. Removal of the bursa does not hurt the hip, and the hip can function normally without it.
Prevention
Although hip bursitis cannot always be prevented, there are things you can do to prevent the inflammation from getting worse.
- Avoid repetitive activities that put stress on the hips.
- Lose weight if you need to.
- Get a properly fitting shoe insert for leg-length differences.
- Maintain strength and flexibility of the hip muscles.
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