Hip & Thigh

Developmental dysplasia of the hip (DDH) is a common disorder that is seen in infants and young children. It may be present at birth or may occur during the first year of life of the infant. As the name suggests, it occurs due to improper development of the hip joint either while the fetus is in the uterus or during the growth phase in the first year of life.

In normal hip, the head of the femur (thigh bone) fits well into the socket (acetabulum) whereas in hip dysplasia, the socket and femoral head are not congruent because of their abnormal development. The exact cause of DDH is not clear. However, there are factors that may contribute to the development of DDH, and may include:

• Abnormal position of the femoral head
• Too shallow or sloping acetabulum rather than normal cup shape
• Laxity or looseness of the ligaments around the joint
• Breech position of the fetus leading to abnormal stress on the hip joint
• Swaddling or wrapping of the infant with both legs tied together and extended out straight

The hip joint is a “ball and socket” joint. The “ball” is the head of the femur or thigh bone and the “socket” is the cup shaped acetabulum. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.

Hip fracture is a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part – the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.

Pelvic fracture is a condition that arises due to breakage of the pelvis bones. It may damage internal organs, nerves, and blood vessels associated with the pelvis region.

The pelvis is a round structure of bones located at the base of the spine, connected to the sacrum of the spine with the help of strong ligaments. The pelvis is composed of three bones, namely ilium, ischium, and pubis that are fused together. The side of the pelvis is composed of a cup shape socket, known as acetabulum.

Hip bursitis is a painful condition caused by inflammation of a bursa in the hip. Bursae are fluid filled sacs present in joints between bone and soft tissue to reduce friction and provide cushioning during movement.

The bony prominence of the hip is called greater trochanter and is present on the outer side of the upper thigh bone or femur. The bursa overlying it is called trochanteric bursa. Another bursa is located towards the groin region and is called iliopsoas bursa. Bursitis of the trochanteric bursa is more common than that of iliopsoas bursa.

The hip joint is a ball and socket joint. The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum. The joint is surrounded by muscles, ligaments, and tendons that support and hold the bones of the joint in place. Hip dislocation occurs when the head of the femur moves out of the socket. The femoral head can dislocate either backward (posterior dislocation) or forward (anterior dislocation).

Hip dislocation can be caused by injuries from motor vehicle accidents or severe falls. The common symptoms of hip dislocation include pain, inability to move your legs and numbness along the foot or ankle. A dislocation may also be associated with a fracture in the hip, back or knee bones. When you present to the clinic with these symptoms, your doctor performs a thorough physical examination and may order imaging studies such as X-rays to confirm the diagnosis.

A tear in the muscle fibers caused by either a fall or direct blow to the muscle, overstretching and overuse injury is called a strain. Muscle strains often occur in the hip region whenever a muscle contracts all of a sudden from its stretched position. It can be mild, moderate or severe and depends on the level of injury. The chances of having a hip muscle strain becomes high if you have had a previous injury in the area or if there is no warm-up before exercising. The most common symptom of hip strain is pain and swelling in the area of injury. Pain may worsen on using the injured muscle and also the strength in the muscle may also decrease.

Apart from physical examination of your hip and leg, your doctor may order an X-ray to rule out a stress fracture of the hip and confirm the diagnosis. Initial treatment aims at relieving pain and swelling. RICE protocol should be followed for mild to moderate strains. It includes:

• R-Rest: Avoid bearing excess weight on your hip. You should use crutches for the first 1-2 days after injury.
• I- Ice: Gently rub the area with ice. This decreases the swelling.
• C-Compression: Wrap a bandage over the area to help decrease the swelling.
• E-Elevation: Elevate the injured area above heart level.

Inflammation of the joints is referred to as arthritis. The inflammation arises when the smooth covering (cartilage) at the end surfaces of the bones wears away. In some cases, the inflammation is caused when the lining of the joint becomes inflamed as part of an underlying systemic disease. These conditions are referred to as inflammatory arthritis.
The most common types of inflammatory arthritic conditions of the hip include:

• Rheumatoid Arthritis:systemic disease of the immune system commonly affects multiple joints on both sides of the body at the same time
• Ankylosing Spondylitis:chronic inflammatory disease of the spine and the sacroiliac joints (junction where the spine meets the pelvic bone)
• Systemic Lupus Erythematosus (SLE):an autoimmune disease in which the body’s immune system attacks its own healthy cells and tissues

A hamstring strain is an excessive stretch or tearing of hamstring muscles which are located at the back of the thigh. It is a common injury particularly seen in athletes who participate in sports activities that requires running, jumping, and kicking. During growth spurt the bones grow faster than the muscles. As a result the muscle becomes tight and a sudden jump or stretch can tear the muscle away from its connection to the bone resulting in strain.

Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage). In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected joint. Although osteoarthritis may affect various joints including hips, knees, hands, and spine, hip joint is most commonly affected. Rarely, the disease may affect the shoulders, wrists and feet.

Osteoarthritis is characterized by damaged articular cartilage, cartilage lining the hip joint. Advanced age is one of the most common reasons for osteoarthritis of hip. You may also develop osteoarthritis if you had hip injury or fracture in the past, if you have family history of osteoarthritis, suffering from hip diseases such as avascular necrosis and other congenital or developmental hip diseases.

Osteonecrosis, also known as avascular necrosis, is a condition characterized by bone death due to inadequate blood supply. Lack of blood flow may occur when there is a fracture in the bone or a joint dislocation that may damage nearby blood vessels. Chronic use of high doses of steroid medications and heavy alcohol consumption are the two main risk factors of osteonecrosis. Initially, small breaks appear in the bone that may eventually collapse. Hip joint is most commonly affected; however the knee and shoulder may also be involved.

The femur or thighbone is the largest and strongest bone in the human body. Pediatric thighbone fractures can occur when your child falls hard on the ground, gets hit during sports, automobile accidents, and child abuse. In a thighbone fracture, the broken bones may be aligned or displaced. The fracture can either be closed (with skin intact) or open (with the bone piercing out through the skin). Your child may experience severe pain, swelling, inability to stand and walk, and limited range of motion of hip or knee.

Your child’s doctor will conduct a physical examination. An X-ray or CT-scan may be recommended to locate the position and number of fractures, and determine if the growth plate is damaged. Femur fractures may be treated with non-surgical or surgical methods.

Perthes disease, also known as Legg-Calve-Perthes Disease (LCPD) is a disorder of the hip that affects children, usually between the ages of 4 and 8. Hip is the largest weight-bearing joint in our body. It is a ball and socket joint that allows movement of the upper leg. Perthes disease usually involves both hips. In this condition, there is a temporary loss of blood supply to the ball of the hip joint (the femoral head) that leads to death of the bone. Over the course of several months, the blood supply eventually returns back to the bone tissue and new bone cells gradually replace the dead bone.

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents causing slippage or separation of the femoral head (ball at the upper end of the femur bone) from the weakened epiphyseal growth plate (growing end of the bone).This condition often develops during the rapid growth period after the onset of puberty, and may affect one or both legs at a time. The separation may be caused by an injury or other factors such as obesity and hormonal imbalances. SCFE commonly occurs in children between 11 and 15 years and boys are more likely to develop the condition than girls.

The hip is an important joint that helps us walk, run and jump. The ball-and-socket joint in the hip is formed between the round end of the femur (thighbone) and the cup-shaped socket of the acetabulum (part of the hip bone). Joint stability in the hip region is achieved through the labrum (a strong fibrous cartilage), which covers the acetabulum and seals it, and ligaments (tissue connecting bone to bone) and tendons (tissue connecting muscle to bone) that encase the hip and control the hip movements.

The femur or thigh bone is the longest and strongest bone in the body, connecting the hip to the knee. A femur fracture is a break in the femur. The distal femur is the lower part of the thigh bone which flares out like an upside-down funnel and its lower end is covered by a smooth, slippery articular cartilage that protects and cushions the bone during movement. Fracture of the distal femur may involve the cartilaginous surface of the knee as well and result in arthritis.

Types

• Distal femur fracture: The distal femur is part of the femur bone that flares out like the mouth of the funnel. A distal femur (top part of knee joint) fracture is a break in thighbone that occurs just above your knee joint.
• Femoral shaft fracture: A femoral shaft fracture is a break that occurs anywhere along the femoral shaft, long, straight part of the femur.
• Proximal femur fracture: A hip fractureor proximal femur fracture is a break in the proximal end of the thigh bone near the hip.

Transient osteoporosis of the hip is a rare condition that causes bone loss temporarily in the upper part of the thighbone (femur). It is mostly found in young or middle aged men between the ages of 30 and 60, and women in their later stages of pregnancy or early postpartum period (following childbirth). It is characterized by abrupt onset of pain that increases with activity.

The hip joint is a ball-and-socket joint. A part of the pelvis bone known as the acetabulum forms the socket and the upper end of the femur, known as the femoral head, forms the ball. In patients with transient osteoporosis of the hip, the femoral head loses its density and strength and becomes more prone to breaking.

What is Meralgia Paresthetica?

Meralgia paresthetica, also known as Bernhardt-Roth syndrome is a neurological condition characterized by pain and numbness in the thigh.