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Hip Pain: New Insights and Treatments for Young and Middle-Aged Adults

April 07, 2010

Learn More At Upcoming Health and Wellness Seminar

Until recently, when young or middle-aged adults complained of hip pain, physicians often were unable to determine the cause of the pain. Now, however, doctors have gained new insights into various hip problems.

"It used to be that if a young or middle-aged person was suffering from hip pain, the physician generally would order X-rays to look for signs of arthritis," says Russell Nord, M.D., an orthopedic surgeon at Washington Hospital. "In many cases, the results would be negative for arthritis, leaving patients and physicians with no concrete answers as to the cause of the pain. We have learned a lot in recent years, though, about the underlying causes of hip pain, resulting in a constellation of new diagnoses and treatments."

To help people in the community learn more about the causes and treatments for hip pain, Washington Hospital is hosting a special seminar featuring Dr. Nord on Monday, April 12 from noon to 1:30 p.m. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building at 2500 Mowry Avenue in Fremont.

One of the conditions Dr. Nord will discuss goes by the complicated name of Femoroacetabular Impingement (FAI). "In laymen’s terms, FAI is basically a case of too much extra bone on the ball or cup of the hip joint," Dr. Nord explains. "These bits of extra bone rub against one another, causing friction that can result in tears in the cartilage that protects the joint. We didn’t used to appreciate the significance of this extra bone, but now if a physical exam and X-ray point to the possibility of this condition, we would likely perform an MRI to aid in the diagnosis and help look for tears in the cartilage."

Dr. Nord notes that symptoms of FAI might include pain in the groin as well as the hip because the ball and cup of the hip joint sit within the groin. Patients with FAI also might experience pain in the buttocks. FAI also can result in loss of motion that limits the patient’s ability to walk or be comfortable while sitting or lying down. FAI mainly affects middle-aged people, but it can be diagnosed in people from their 20s to their 60s. FAI also is an "equal opportunity" condition that is found in both men and women.

"We don’t fully understand why FAI occurs," he says. "There very well may be some genetic predisposition to developing FAI, but because it’s a fairly recent discovery, there have been no formal studies and we haven’t been able to track it through generations. It’s also possible that FAI could be due to certain physical activities or aggravated by those activities, but again, we just don’t know enough about FAI yet to say for certain."

While the details of how FAI develops remain a mystery, the good news is that there are treatments available.

"The first treatment option would be to try physical therapy, as well as anti-inflammatory medications or cortisone injections," says Dr. Nord. "Some cases may require arthroscopic surgery to trim off the extra bone from the ball or cup of the joint or to repair or trim the cartilage surrounding the joint. We also can try to grow new cartilage using a procedure called microfracture, in which we poke small holes in the bone so new cartilage will grow up through the holes in the bone."

If left untreated, FAI could cause the cartilage to continue deteriorating. "We don’t know if untreated FAI will lead to arthritis or not, but we do know that patients usually get relief from their pain with these surgical procedures, usually recovering within a few months," Dr. Nord says.

At the seminar, Dr. Nord also will discuss other conditions that can cause hip pain, including "snapping" or "popping" hip. "With snapping hip, the patient feels a snapping sensation and often hears an audible popping noise when the hip is flexed and extended," he notes. "This happens when the tendons around the hip get caught on bone and pull until they snap back. It’s somewhat like the effect of ‘twanging’ the strings of a guitar."

X-rays are often normal with snapping hip syndrome, and other imaging studies such as ultrasound and MRI may be useful in diagnosing the condition, but the physical exam is probably the most useful test. In most cases, the treatment emphasizes physical therapy, perhaps combined with anti-inflammatory medications. Cortisone injections may be considered for patients who have persistent pain despite physical therapy efforts.

"In rare cases, patients may require surgery for snapping hip, and there are several surgical approaches that have been used successfully," Dr. Nord says.

"In any case, if you’re having pain in your hip or groin that is not diagnosed as arthritis on an X-ray, you should seek a further evaluation," he adds. "There is no need to suffer in silence when there are options for relief available."

To find an orthopedic physician near you, visit www.whhs.com and click on Find My Physician. To register for Dr. Nord’s free upcoming seminar on hip pain, register online at www.whhs.com and click on the seminar link under "Upcoming Seminars."