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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Hip pain may be caused by a variety of illnesses. Anything that causes systemic inflammation in the body may also affect the hip joint. The synovium is a lining tissue that covers those parts of the hip joint not covered by cartilage. Synovitis (syno=synovium + itis= inflammation), or inflammation of this lining tissue, causes fluid to leak into the joint, resulting in swelling and pain.

Arthritis

• Osteoarthritis is the most common cause of hip pain in those over the age of 50; however, other types of arthritis can be present. These may include
• rheumatoid arthritis,
• ankylosing spondylitis, 
• arthritis associated with inflammatory bowel disease (Crohn's disease or ulcerative colitis).
• Some systemic diseases are associated with hip pain, including sickle cell disease, in which a joint may swell during a sickle crisis either with or without an underlying infection. The hip joint is not the only joint that may be involved.
• Viral or bacterial infections may cause hip inflammation. Examples include Lyme disease, Reiter's syndrome, and infections caused by food poisoning.
• Avascular necrosis of the femoral head may occur in people who have taken corticosteroid medications like prednisone for a prolonged period of time. In this condition, the femoral head loses its blood supply, becomes weakened, and causes hip pain.
• Legg-Calvé-Perthes disease (or just Perthes disease) describes avascular necrosis of the femoral head in children and is idiopathic, meaning the cause is unknown. It usually affects males between the ages of 4 and 8.
• Fibromyalgia is a systemic pain syndrome associated with pain and stiffness that can cause significant discomfort throughout the body and may present as hip pain. There may be associated sleep disorders, muscle cramps and spasms, tenderness of a variety of muscle groups in the whole body, and fatigue.

Referred Hip Pain

Hip pain may not originate in the hip itself but may be caused by problems in adjacent structures.

• A hernia or defect of the abdominal wall may cause pain in the front part of the hip. A hernia occurs when there is a weakness or tear in an area where muscles of the abdominal wall come together. They are named according to their location; inguinal (groin) hernias are most common.
• Nerve branches can become inflamed to cause hip pain. Meralgia paresthetica occurs when the lateral femoral cutaneous nerve of the thigh becomes irritated. This condition is seen most commonly in pregnancy, in people wearing tight clothes, or in people with diabetes.
• Sciatica, or inflammation of nerve roots from the spinal cord, may also present with hip pain. There are a variety of reasons for the sciatic nerve to become inflamed, including spinal stenosis due to osteoarthritis of the lumbar spine, ruptured or bulging disks in the vertebral column of the back, and spasms of the muscles that support the low back. Piriformis syndrome describes sciatic nerve inflammation that causes buttock and posterior hip pain due to sciatic nerve irritation as it travels through the buttock muscles.

Special Considerations for Children

Children who complain of leg or hip pain should not be ignored. If the pain is persistent, if a limp is present, or if the child has a fever, a health-care practitioner should be contacted.

Potential concerns in children with hip pain include

• a slipped capital femoral epiphysis, a condition in which the bone growth plate of the femoral head shifts out of place,
• Legg-Calvé-Perthes disease, or avascular necrosis of the femoral head,
• juvenile rheumatoid arthritis, or Still's disease.

If a fever is present, septic arthritis or an infection of the hip joint may be present. This may be due to a virus or bacteria. Symptoms include fever, pain, limping, and sometimes refusal to walk. Viral infections are the most common cause of synovitis in infants and. resolve without treatment. If the care provider is concerned that the cause of synovitis may be a bacterial infection, urgent orthopedic consultation and evaluation may be needed in this situation.

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