The hip is a ball and socket type of joint, formed by the articulation of the head of the femur with the pelvis.
Normal range of motion includes:
Abduction 45 degrees, Adduction 20-30 degrees, Flexion 135 degrees, Extension 30 degrees, Internal and external rotation.
Hip pathology can cause symptoms anywhere around the joint, though frequently pain is anterior and radiates to the groin region. Additionally, pathology outside of the hip can be referred to this region.
History and exam obviously help in making these distinctions. Lets discuss few conditions related to this joint :
- Degenerative Joint Disease and Osteoarthritis:
Patients usually report pain with weight bearing and ambulation. Symptoms progress slowly over time (i.e. years) with pain precipitated by less activity (i.e. shorter distances walked) as the disease worsens. This tends to occur in patients above 50, as age progresses the risk of wear and tear on the joint too increases.
Obesity, which chronically increases the load and stress, is a major risk factor. There may also be a history of significant antecedent trauma that damaged the joint, “setting it up” for degenerative changes over time.Points to look for while examination:
- Pain with walking, perhaps even with limping. Patient’s may develop an Antalgic gait, characterized by trying to minimize the amount of time spent with weight bearing on the affected joint.
- Range of motion reduced as degeneration progresses. Early on, internal rotation may elicit more pain then movement in other directions.
- Trochanteric Bursitis:
The troachanteric bursa overlies the greater trochanter of the femur.
When it becomes inflamed, patient’s report vague hip pain, focused on the lateral area of the joint.
Symptoms tend to get worse with walking.Points to look for while examination:
- Range of motion is generally preserved
- Pain on direct palpation over the bursa
- Pain with resisted abduction. This can be assessed by having patient lie on unaffected side and asking them to abduct the affected hip as you provide resistance.