Joint Knowledge: Common Hip Injuries Part II

Previously, we discussed hip injuries and looked at several different hip injuries. Today, we’re going to take a deeper dive and explore some of the most common specific injuries.

Fractures of the Femoral Neck

The hip is a joint that joins the femur (the thigh bone) with the pelvis. Both bones can be broken or fractured. A fracture in either bone is extremely painful and can cause mobility problems.

The femur is the largest and strongest bone of the human body. However, fractures of the femur are not uncommon. As we age, our bones become less dense. Furthermore, many older adults suffer from osteoporosis, a condition in which the bones become especially brittle. The femur is much more prone to fracture among people with osteoporosis. Finally, broken femurs can occur due to car accidents and other traumatic injuries.

The femur has several distinct features we need to consider when discussing fractures. Near the top is the femoral head and neck. This is the portion of the thigh bone that connects into the hip joint and attaches to the pelvis. The longest part of the bone is the body, also known as the shaft. Finally, the lower part of the femur has two prominent surfaces called condyles.

For now, let’s focus on the head and neck. Fractures of the femoral neck are the most common type of hip fracture. After all, the neck is the narrowest part of the bone, the place where it inserts into the hip joint. This makes it more prone to breaking.

A femoral fracture typically requires surgery¹ and can take up to 6 months to fully heal. Seek medical attention immediately if you think you have a broken hip. Signs include pain around your hip and thigh, difficulty walking or bearing weight, and inability to rotate the hip. Complications from a fractured femur can lead to death in approximately 20% of older adults.² Be sure to follow all your doctor’s advice for recovery.

 

Trochanteric Bursitis

Near the head of the femur is a large protrusion called the greater trochanter. This is the thickest part of the bone, just before the narrowing at the femoral neck.

One common issue people have with the greater trochanter is trochanteric bursitis. Bursitis is inflammation and swelling of the bursa, a fluid-filled sac that lubricates a joint. Trochanteric bursitis, then, is inflammation of the bursa near the hip. Which just so happens to come into close contact with the greater trochanter.

Trochanteric bursitis is marked by pain in the hip,³ often experienced during strenuous activity or when applying pressure to the affected area (such as by laying on your side).

Trochanteric bursitis can be caused by accidents and injuries or underlying orthopedic conditions.³ People with osteoarthritis or rheumatoid arthritis are affected by bursitis more frequently. Poor posture can also contribute to trochanteric bursitis.

The most common treatments for trochanteric bursitis focus on reducing pain and inflammation. Anti-inflammatory drugs, such as ibuprofen, can help manage both symptoms. Physical therapy can also help to strengthen the muscles and joints as well as improve your posture to alleviate trochanteric bursitis. Finally, if the pain and swelling are persistent, your doctor can give you steroid injections or even perform surgery.

 

Labral Tear

The labrum is a band of cartilage that surrounds a joint. It helps to support the joint and provide cushion for the motions of the bones in the joint.

As you can imagine, tearing the labrum can be painful. Like the other injuries we’ve discussed, a labral tear can cause pain in the hip and thigh. Your range of motion may be limited. In some cases, you may feel a locking sensation as you try to move your hip normally.⁴

Labral tears occur due to trauma to the hip. High-impact sports, such as football, can increase your likelihood of a labral tear. However, repetitive motion can also cause a labral tear. Repeating rotation of the hip, as in golf (believe it or not!), can cause a tear.⁴ Car accidents are also a risk factor.

As with bursitis, treatment usually consists of non-steroidal anti-inflammatory drugs and physical therapy. Steroid injections may be considered in some cases. Finally, surgery is an option if other treatment plans don’t work.

 

Snapping Hip

Snapping hip is a general term for a group of hip injuries related to damaged tendons. The three main tendons that cause snapping hip are the iliotibial band (outside the hip), the rectus femoris tendon (front of the hip), and the hamstring tendon (back of the hip).

Each tendon is involved in different movements. Therefore, the symptoms of each injury are slightly different. The region of the hip affected will depend on the tendon that was damaged. For example, damaging the rectus femoris tendon will cause the joint to “snap” when you extend your hip forward. What you’re feeling is the damaged tendon slipping over the surface of the muscle.⁵

Snapping hip is usually caused by tightness in the muscles or repetitive exercise. Dancers are prone to snapping hip because they are constantly using their legs. Young people can also develop snapping hip; as their bodies grow, the muscles in the hip can become tight, making it easier to damage the tendons.⁵

Despite the frightening name, snapping hip is not usually very painful. However, if left untreated, snapping hip can cause complications, including bursitis. Like many of the other injuries we discussed, physical therapy and rest are the primary treatments. Anti-inflammatory medications and steroids are not typically administered because pain relief is not usually a primary concern. Surgery is an option for tendons that don’t heal on their own.

References

1. Kazley J, Bagchi K. Femoral neck fractures. 2020. https://www.ncbi.nlm.nih.gov/books/NBK537347. Accessed 9/3/2020.
2. Brunner LC, Eshilian-Oates L, Kuo TY. Hip fractures in adults. Am Fam Physician. 2003;67(3):537-542.
3. Trochanteric Bursitis: Management and Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4964-trochanteric-bursitis/management-and-treatment. Accessed 9/3/2020.
4. Hip Labral Tear. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hip-labral-tear/diagnosis-treatment/drc-20354878. Accessed 9/3/2020.
5. Snapping Hip. American Academy of Orthopedic Surgeons. https://orthoinfo.aaos.org/en/diseases–conditions/snapping-hip/#:~:text=Snapping%20hip%20is%20a%20condition,bony%20protrusion%20in%20your%20hip. Accessed 9/3/2020.