What Are Causes of Traumatic Hip Pain?

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DR. SUNIL RAJAN
Head of Department Apollo Institute of
Orthopaedics, Apollo Hospitals, Indore M.S
Orthopedics, Specialization Joint Replacement
Surgery
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What Are Causes of Traumatic Hip Pain?
Hip Fracture
Falls are the most common reason that elderly
people break a hip. The fracture is due to a
combination of two effects of aging, osteoporosis
(thinning of bones), and a loss of balance. These
two risk factors are the potential cause of many
falls. Occasionally, the bone may spontaneously
break due to osteoporosis and become the cause of
the fall.
Bones may also weaken because of other diseases
that have affected the hipbones. A pathologic hip
fracture describes this situation, and
osteoporosis is but one cause. Other potential
causes of bone weakening are cancer within the
bones, benign tumors and cysts, Paget's disease,
and inherited diseases of bone.
When health care professionals talk about a hip
fracture, they really mean a fracture of the
proximal or upper part of the femur. Fractures of
the acetabulum are less common and usually are
due to major trauma like a motor-vehicle
collision or a fall down a flight of stairs.
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The precise location of the fracture is
important, because it guides the decision of the
orthopedic surgeon as to which type of operation
is needed to repair the injury. Aside from a
fall, any trauma can potentially cause a hip
fracture. Depending upon the mechanism of injury,
the femur may not break rather, a portion of the
pelvis (often the pubic ramus) may be fractured.
The initial pain may be in the hip area, but
examination and X-rays may reveal a source
different than the hip joint as a cause of hip
pain. Trauma can also cause a hip dislocation in
which the femoral head loses its relationship
with the acetabulum. This usually is associated
with an acetabular (pelvic bone) fracture
however, in patients with hip replacements, the
artificial hip may dislocate spontaneously.
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Contusions (Bruises)
Contusions (bruises), sprains, and strains may
occur because of trauma, and even though there is
no broken bone, these injuries can still be very
painful. Sprains are due to ligament injuries,
while strains occur because of damage and
inflammation to muscles and tendons (tendinitis
tendon itis inflammation). Because of the
amount of force required to walk or jump, the hip
joint is required to support many times the
weight of the body. The muscles, tendons, bursas,
and ligaments are designed to shield the joint
from these forces. When these structures are
inflamed, the hip cannot function and pain will
occur.
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Overuse Injuries Hip pain may also arise from
overuse injuries in which muscles, tendons, and
ligaments can become inflamed. These injuries may
be due to routine daily activities that may cause
undue stress on the hip joint or because of one
specific strenuous event. Overuse may also cause
gradual wearing away of the cartilage in the hip
joint, causing arthritis (arth joint itis
inflammation).
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Other structures should be mentioned as a cause
of hip pain because they become inflamed.

• Hip tendonitis is a common cause of pain,
  especially with involvement of the hip flexor
  tendons.
• The iliotibial band stretches from the crest of
  the pelvis down the outside part of the thigh to
  the knee. This band of tissue may become inflamed
  and cause hip pain, knee pain, or both. This is a
  type of overuse injury that has a gradual onset
  associated with tightness of the muscle groups
  that surround the knee and hip.
• Piriformis syndrome, in which the piriformis
  muscle irritates the sciatic nerve in the
  buttock, can also cause significant posterior hip
  pain. This pain often occurs when sitting,
  squatting, straining to have a bowel movement, or
  when trying to get out of bed. Because the
  sciatic nerve may be irritated, pain may radiate
  down the leg.

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