HIP PAIN

When to Consult a Healthcare Provider for Hip Pain

Dealing with hip pain can become bothersome, but determining when to seek medical help is crucial. Here’s a comprehensive guide to help you identify the right time to consult a healthcare professional:

1. Persistent or Severe Pain

• If your hip pain is unrelenting or disrupts your daily life and routine activities, it’s time to visit a healthcare provider. Continuous discomfort should not be ignored as it may indicate underlying issues.

2. Following an Injury

• Seek immediate medical attention if your hip pain is the result of an injury, such as a fall or car accident. Trauma to the hip area can lead to serious conditions that require urgent care.

3. Limited Mobility

• If you find yourself unable to move your hip or leg, or if movement is significantly restricted, scheduling an appointment with a doctor is recommended. This could indicate a sign of joint or bone complications.

4. Suspected Broken Bone

• In cases where you suspect a fracture or broken bone in the hip or surrounding area, a visit to the emergency room is necessary. Symptoms such as swelling, severe pain, and visible deformities need prompt evaluation.

By understanding these signs, you can make informed decisions about when to seek professional medical advice, ensuring better health and peace of mind.

Diagnosing the Cause of Hip Pain

Many factors can cause hip pain in children.  Upon visiting a doctor regarding the pain, the doctor will ask the following important questions.

• Has there been a fever, and how high has it been?
• Has there been a recent viral illness?
• Tick exposure?
• Has there been any trauma?
• Has there been knee pain?
• Acute onset is more suggestive of trauma or infection. How long have there been symptoms?
• Are there any underlying conditions? Sickle cell disease, rickets, SLE, Anorexia Nervosa, and medications such as steroids.
• Is there a family history of hip disease?
• Evidence of systemic disease: weight loss, pallor, fatigue, rash, bowel irregularity

Symptoms of Conditions that Cause Hip Pain in Children

Hip pain is discomfort or soreness you experience in or around the hip joint, a crucial point where the thigh bone (femur) connects to the pelvis. It’s one of the largest and strongest joints in the body, essential for movement, weight support, and balance. Despite its strength, hip pain can vary from mild, temporary discomfort to a more severe issue that requires medical attention.

In children, hip pain often stems from conditions unique to their growing skeletons. Hip Dysplasia, Transient Synovitis, and Septic Arthritis are the most common causes in young children. Additionally, conditions like Perthes’ disease, slipped capital femoral epiphysis (SCFE), and apophyseal avulsion fractures of the pelvis can also provide contributing factors.

How Hip Pain Manifests

The location and intensity of hip pain can depend on which part of the joint is affected. Pain might surface close to the skin, indicating issues with muscles, tendons, or ligaments, or deeper inside the joint, suggesting problems with bones or cartilage. Sometimes, hip pain radiates to areas like the lower back or groin, revealing the body’s sophicated pain responses.

Common Symptoms in Children

When healthy, the hip joints require significant force to sustain injury. However, children’s bones aren’t as robust as adults’, and their active play increases the likelihood of injury. Here are some key indicators of hip pain in children:

• Bruising: A common sign of injury. If your child has deep bruises around the hip, it might indicate a hip injury or damage to surrounding muscles, potentially leading to tenderness or painful spasms.
• Referred Thigh Pain: Pain from a hip injury can travel down to other parts of the body, such as the knees or thighs. If your child complains of knee or thigh pain, especially after activities like running, it may be due to a hip issue needing a pediatric orthopedist’s examination.
• Abnormal Gait: Hip injuries can affect posture, causing children to walk on tiptoes or limp, shifting weight to the less painful leg.

Understanding the Variability

Hip pain’s severity can fluctuate; it may worsen with movement but improve with rest. Some children experience more pain at specific times, such as in the morning or at night, especially when lying on the affected side. Recognizing these patterns can be crucial for diagnosis and treatment.

By understanding both the general nature of hip pain and the specific challenges it poses for children, parents, and caregivers can better address these concerns and seek appropriate medical care.

Medical Conditions that Cause Hip Pain

The following are the different kinds of medical conditions that can cause hip pain:

Transient Synovitis

If your child has this common cause of hip pain, they may limp and tell you their hip hurts after sitting for a long time. They’ll also walk with their toes pointed outward. They may walk on the tips of their toes, have knee or thigh pain, or refuse to walk if the pain is very bad. Your baby will cry when you move their hip joint.t

This inflammatory problem is most common in preschool and elementary students. Boys get it more often than girls. Doctors don’t know why, but it happens a lot in children who’ve had a virus. Your child’s pediatrician may prescribe anti-inflammatory medicine, sometimes with pain meds. Within a few weeks, they should feel better, without any lingering problems.

Idiopathic Chondrolysis

Idiopathic Chondrolysis of the Hip (ICH) is a rare condition, occurring mostly in black female adolescents. It is characterized by the rapidly progressive destruction of articular cartilage in the hip joint, resulting in premature degeneration and subsequent joint arthrosis.

Hip Dysplasia

When developmental hip dysplasia occurs at birth, doctors may discover the abnormality during a routine physical examination of the newborn. During this examination, the doctor gently flexes the child’s hips in different directions. If the hip appears unstable, the doctor may feel a “clunk” as the hip moves out of alignment.

In a smaller percentage of cases, hip dysplasia does not become apparent until later in infancy or early childhood. Doctors will discover the condition during routine examinations of hip stability in the pediatrician’s office. Signs that may bring undiagnosed developmental hip dysplasia to the attention of parents and doctors include:

• Limb asymmetry, including asymmetry in skin folds
• A leg length discrepancy on the affected side
• A limp
• A waddling gait (indicating both legs are affected)
• Restricted range of motion

To confirm a diagnosis of developmental hip joint problems in children up to 4-6 months of age, the orthopedist uses a sonogram. This ultrasound technology offers a significant advantage over the conventional X-ray exam. This is because images with the hip in motion have no risk of radiation. To ensure proper development of the bones that make up the hip joint, early intervention should take place.

Arthritis

Elderly people are not the only ones who get arthritis. Certain kinds of arthritis can cause hip pain in children. The most common type is juvenile idiopathic arthritis (JIA). If your child has it, they may feel stiffness or swelling in more than one joint. Their hips may seem stiff as well. Your child may also have an unusual gait or run a fever for unknown reasons. Doctors aren’t sure what causes JIA, but some think it may be linked to a virus. It’s most common in children before they reach puberty. Doctors treat JIA with medicine and physical therapy.

Legg-Calve-Perthes Disease

Perthes Disease is a very unusual childhood hip disorder that affects the hip. It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. This can cause your child to limp or have stiffness and pain in the hip, knee, or thigh.  Because without an adequate blood supply, the bone cells die, a process called avascular necrosis. As specialists, we use a treatment that produces positive results.

Doctors don’t know why blood stops flowing to the hip joint in some children. It’s more common among kids up to age 8. Boys are more likely to have it. Doctors usually treat Perthes by surgery, but in some cases, there are nonsurgical treatments that work. Having Legg-Calve-Perthes disease after age 6 makes someone more likely to have hip problems as an adult.

Slipped Capital Femoral Epiphysis

Slipped Capital Femoral Epiphysis is a fracture of the growth plate under the ball joint in the hip. The condition causes pain, sometimes in the hip but other times in the thigh or knee. Sometimes, your child may need crutches. Other times, they can’t walk or move their leg because the pain is so severe.

This condition is more common in older children (from age 8 to teenage years) and those who are overweight. Boys get it more often. Surgery is a common treatment. Many children recover fully, but they’re more likely to have arthritis of the hip than adults. Slipped Capital Femoral Epiphysis is the slipping away of the epiphysis, or head of the femur, downwards and backward off the neck of the bone at the growth plate.

It occurs mostly in older children around the ages of 10-16 who have just had a growth spurt, although the reason is unknown. It can be described as stable or unstable SCFE based on whether or not the patient can walk on the affected leg with crutches.  SCFE severely affects the motor skills of kids to the point that they may need crutches, or they cannot walk at all, as in unstable SCFE.

Infections

Several infections can cause pain in a child’s hip. This may make them limp or give them trouble walking. One condition, called septic arthritis, can cause painful hip swelling and redness. It may be caused by bacteria (like a staph infection), a virus, or even a fungus. Other bacterial infections or Lyme disease (which your child may get from the bite of an infected tick) can also cause hip pain.

Antibiotics may help to treat some infections. Other times, your child may need a procedure to drain the infection from the joint.

Other Rare Causes

Sometimes, in rare cases, the following can cause hip pain

• Tumors
• Leukemia
• Orthopedic birth defects

Types of Injuries that Cause Hip Pain

There are various types of hip injuries in children that can be linked to a variety of reasons. The injuries can occur from direct force applied to the hip, a fall on the hip side, or even an abnormal twisting or bending of the leg.

Hip Fractures

A hip fracture is simply a break in one or more bones of the hip, pelvis, or joints, such as the femoral neck, the intertrochanteric area, or even the intracapsular fractures.

The part where fractures most commonly occur in a child’s hips is the points where the muscles attach to the bone. It’s a weak point in their hip because it isn’t fully formed in children. These fractures usually occur more in children who are a bit older and are used to rough play, cycling accidents, or even automobile accidents, compared to very young children.

Fortunately, most hip fractures in children heal easily without a problem. Within 6 weeks of giving up physical activities, the hip should be almost healed, although in some cases, the fractures might require surgery to repair.

Dislocated Hips

Dislocation of the hips is another serious effect that trauma might have on the hips. In this case, the thigh bone or femur may slip out of its socket. Our pediatric orthopedic doctors at Medical City Children’s Orthopedic and Spine Specialists can fix this by putting your child’s hip back in place, and then, depending on the age of your child, they decide how the healing process proceeds.

The doctor may place your child’s hips in a cast that keeps the hip from moving. The cast is kept for several weeks or months while the hip heals. Exercise and physiotherapy might also be recommended to help the hips get stronger and aid normal movement.

Avulsion Fractures

Avulsion fractures occur in the hips when a ligament or a tendon is forcibly torn away from the hip bone. This leads to a piece of bone breaking off along with the tendon. It is usually caused by sudden and forceful movements like harsh falls.  Traumatic incidents will cause the ligaments or tendons that attach to the bones to pull away, breaking the bone.

Muscle Strain

A strain refers to the overstretching of a tendon or ligament. Hip muscle strains are mostly associated with intense physical activities.  For example, running or jumping, especially without adequate preparations or warm-ups. Muscle sprains manifest as sharp, piercing pains in the affected area and can range from mild to severe. Minor strains can be treated at home, but if the pain persists for over ten days, the best option is to get it checked as quickly as possible.

Complications from Hip Injuries

Sometimes, serious complications can result from a hip injury, depending on the severity of the injury.

Bleeding

Blood vessels may get injured during hip fractures.  Depending on the accessibility of care and first aid treatments, there might be a lot of bleeding involved.

Bladder Injury

Due to its proximity to the hip or pelvic area, the bladder can get injured during a hip injury. This can be detected by the presence of blood in the urine. Bladder injuries can also cause pain or difficulty in passing urine, the need to urinate more frequently than before, or even cause incontinence.

Nerve Injury

One of the complications of hip fracture is nerve damage, with the most commonly damaged nerve being the sciatic nerve. The sciatic nerve is the longest in the body that passing along the back of the thigh and sending branches into the lower leg. Symptoms of sciatic nerve injury vary and include weakness of the foot and ankle, pain or numbness in the foot, calf, or thigh, or even inability to move the leg.  Some other nerves can also get damaged, resulting in similar symptoms in the parts of the leg they supply. Although recovery from nerve injuries can take a long time to completely recover, having no recovery at all is unusual.

Femoral Vascular Necrosis

As a result of some fractures, mostly those of the femoral neck, blood supply to the hip joint may be cut off, leading to necrosis. This complication depends on the type of fracture and the specific anatomy of a person’s blood supply to the head of the femur bone. Other complications that may occur include:

• Pulmonary Embolism
• Muscle Atrophy
• Improper Union or Non-Union of Bones

Treatments for Hip Injuries and Hip Pain

Treatment for hip abnormalities and injuries in children depends on the specific condition and its severity:

• Non-Surgical Management: Mild cases or conditions like Developmental Dysplasia of the Hip (DDH) may be managed non-surgically through methods such as bracing, casting, or physical therapy to promote normal hip joint development.
• Physical Therapy: Physical therapy can be beneficial to improve hip joint strength, mobility, and stability, as well as to address pain and functional limitations.
• Medications: In cases of infection or inflammatory conditions, appropriate medications, such as antibiotics or anti-inflammatory drugs, may be prescribed.
• Rest and Activity Modification: For overuse or stress-related injuries, rest and activity modification may be recommended to allow the hip joint to heal.
• Surgical Interventions: Some conditions, like Slipped Capital Femoral Epiphysis (SCFE) or severe hip fractures, may require surgical treatment to realign or stabilize the hip joint. Surgery becomes necessary when pain is severe and other treatments haven’t provided relief.
  • Hip Arthroscopy: This is a common procedure for addressing a variety of hip issues. During this surgery, a surgeon makes small incisions and inserts an arthroscope—a tool equipped with a camera and light—into the hip joint to identify and repair damage.
  • Hip Replacement (Hip Arthroplasty): In cases where pain and symptoms severely impact mobility, a hip replacement might be recommended. This involves replacing the hip joint with an artificial implant to restore function.

Your healthcare provider will guide you through the process, explaining what to expect from surgical interventions and outlining recovery timelines to ensure the best possible outcome for your child’s hip health 

Preventing Hip Injuries

• Encouraging your kids to exercise often helps to make them stronger.
• Healthy diets with calcium and other nutrients while cutting out unhealthy fat.
• Monitoring your kid’s activities to minimize the risk of accidents and excessive use of muscles.
• Planning regular check-ups to ensure everything is alright.

Strategies to Prevent Hip Pain During Physical Activities

Preventing hip pain isn’t always possible, especially when unexpected accidents occur or due to inherent structural issues in the hip joint. However, adopting certain strategies can minimize the risk during physical activities.

Gear and Equipment

• Use Protective Gear: Invest in quality protective equipment for sports. Helmets, pads, and proper footwear can make a big difference.

Listen to Your Body

• Avoid Ignoring Pain: If you feel any discomfort in your hip, avoid pushing through it. Respect the signals your body sends and take necessary breaks.

Rest and Recovery

• Prioritize Rest: After intense workouts or sports activities, allow your body time to recuperate by scheduling rest days.

Preparation

• Warm-up Routine: Engage in a comprehensive warm-up before you start your activity. Focus on stretches that target muscles around your hips.
• Cooling Down: Incorporate stretching into your cool-down routine to maintain flexibility and reduce muscle tightness.

Safe Practices

• Declutter Spaces: Ensure that both your living and working environments are free from obstacles that could lead to trips and falls.
• Proper Equipment Use: Utilize tools like ladders instead of chairs or tables when reaching high places at home or work.
• Mobility Aids: If you have difficulty walking or are at risk of falling, using a cane or walker can provide essential support.

Incorporating these strategies may not eliminate the possibility of hip pain, but they greatly enhance safety and reduce potential injury during physical activities.

Why Should Parents Bring Their Child to the Medical City Children’s Orthopedics and Spine Specialists?

Parents choose to bring their children to the Medical City Children’s Orthopedics and Spine Specialists for several reasons, including that we have four offices which are in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX:

• Expertise: Doctors at Medical City Children’s Orthopedics and Spine Specialists have extensive experience and training in treating pediatric orthopedic and spinal conditions.
• Comprehensive care: They offer a range of services, including diagnostic evaluations, conservative treatment options, and minimally invasive surgical procedures.
• Great Doctors: The Doctors and staff provide comprehensive care for children with orthopedic and spinal issues.
• Child-centered approach: They understand that children have unique needs and concerns.
• Pediatric Specialists: Our Team ensures that children feel comfortable and understood throughout their treatment journey.
• Cutting-edge technology: They utilize the latest technology and techniques to diagnose and treat the children, thereby offering the best care available.
• Multidisciplinary team: The team consists of specialists, including orthopedic surgeons, technicians, nurses, rehabilitation specialists, and pain management specialists.

Overall, parents should bring their children to the Medical City Children’s Orthopedics and Spine Specialists for high-quality, comprehensive, and compassionate care for a wide range of pediatric orthopedic and spinal conditions, including Hip Pain.

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Footnote:

Healthline: Hip Abnormalities