Hip and Leg Pain

What are common hip and leg pain causes?

The hip joint is a ball and socket joint where the femur (large thigh bone) connects to the pelvis. The top of the femur is a round ball that fits into the socket formed by the pelvic bone (acetabulum).

The ball is allowed to glide and rotate within the acetabulum because a group of ligaments and muscles support the joint and inhibit overextension or improper rotation from occurring. Also, within the joint is a synovial lining that provides lubricating fluid to decrease friction, and bursa, fluid-filled sacs that cushion and smooth movement.

The anatomy of the legs includes the muscles of the calf, quadriceps, and hamstrings, plus the femur bone in the upper thigh and the tibia and fibula of the lower leg. The knee and ankle joints may also be connected to your pain.

Hip and leg pain can be felt anywhere in these parts of the body (and are often related). Common areas for hip or leg pain include:

• In your groin region
• In your lower back
• On the outside of the hip
• In your buttocks
• Radiating into your thighs
• Down the backs of your legs
• Down the side of your leg into your knee

Radiating pain is often referred to as sciatica, but it is only technically sciatica when the sciatic nerve is involved.

Hip and leg pain causes can be systemic or related to the mechanics of the hip and leg themselves. Here’s some of the more common causes.

Injury and trauma

Injury and trauma are two of the most common causes of hip and leg pain. This can occur in anyone from the very active to the sedentary.

Without proper treatment and rehabilitation, the pain that occurs after trauma can become chronic. Common causes of hip and leg pain related to injury and trauma include:

• Hip dislocations
• Femur fractures
• Car accidents
• Sports-related incidents
• Falls

Bursitis

Bursitis occurs when the bursa in the hip joint becomes irritated and inflamed. This may result in a burning sensation that increases with movement.

Diseases, besides trauma, that can cause chronic hip pain include the following.

Osteoarthritis (OA)

Osteoarthritis (OA) is known as degenerative arthritis or degenerative joint disease. This is the most common cause of arthritis in the United States. It is most common in:

• Women
• People over the age of 55
• Obese people
• Those with a history of previous joint trauma or disease

Osteoarthritis results from repetitive wear and tear of the joint and can cause chronic, non-inflammatory arthritis of any moveable joint. The most common joints susceptible to osteoarthritis are the DIP joints (small joints closest to your fingernails) of the fingers and the knees, but it can occur in any joint.

Typically, symptoms are one-sided and asymmetric. Patients also typically experience crepitus, which is a crackling or popping sound and sensation. This is created when the cartilage has broken down and two rough edges are coming into contact with each other. This can also cause a decrease in range of motion and pain that worsens with activity and improves with rest. There is typically no localized swelling or redness seen with this cause of arthritis.

Rheumatoid arthritis (RA)

Unlike osteoarthritis (OA), rheumatoid arthritis (RA) is a chronic, systemic, destructive, and inflammatory arthritis. It is commonly seen in younger aged women 35-50, although can be seen in anyone. It’s characterized by symmetric involvement of the large and small joints.

Infections by viruses and bacteria and genetic factors (HLA-DR4) may possibly trigger the destructive inflammation. The originating cause is by a nonspecific inflammation which then produces T-cell activation (cell of your immune system) and a pannus (flap of tissue) forms. The pannus erodes into the surrounding cartilage, tendons, and even bones.

Avascular femoral head necrosis

This condition results from incomplete blood supply to the bone. Without adequate blood supply, the bone develops necrosis or destruction of normal tissue. Compromised blood supply may be prompted by a fracture of the femoral neck or dislocation of the femoral head that damages the blood vessels that supply the femoral head.

Other causes can be from arthritis, local or systemic steroids, infection, radiation, or unknown causes. When there is necrosis in the femoral head, the bone typically cannot support the body weight and the femoral head can eventually collapse and fracture, causing pain and further complications.

Labral tears

The hip socket or acetabulum is lined with cartilage called your labrum. It allows for smooth movements of the femur ball in your hip joint.

A labral tear can result from injury or wear-and-tear arthritis. Labral tears can often be painful, and those affected often experience a catching or locking sensation with certain movements.

Lumbar radiculitis

Spinal nerves in the lower back can become irritated and aggravated by various conditions. If a nerve root becomes irritated it can cause painful radiation into your lower extremities.

The pain is called referred pain because it is felt in the hip, but the original source of pain is in the low back. Typically, your doctor can diagnose radiculitis with a physical exam and relevant spinal imaging.

Getting a diagnosis

Diagnosing patients with leg or hip pain is never straightforward and is often difficult, as many of the symptoms are similar for different conditions.

The first step is often taking a comprehensive history and physical exam. Your doctor will cover several aspects of your health in this history. Some of the most common questions your doctor will ask you include:

• Where is the pain located?
• How long has the pain been there?
• What were you doing when you first noticed the pain?
• Is there anything you can do that alleviates the pain?
• Are you currently taking any medications or other treatments for the pain? Do they work?
• Is there any family history of arthritis or other autoimmune disease?

Testing

After conducting a full history and physical exam, your physician may want additional studies, including radiological films and blood work. Imaging techniques are useful because your physician can see what’s happening inside the painful joint. There are three common imaging techniques for hip and leg pain diagnoses. These include:

1. X-rays: A diagnostic test that uses an electromagnetic energy rays to look at more solid structures in the body (bones, but not great to view tissues).
2. CT scans: A diagnostic test that combines X-rays with computer technology to produce cross sectional views of the body. This is helpful because it helps to visualize detailed images of the body, including the bones, muscles, and organs.
3. MRI scans: A diagnostic image that uses large magnets and a computer to produce detailed images of the structures within the body. This is even more detailed than the CT scan and X-ray.

Your doctor may also suggest lab tests to rule out other conditions. These might include:

• Complete blood count (CBC)
• Antinuclear antibody (ANA)
• Erythrocyte sedimentation rate
• Rheumatoid factor
• Urinalysis
• White blood cell count (WBC)

Another diagnostic tool when the situation calls for it is an evaluation of the fluid in your joint that includes how much fluid is there and its consistency. An arthrocentesis is especially crucial when your doctor suspects gouty arthritis or a septic arthritis.

An orthopedic surgeon can also evaluate your case. An arthroscope involves placing a small, optic tube (arthroscope) into your joint. Images of the joint are projected onto a screen and viewed by you and your doctor. Your doctor looks to see what types of injury or disease are indicated by the projection and proceeds with treatment accordingly.

What are hip and leg pain treatments that could help me?

Hip and leg pain treatments rely on a proper diagnosis that includes the cause of your pain. This allows your pain doctor to design a personalized treatment to address the underlying cause as well as symptoms.

The most common and recommended methods for treating hip and leg pain from all causes include staying active and participating in physical therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol) can help with pain and inflammation when taken as directed, on an as-needed basis.

Intra-articular joint injections are rapidly gaining popularity for treating arthritis because of their success, minimally-invasive nature, and long-acting effects. A joint injection may help patients with arthritis by not only relieving pain by reducing the inflammation and numbing the joint but they can also help diagnose the source of pain.

The most important and greatest benefit of joint injections is the rapid relief of symptoms that allows you to experience enough relief to become active again. When this happens, you can resume your daily activities and work towards long-term healing. You can also engage in physical therapy to correct the underlying cause of your pain.

There are many surgical and interventional options for severe causes of arthritis and joint pain. Depending on the cause of your specific pain, more treatments may be available. Each person suffering from pain is an individual and needs an individualized pain plan. Arizona Pain can help diagnose your pain and treat it properly.

References

1. Arthritis burden and impact are greater among U.S. women than men: intervention opportunities. J Womens Health (Larchmt). 2007 May;16(4):441-53 Theis KA, Helmick CG, Hootman JM.
2. The effect of physiotherapy training program on postural stability in men with hip osteoarthritis. Giemza C, Ostrowska B, Matczak-Giemza M. Aging Male. 2007 Jun;10(2):67-70