Hip Tendon Pain
What is Hip Tendon Pain?
There are many sources of pain outside of the hip joint (extra-articular), and some of these sources can be the tendons that surround the hip or originate/insert near the hip joint.
People of all ages can be affected by hip tendon pain. It is common for certain tendons around the hip to be injured during sporting activities, and hence it is commonly seen in younger patients. The most common form of hip tendon pain however is seen in middle age people, and it is estimated up to 25% of this group are affected by this condition at some point in their life.
Gluteus Medius Tendonosis / Trochanteric Bursitis
This is the most common soft tissue disorder of the hip. Previously, it was known as trochanteric bursitis. This term is still used by many to describe lateral sided hip pain (centred over the greater trochanter). It is extremely common in middle age/elderly population group, affecting up to 25% of this group at some point. It is a debilitating condition causing significant pain, loss of sleep, and reducing quality of life. It is not however a dangerous condition, with the prognosis being ultimately very good. Most people will recover within 12 – 18 months. Recovery can be accelerated with intervention.
This condition is a degenerative condition of the gluteus medius tendon which inserts onto the greater trochanter of the femur. It is often seen in conjunction with other tendon conditions such as Achilles tendonopathy, tennis elbow, and rotator cuff tears of the shoulder. It is not an inflammatory condition, although a distended bursa (fluid sac) around the greater trochanter is often seen secondary to the tendon degeneration.
How will it affect me?
Usually it causes pain over the greater trochanter which often radiates down the lateral aspect (outside) of the thigh to the knee. Sometimes the pain radiates to the groin. There is usually a tender area to press over the greater trochanter. It will be difficult to lie on the affected side, and typically walking, particularly up inclines, worsens the symptoms.
What is the treatment?
It may be appropriate to use either ultrasound or magnetic resonance imaging (MRI) to look at the area in some detail. This can confirm the clinical diagnosis and also look to see if there are large tears of the gluteus medius tendon.
Physiotherapy is usually recommended as a first line treatment. This strengthens the muscles around the hip and can reduce the forces going through the gluteus medius tendon.
A physiotherapist or doctor may recommend an injection of corticosteroid into the area. This should be performed by someone who knows the anatomy of the area in some detail. Injections have been shown to have significant short term benefit in achieving pain relief.
Extra corporeal shockwave therapy is a new non invasive treatment for this condition. Shockwave therapy uses sound energy in pulses to stimulate healing to a damaged tendon. It is recommended as a second line treatment for this condition, after injections. It can yield excellent results and is popular with patients because it is non-invasive and can be performed in the clinic setting.
Occasionally surgery is recommended. This may be the case if there is a repairable tear of the gluteus tendon. In addition, a decompression of the overlying tissue can improve pain.
This condition causes groin pain felt at the inside of the thigh, pubic bone, and lower abdominal muscles. It is often seen in the younger patient age group who are physically active, being particularly common in sportspeople and elite athletes. It is occasionally seen in patients after hip replacement. This condition often responds to physiotherapy or shockwave therapy. Occasionally surgery is necessary if there is evidence of a small hernia (sports hernia).
This condition usually causes pain in the posterior (back) of the thigh. It can also cause buttock pain. It is common amongst sports people and elite athletes, although can affect middle age active people. It can take the form of muscular tears of the hamstrings, tendon tears or avulsions of the tendon (the tendon being forcibly pulled off its bony insertion point). Treatment is usually with physiotherapy but occasionally surgery is performed to reattach an avulsion.
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