Hip & Thigh Anatomy

The hip is a ball-and-socket joint that connects the lower limb to the pelvis, enabling a wide range of motion and providing stability for weight-bearing activities. It consists of two main parts: the femoral head (the ball) and the acetabulum (the socket) of the pelvis. The joint is surrounded by a strong capsule of ligaments and tendons, which help stabilize the hip while allowing for movements such as walking, running, and rotating. The hip also contains cartilage that cushions the joint and helps reduce friction during movement.

The muscles around the hip, including the gluteal, hip flexors, and adductors, play a significant role in both mobility and strength, supporting the body during activities like standing, squatting, and climbing. Its structure is designed for both mobility and stability, allowing for dynamic movements while supporting the body’s weight.

Specializing Surgeon

Charles E. Stewart M.D.

Conditions & Treatments

Hip Osteoarthritis: A Common Cause of Hip Pain 

Hip osteoarthritis (OA) is a degenerative joint disease that occurs when the protective cartilage in the hip joint breaks down over time, leading to pain, stiffness, and reduced mobility. OA of the hip is a common condition, particularly in older adults, and can significantly impact daily activities such as walking, bending, and climbing stairs. 

What Is Hip Osteoarthritis? 

Hip osteoarthritis involves the gradual wear and tear of the cartilage in the hip joint, which is essential for smooth and pain-free movement. As the cartilage deteriorates, the bones may begin to rub against each other, causing pain, inflammation, and a decrease in the joint’s range of motion. This condition can occur due to aging, previous joint injuries, genetic factors, or overuse. 

When Is Treatment Needed for Hip Osteoarthritis? 

Treatment for hip OA is typically recommended when symptoms such as pain, stiffness, and limited movement begin to affect daily activities. Common treatment options include: 

  • Physical Therapy: Strengthening the muscles around the hip joint can help improve stability and reduce pain.
  • Medications: Over-the-counter pain relievers or anti-inflammatory medications can help manage pain and inflammation.
  • Injections: Corticosteroid or hyaluronic acid injections may provide temporary relief from pain and inflammation.
  • Surgical Intervention: In severe cases, when conservative treatments are not effective, surgery, such as hip replacement, may be considered. 

Benefits of Managing Hip Osteoarthritis 

  • Pain Relief: Proper treatment helps manage and reduce pain, improving quality of life.
  • Improved Mobility: Addressing the underlying causes of pain can restore movement and function in the hip joint.
  • Avoiding Surgery: Early intervention with conservative treatments can help delay or avoid the need for joint replacement surgery.
  • Enhanced Daily Function: Effective management allows patients to maintain their daily activities with greater ease and comfort. 

If you’re experiencing symptoms of hip osteoarthritis, consult with an orthopedic specialist to explore treatment options that can help manage pain, improve mobility, and prevent further damage to the hip joint. 

Bursitis: Causes, Types, and Symptoms 

Bursitis is the inflammation of a bursa, a small, fluid-filled sac that acts as a cushion between bones and soft tissues like muscles and tendons. When a bursa becomes irritated or inflamed, it can cause pain and swelling, making movement difficult. 

Causes of Bursitis 

Bursitis often results from repetitive motion, prolonged pressure, or injury to the affected area. Common causes include: 

  • Repetitive Movements: Activities that involve repetitive motion, such as sports or manual labor, can lead to bursitis.
  • Trauma or Injury: A direct blow or injury to a joint can cause inflammation in the bursa.
  • Overuse: Excessive use of certain joints, especially in positions that put pressure on the bursa, can lead to irritation.
  • Infection: In rare cases, a bacterial infection can cause septic bursitis, leading to more severe symptoms.
  • Medical Conditions: Conditions like rheumatoid arthritis, gout, or diabetes can increase the risk of developing bursitis. 

Common Types of Bursitis 

  • Shoulder Bursitis: Inflammation of the bursa in the shoulder, often caused by repetitive overhead movements.
  • Elbow Bursitis: Also known as “student’s elbow,” it occurs when the bursa at the tip of the elbow becomes inflamed, typically from prolonged pressure or frequent leaning.
  • Hip Bursitis: Inflammation of the bursa in the hip, often caused by repetitive movements or long periods of sitting.
  • Knee Bursitis: Common in athletes or individuals who kneel frequently, this condition affects the bursa in the knee joint. 

Symptoms of Bursitis 

  • Pain: Aching or sharp pain in the affected joint, often aggravated by movement or pressure.
  • Swelling: Visible swelling around the affected joint.
  • Tenderness: The area around the bursa may be sensitive to touch.
  • Stiffness: Limited range of motion in the affected joint.
  • Redness and Warmth: In the case of infection, the skin may appear red and feel warm to the touch. 

Bursitis can significantly affect daily activities, but treatment options such as rest, ice, anti-inflammatory medications, physical therapy, or in more severe cases, injections or surgery, can help alleviate symptoms.

Tendonitis and Tendinosis: Causes, Types, and Symptoms 

Tendonitis and tendinosis are conditions that involve inflammation or degeneration of tendons, the thick cords that attach muscles to bones. These conditions can cause significant pain and limit movement, often affecting active individuals or those engaged in repetitive motions. 

Common Types of Tendonitis and Tendinosis 

Tendonitis

Tendonitis is the inflammation of a tendon, often caused by overuse, injury, or repetitive stress. It typically occurs in the shoulder, elbow, wrist, knee, or Achilles tendon. Inflammation can make the tendon swollen, painful, and less flexible. Common types include: 

  • Rotator Cuff Tendonitis (shoulder)
  • Tennis Elbow (lateral epicondylitis, elbow)
  • Achilles Tendonitis (ankle)
  • Patellar Tendonitis (knee) 

Tendinosis

Tendinosis is the degeneration of a tendon’s collagen due to chronic overuse, without the inflammation seen in tendonitis. This leads to weakened tendons, increasing the risk of further injury. It most often affects tendons in the: 

  • Elbow (lateral epicondylitis or “tennis elbow”)
  • Knee (patellar tendon)
  • Shoulder (rotator cuff tendons)

Symptoms of Tendonitis and Tendinosis 

  • Pain: Localized pain at the site of the tendon, often worsened by movement or activity.
  • Swelling: Tenderness and visible swelling around the affected tendon.
  • Stiffness: Reduced range of motion in the joint or muscle.
  • Weakness: Difficulty using the affected limb due to pain or discomfort.
  • Crepitus: A sensation of grating or crackling during movement. 

Tendonitis and tendinosis can significantly impact quality of life, particularly for individuals who rely on repetitive motions. Early diagnosis and treatment, including rest, physical therapy, medications, injections, or surgery, can help manage symptoms and promote recovery.

Ligament Sprains: Causes, Types, and Symptoms

A ligament sprain is an injury to the tough, fibrous tissue that connects bones together and stabilizes joints. Ligament sprains can range from mild to severe, often causing pain, swelling, and difficulty moving the affected joint.

Causes of Ligament Sprains

Ligament sprains typically occur when a joint is forced beyond its normal range of motion. Common causes include:

  • Trauma: A sudden impact or forceful movement, such as a fall, car accident, or sports-related injury, can overstretch or tear ligaments.
  • Twisting or Overextending: Activities that involve rapid twisting motions, such as twisting an ankle or knee, can lead to sprains.
  • Repetitive Stress: Overuse or repetitive strain on a joint, such as during sports or strenuous physical activities, can weaken ligaments and make them more prone to injury. 

Types of Ligament Sprains 

Ligament sprains are classified into three grades based on the severity of the injury: 

  • Grade 1 (Mild): A mild sprain occurs when the ligament is stretched but not torn. This usually causes mild pain, swelling, and minimal joint instability.
  • Grade 2 (Moderate): A moderate sprain involves partial tearing of the ligament, leading to more significant pain, swelling, bruising, and some instability in the joint.
  • Grade 3 (Severe): A severe sprain is a complete tear or rupture of the ligament, resulting in intense pain, swelling, bruising, and significant joint instability or immobility. 

Common Areas Affected by Ligament Sprains 

  • Ankle: One of the most common sprains, typically caused by rolling or twisting the ankle.
  • Knee: Sprains to ligaments such as the ACL (anterior cruciate ligament) or MCL (medial collateral ligament) often occur during sports or physical activities.
  • Wrist: Ligament sprains in the wrist can occur from falls or direct trauma.
  • Thumb: Sprains in the thumb are common in contact sports or activities requiring gripping. 

Symptoms of Ligament Sprains 

  • Pain: Localized pain in the affected joint, which may increase with movement.
  • Swelling: Inflammation around the joint, making it tender to touch.
  • Bruising: Discoloration due to blood pooling under the skin.
  • Instability: The feeling that the joint may give way or lack strength, especially in severe sprains.
  • Limited Mobility: Difficulty moving the joint due to pain or stiffness. 

Treatment for ligament sprains depends on the severity of the injury and may include physical therapy, medications for pain management, and in more severe cases, surgical intervention. 

Strains: Causes, Types, and Symptoms 

A strain is an injury to a muscle or tendon (the tissue that connects muscles to bones), caused by overstretching or tearing. Strains can range from mild to severe and typically result from overuse, improper movement, or sudden forceful actions. They often affect the back, hamstrings, and other muscles throughout the body, causing pain and limiting mobility. 

Causes of Strains 

Strains commonly occur due to: 

  • Overuse or Repetitive Motion: Continuous or excessive use of a muscle without proper rest can lead to strain, especially in athletes or individuals with physically demanding jobs.
  • Sudden or Forceful Movements: Lifting heavy objects, twisting motions, or explosive actions (such as sprinting or jumping) can strain muscles or tendons.
  • Poor Flexibility or Warm-Up: Lack of proper stretching or warm-up before physical activity increases the risk of muscle strains. 

Types of Strains 

Strains are typically classified into three grades based on severity: 

  • Grade 1 (Mild): A mild strain involves overstretching or slight tearing of the muscle or tendon fibers, causing minimal pain, swelling, and no significant loss of function.
  • Grade 2 (Moderate): A moderate strain involves partial tearing of muscle fibers, leading to moderate pain, swelling, and some loss of strength or movement.
  • Grade 3 (Severe): A severe strain refers to a complete tear of the muscle or tendon, often causing intense pain, significant swelling, bruising, and a noticeable loss of function or stability. 

Symptoms of Strains 

  • Pain: Sharp or aching pain in the affected muscle, which may worsen with movement or activity.
  • Swelling: Inflammation or puffiness around the injured muscle or tendon.
  • Bruising: Discoloration from blood accumulating beneath the skin.
  • Limited Range of Motion: Difficulty moving the affected area due to pain or weakness.
  • Weakness: A feeling of instability or weakness in the muscle, making it hard to perform usual movements or activities. 

Treatment for strains typically includes rest, ice, compression, and elevation (R.I.C.E.), along with stretching and strengthening exercises to aid in recovery. Severe strains may require medical intervention, including physical therapy or, in some cases, surgery. 

Hip and Pelvis Fractures: Causes, Types, and Symptoms 

Hip and pelvis fractures are common injuries that can result from trauma, falls, or underlying medical conditions. These fractures can cause significant pain, mobility issues, and, in some cases, complications that require medical intervention. Understanding the types and symptoms of these fractures is essential for proper diagnosis and treatment. 

Common Types of Hip and Pelvis Fractures 

  • Hip Fractures: These fractures typically occur in the femoral neck (the area just below the ball of the hip joint) and are most common in older adults, especially those with osteoporosis or a history of falls. They can significantly affect mobility and require prompt treatment.
  • Pelvic Fractures: Pelvic fractures are typically the result of high-impact trauma, such as car accidents or falls from a significant height. These fractures can involve the bones of the pelvis, such as the iliac crest, sacrum, or pubic symphysis. They may be stable or unstable, with unstable fractures requiring urgent medical attention.
  • Stress Fractures: Stress fractures of the pelvis are common in athletes or individuals who engage in repetitive activities, such as running or jumping. These fractures often develop over time due to repetitive stress on the bone and may not be immediately obvious. 

Symptoms of Hip and Pelvis Fractures 

  • Pain: Sharp or throbbing pain in the hip or pelvic area, especially when moving or bearing weight.
  • Swelling: Inflammation or visible swelling around the injury site.
  • Bruising: Discoloration or tenderness at the location of the fracture.
  • Deformity: In some cases, a visible misalignment or deformity of the hip or pelvic area may occur.
  • Limited Mobility: Difficulty moving the leg or walking, often due to pain or instability in the joint. 

Treatment of Hip and Pelvis Fractures 

The treatment for hip and pelvis fractures depends on the type and severity of the injury. Some fractures can be treated conservatively with rest, physical therapy, and pain management, while others may require surgical intervention, including the use of plates, screws, or joint replacement. Prompt medical evaluation and intervention are crucial for a proper recovery and to prevent further complications. 

If you suspect a hip or pelvis fracture, seek immediate medical attention for an accurate diagnosis and appropriate treatment. 

Avascular Necrosis of the Hip: Understanding Bone Damage in the Hip Joint 

Avascular necrosis (AVN) of the hip, also known as osteonecrosis, occurs when the blood supply to the bone in the hip joint is disrupted, causing the bone tissue to die. Without a sufficient blood supply, the bone weakens, and over time, it may collapse. This condition can lead to pain, limited range of motion, and eventual joint dysfunction, making it a serious concern for hip health. 

What Is Avascular Necrosis of the Hip? 

Avascular necrosis of the hip occurs when the blood flow to the femoral head (the ball part of the hip joint) is interrupted. This loss of blood supply deprives the bone of necessary nutrients, leading to the death of bone tissue. As the bone weakens, it can begin to collapse, which in turn may cause the hip joint to become misaligned and cause arthritis. Common causes of AVN include trauma (like fractures or dislocations), long-term use of steroids, excessive alcohol use, and certain medical conditions like sickle cell disease. 

When Is Treatment Needed for Avascular Necrosis of the Hip? 

Treatment for AVN is required when symptoms such as hip pain, stiffness, and difficulty moving the joint start affecting daily activities. If left untreated, AVN can lead to the collapse of the hip joint and the need for more extensive interventions, including joint replacement. Early intervention is key in preventing further damage and preserving hip function. 

Treatment options include: 

  • Non-Surgical Options: In the early stages, non-surgical treatments such as medications for pain relief, physical therapy, or weight-bearing restrictions may help manage symptoms.
  • Surgical Options: As the condition progresses, surgical procedures may be necessary. This can include core decompression (removing a small portion of the bone to improve blood flow), bone grafting, or even hip replacement in severe cases. 

Benefits of Managing Avascular Necrosis of the Hip 

  • Pain Relief: Timely treatment can reduce pain and improve mobility.
  • Preservation of Joint Function: Early intervention can help prevent the collapse of the femoral head, delaying or avoiding the need for joint replacement.
  • Improved Quality of Life: Effective management helps restore function, allowing individuals to resume daily activities with less discomfort. 

If you suspect you have avascular necrosis of the hip, it’s important to consult an orthopedic specialist for an accurate diagnosis and to explore treatment options that can prevent further joint damage and help manage symptoms effectively. 

Hip Labral Injuries & Pathology 

Labral pathology in the hip refers to damage or tears in the labrum, the cartilage that forms a cup around the ball of the hip joint (acetabulum). This cartilage helps to stabilize the joint and allows smooth movement. When the labrum is injured, it can cause pain, stiffness, and limited mobility, significantly affecting daily activities and quality of life. 

What Is Hip Labral Pathology? 

The labrum in the hip is a ring of cartilage that surrounds the acetabulum, creating a deeper socket for the femoral head (the ball of the hip joint). Labral tears or damage can result from trauma, repetitive motion, or hip conditions like hip impingement (FAI), where the bones of the hip joint do not fit together properly. Over time, this abnormal motion can cause wear and tear on the labrum, leading to pain and dysfunction. 

Common Causes of Hip Labral Pathology 

  • Hip Impingement (FAI): A deformity in the shape of the femur or acetabulum that causes abnormal contact within the joint, increasing the risk of labral tears.
  • Trauma: A direct injury or fall can tear the labrum.
  • Repetitive Movements: Activities that involve excessive twisting, pivoting, or high-impact actions can wear down the labrum over time.
  • Degenerative Changes: Age-related changes in the hip joint, including osteoarthritis, can contribute to labral damage. 

Symptoms of Hip Labral Pathology 

  • Pain: A deep, aching pain in the hip, often felt in the groin area, which may worsen with certain movements or after prolonged activity.
  • Clicking or Locking: A sensation of clicking, popping, or catching in the hip joint, particularly with movement.
  • Stiffness: Reduced range of motion in the hip, making activities such as walking, climbing stairs, or sitting for long periods more difficult.
  • Instability: A feeling of weakness or instability in the hip joint. 

Treatment of Hip Labral Pathology 

Treatment for hip labral pathology depends on the severity of the damage and the symptoms. Initially, non-surgical approaches like physical therapy, anti-inflammatory medications, and activity modification can help relieve symptoms. If conservative treatments do not provide relief, or if the tear is severe, surgery may be recommended. Hip arthroscopy is a minimally invasive procedure used to repair or remove the damaged labrum, providing pain relief and restoring joint function. 

If you experience hip pain, clicking, or reduced mobility, consulting with an orthopedic specialist is important for an accurate diagnosis and to discuss the best treatment options for restoring your hip’s function and comfort. 

IT Band Friction Syndrome 

Iliotibial (IT) band friction syndrome is a common condition that causes pain on the outside of the knee or hip, often experienced by runners, cyclists, or individuals who engage in repetitive lower body movements. This condition occurs when the IT band, a thick band of tissue running down the outside of the thigh from the hip to the knee, becomes tight or irritated, rubbing against the bones of the knee joint. 

What Is IT Band Friction Syndrome? 

The IT band is a strong fibrous tissue that helps stabilize the knee during movement. In IT band friction syndrome, repeated friction between the IT band and the outer part of the knee leads to inflammation and pain. The condition is often associated with overuse, improper biomechanics, or muscle imbalances that cause the IT band to become tight and irritated. 

Causes of IT Band Friction Syndrome 

  • Overuse: Repetitive activities such as running, cycling, or hiking, especially on uneven terrain or long distances, can stress the IT band.
  • Muscle Imbalances: Weak hip abductors or tight quadriceps can alter the way the IT band moves, increasing friction on the knee joint.
  • Poor Biomechanics: Abnormalities in walking or running form, such as overpronation or an improper stride, can contribute to the condition.
  • Inflexibility: Lack of flexibility in the hips, knees, or IT band itself can make it more prone to irritation. 

Symptoms of IT Band Friction Syndrome 

  • Pain on the Outer Knee: A sharp or burning pain on the outside of the knee, often worsened by activities like running, cycling, or descending stairs.
  • Pain that Worsens with Activity: The pain may start mild but can intensify with prolonged use of the affected leg or after activity.
  • Swelling or Tenderness: Swelling may occur along the outside of the knee, and the area may be tender to the touch.
  • Decreased Range of Motion: Difficulty bending or straightening the knee due to discomfort. 

Treatment for IT Band Friction Syndrome 

Treatment for IT band friction syndrome focuses on reducing inflammation, improving flexibility, and addressing the underlying causes of the condition. Initial treatments include rest, ice, and anti-inflammatory medications. Stretching and strengthening exercises, particularly for the hip and thigh muscles, can help relieve tension in the IT band. Physical therapy may also help improve biomechanics and prevent recurrence. In rare cases, if conservative treatments do not provide relief, corticosteroid injections or surgery may be considered. 

If you’re experiencing pain or discomfort on the outside of your knee or hip, especially after physical activity, it’s important to consult with an orthopedic specialist to assess your condition and explore the most effective treatment options.