Pain that is in or around one’s hip joint may or may not be present secondary to a hip issue. The pain can also be coming from a low back spinal problem.
The potential generators of the pain can be:
1) Hip joint arthritis or a soft tissue problem inside the hip joint (labrum)
2) Intervertebral disc herniation
3) Spinal Stenosis
4) Soft tissue problem around the hip
5) Fracture in the spine
6) Hip Fracture
Hip arthritis pain or a labral tear may cause significant pain in the groin area on the affected side. Physical examination and x-rays will typically confirm the culprit as degenerative joint disease (DJD) in the hip. If the patient receives a hip injection as treatment and the pain is eliminated even for an hour, one can be certain the hip is in fact the problem with further treatments confined to the hip.
Groin pain can also be a result of a disc herniation. It’s not something typically seen in a textbook and it is an atypical presentation, but an L5-S1 disc herniation can in fact cause groin pain on the affected side. So if the exam and radiologic studies of the hip are not definitive for a hip problem, potentially obtain and MRI of the lumbar spine for the answer.
Pain that is around the hip joint may be coming from the spine. It is called radiating pain if it emanates from a spinal problem and then travels down into the buttock area or hip region. One such problem is called spinal stenosis, which represents nerve root compression at one or multiple levels from an arthritic process.
Spinal stenosis typically occurs in older individuals that may also be experiencing pain in the hip from arthritis. So the hip pain can be a combination of radiating pain from spinal stenosis along with the direct pain from the DJD in the hip. How is the diagnosis then made.
The combination of a good history, physical examination, and imaging studies often elucidates the source of the pain. If there’s still a question mark, injections can give the answer. Here’s an example. Betty is 74 years old and experiences pain on the outside and front of her right hip area on a daily basis. Activity makes it worse, and at times it wakes her up at night. Also it radiates down the front of her thigh a bit.
She is convinced the pain is coming from her hip since she has no back pain at all. On physical examination while moving her right hip all over the place, however, she has minimal provocation of her pain. X-rays show moderate arthritis in her right hip, with the same degenerative joint disease existing on her left side as well.
The physician orders x-rays and an MRI of Betty’s lumbar spine which shows numerous nerve roots being compressed as they are trying to get out from the spine on the right side. So she has spinal stenosis.
As a diagnostic test, the physician performs a right hip injection under x-ray guidance. Betty’s pain only decreased 20% over the next three days. So the physician sent Betty to a pain doctor the following week who performed an interventional pain management procedure called an epidural injection.
And you know what happened? Betty’s pain decreased another 50% after the first injection and another 20% with the second injection, adding up to a 90% pain reduction with the epidural injections. Both the spinal injections and the hip injection therefore served both a diagnostic and therapeutic purpose.
It is important to keep in mind that pain in and around the hip may in fact be coming either partly or completely from a problem in the spine. This can be the difference between a frustrated patient still in pain versus one who shows dramatic improvement.