Man with hip pain. Credit Towfiqu barbhuiya

Hip pain explained

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Hip pain is a common complaint, particularly among middle-aged and older adults. Two frequent causes are Hip Osteoarthritis (OA) and Greater Trochanteric Pain Syndrome (GTPS). While these conditions share some symptoms, they differ in causes, treatment, and long-term outcomes. Understanding these distinctions is key for accurate diagnosis and management.

What is Hip Osteoarthritis?

Hip osteoarthritis is a degenerative joint disease characterized by age-related changes in the cartilage of the hip joint. The hip’s ball-and-socket structure relies on cartilage for smooth movement, but this can wear down over time, leading to pain, stiffness, and decreased function.

Signs and Symptoms of Hip OA:

  • Pain in the Groin or Thigh: Pain is typically deep in the groin, buttock, or thigh, worsening with activity and improving with rest.
  • Stiffness: Morning stiffness lasting less than 30 minutes is common, especially after inactivity.
  • Reduced Range of Motion: Difficulty with daily activities such as putting on socks or shoes.
  • Crepitus: A grinding sensation during movement due to rough joint surfaces.
  • Functional Limitations: Challenges with walking, climbing stairs, or standing up from a seated position.

What is Greater Trochanteric Pain Syndrome?

Greater Trochanteric Pain Syndrome (GTPS) involves pain over the lateral hip, specifically around the greater trochanter, the bony prominence on the hip’s outer side. Unlike OA, GTPS stems from issues in the soft tissues, such as the gluteal tendons and bursae.

Signs and Symptoms of GTPS:

  • Lateral Hip Pain: Pain over the outer hip, often radiating down the thigh and exacerbated by lying on the affected side or climbing stairs.
  • Tenderness: Pain upon palpation of the greater trochanter.
  • Pain with Activity: Aggravated by repetitive movements or prolonged standing.
  • Night Pain: Discomfort when lying on the affected side, disrupting sleep.
  • Muscle Weakness: Weakness in the hip abductors, affecting gait and mobility.

Key Differences Between Hip OA and GTPS

  1. Location of Pain
    • Hip OA: Pain is typically deep in the groin, buttock, or thigh, potentially radiating to the knee.
    • GTPS: Pain is localized to the lateral hip, radiating down the outer thigh but rarely affecting the groin.
  2. Underlying Pathology
    • Hip OA: A degenerative joint disease involving cartilage degradation.
    • GTPS: A soft tissue condition involving inflammation or degeneration of the gluteal tendons and bursae.
  3. Risk Factors
    • Hip OA: Aging, obesity, joint injuries, genetics, and repetitive hip loading.
    • GTPS: More common in peri- and post-menopausal women due to hormonal changes affecting tendon health, as well as altered biomechanics like gait changes or muscle weakness.
  4. Impact of Hormones on Soft Tissue Health Hormonal changes during menopause reduce tendon elasticity, increasing the risk of GTPS. In contrast, OA primarily results from mechanical factors and cartilage degradation.

Management and Treatment

Hip Osteoarthritis:

  • Exercise and Physiotherapy: Low-impact activities like swimming or cycling help maintain joint mobility and muscle strength.
  • Weight Management: Reducing body weight can alleviate stress on the hip joint.
  • Medication: NSAIDs are commonly used for pain and inflammation.
  • Joint Injections: Corticosteroid injections under ultrasound guidance can provide temporary relief and aid diagnosis in complex cases.
  • Surgery: Total hip replacement may be necessary in severe cases.

Greater Trochanteric Pain Syndrome:

  • Activity Modification: Reducing activities that exacerbate symptoms, such as prolonged standing or lying on the affected side.
  • Physiotherapy: Strengthening the hip abductor muscles and improving flexibility is key.
  • Shockwave Therapy: Effective in some cases for promoting tissue healing and reducing pain.
  • Corticosteroid Injections: These can temporarily reduce inflammation for patients unresponsive to conservative treatment.
  • Surgery: Rarely required but an option for severe or unresponsive cases.

Conclusion

Hip Osteoarthritis and Greater Trochanteric Pain Syndrome are distinct conditions causing hip pain, with different causes, symptoms, and treatments. While OA is a degenerative joint condition affecting cartilage, GTPS is a soft tissue disorder involving the tendons and bursae around the greater trochanter. Accurate diagnosis is essential for effective management, and consulting a healthcare professional is critical for those experiencing hip pain.

For more information see www.genuinephysio.com

Image: Man with hip pain. Credit Towfiqu Barbhuiya

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