Pain above the hip

introduction

Pain above the hip can be caused by various diseases or injuries to the musculoskeletal system. Some diseases are exemplified in this article and presented in more detail. During the physical examination of the spine and chest, attention is paid to the curvature of the spine and the symmetries of the shoulder and pelvic stance and the mobility of the spine is checked. In addition, the nervous system is examined for orientation.

causes

The main causes of pain above the hip are listed below:

• Lumbar syndrome
• Baastrup's disease
• Herniated disc of the lumbar spine
• Spinal stenosis
• Vertebral blockage
• Thoracic syndrome
• Vortex sliding
• Rheumatic diseases
• osteoporosis
• Vertebral and disc infections
• Bone metastases and tumors
• Further injuries to the spine

Lumbar syndrome

Patients with lumbar syndrome complain of lower back pain that may or may not radiate into the legs. In many cases, patients have previously lifted a heavy object or otherwise engaged in physical activity.

During the examination, the doctor determines that the back extensor muscles are tense and the forward mobility is restricted. Apparatus-based diagnostics are necessary after an accident, but should also be carried out in the event of accompanying symptoms such as fever and weight loss, as well as in tumor patients. If the pain persists over a long period of time, an apparatus-based diagnosis should also be carried out.

Therapy begins with a combination of heat, pain relievers, manual therapy, and injections, although not all options need to be used. The prognosis for low back pain is good; the pain usually decreases significantly within the next few days. However, there is the possibility of chronic pain in the lower back, which is particularly favored by psychological factors.

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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
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Baastrup's disease

Baastrup's disease occurs more frequently in men who work hard. A hollow back posture and large spinous processes result in painful contact with the spinous processes of the vertebral bodies in the area of ​​the lumbar spine, which is clearly visible on the X-ray.

The pain is made worse by stretching your stomach forward and lowering your chest. The treatment is carried out through physiotherapy, application of heat and injections of local anesthetics. Surgery is rarely performed.

You can find a lot more information under our topic: Baastrup's disease

Herniated disc of the lumbar spine

Due to the natural aging of the intervertebral disc, the outer part, the fiber ring, is damaged and in extreme cases it can tear. Through the tear in the fiber ring, intervertebral disc tissue can escape from the inside and irritate the nerve roots.

Patients with a herniated disc of the lumbar spine complain of sharp, stabbing pain that radiates into the legs. Most of the time, the symptoms are only present on one side of the body. The examiner can determine an incorrect posture of the spine, which the patient assumes in order to keep the pain as low as possible. In addition, there are sensory disorders along a dermatome (supply area of ​​a nerve root) and asymmetrically pronounced reflexes.

The X-ray cannot show the intervertebral disc itself, but it provides important information and serves to rule out other diseases. The lumbar spine herniated disc can best be assessed in the lumbar spine MRI.

Therapy is started conservatively with physiotherapy, anti-pain medication and local anesthetics. In most cases, an operation achieves good results and is carried out in the case of severe nerve disorders or if there is no improvement due to conservative therapy. Nevertheless, the symptoms can return, as the scarring in the operating area or a loss of stability due to the procedure can trigger similar symptoms.

Read a lot more information on this topic at: Herniated disc of the lumbar spine

Spinal stenosis

Arthrosis of the spine results in a bony remodeling of the vertebral bodies and joints and a thickening of the ligamentous apparatus.

These changes narrow the spinal canal and lead to spinal claudication symptoms with lower back pain when standing upright and numbness in the legs or genital region while walking upright. The symptoms improve when sitting. The diagnosis is made by the typical clinic, by x-rays and the MRI of the lumbar spine.

The conservative therapy is similar to that of the herniated disc of the lumbar spine or the therapy of a herniated disc of the thoracic spine. If there is no improvement, an operation is performed, the bony attachments are removed and the spinal canal is relieved. In general, surgery gives good results.

Read our articles on this

• Spinal stenosis of the lumbar spine
• Therapy for a herniated disc of the thoracic spine

Spinal blockages

The term "blockage" refers to a reversible functional disorder of a joint in everyday language.

In the area of ​​the spine, not only a vertebral segment but also the overlying skin and soft tissues can be affected. The patient complains of sudden discomfort in a certain area of ​​the spine and of limited mobility. The cause lies in jerky movements or prolonged incorrect posture with little movement (e.g. working on the computer). Previous diseases of the spine such as osteoarthritis can also lead to spinal blockages.

The Kibler skin fold test is carried out for a clear diagnosis. The examiner lifts a fold of skin on the back and rolls it out over the entire back. In the area of ​​the blockage, the skin and underlying soft tissues are thickened and painful. Damage to the spinal cord must be excluded in the examination. Then an X-ray is taken.

Blockages are treated with physiotherapeutic measures, which are very successful if the blockage is not caused by a serious disease of the spine. Manual therapy should not be used after an accident or in severe osteoporosis.

Thoracic syndrome

If the function of the rib-vertebral joints is disturbed or degeneratively changed, the thoracic syndrome can be the result. Wear on the intervertebral discs is also a possible cause.

Typical of the thoracic syndrome are strong muscle tension in the area of ​​the spine and pressure pain in the area of ​​the thoracic spine. People who work a lot on computers are more likely to be affected than others. The prognosis is good, as treatment with painkillers and physiotherapy responds well.

Vortex sliding

During vortex gliding (Spondylolisthesis) the formation of a gap between two vertebral bodies first loosens and then slides the upper vertebral body in this movement segment. In extreme cases, the sliding vertebra can slip and tip over in front of the vertebral body below (Spondyloptosis).

The patients have pain in the affected area, the doctor can determine a step formation in the spine with poor posture and muscle tension and assess the extent of the vertebral slippage by CT or MRI.

In milder cases, physiotherapy is started; in more severe cases, the spinal segment must be surgically stiffened.

osteoporosis

Collapse of the vertebral bodies due to the decreasing bone mass is typical for osteoporosis. An acute vertebral rupture leads to severe pain in the affected area for 1-2 months, after which the fracture heals and the pain subsides.

Rheumatic diseases

Many rheumatic systemic diseases such as Bechterew's disease or rheumatoid arthritis can affect the spine and cause pain above the hip.

Vertebral and intervertebral disc infections

Infections of the vertebral bodies and the intervertebral discs mostly affect older patients with risk factors such as alcoholism, diabetes or cortisone therapy.

The patients complain of a local, very strong pressure pain (mostly in the transition between the thoracic and lumbar spine) and at the same time have a fever and increased inflammation in the blood.

The occurrence of a so-called unspecific vertebral body infection is favored by the spread of germs during surgical interventions, which, however, need not have been in the area of ​​the spine. Specific inflammations of the vertebral bodies are very rare and can occur with tuberculosis, brucellosis or syphilis infection.

Read more on the topic: Brucellosis

Trochanteric bursitis

Bursitis is inflammation of a bursa. Bursae are located in different joints and improve the gliding ability of the joint partners. Trochanteric bursitis affects the bursa, which is located in the hip joint. This inflammation can occur after an accident, for example after falling on the hip joint, overloading the joint or through systemic diseases such as rheumatoid arthritis. In addition to pain above and also in the hips, restricted mobility, swelling, redness and overheating can occur.

With trochanteric bursitis, the joint should be cooled. Therapy with anti-inflammatory painkillers - so-called NSAIDs - such as ibuprofen or diclofenac should also be carried out and the joint should also be protected.

Bone tumors and metastases

There are different types of bone tumors. The chondrosarcoma often affects the pelvis and the plasmacytoma often the vertebral bodies, but other locations are of course also possible.

About half of all bone metastases are in the spine. Spinal metastases are either discovered during staging exams or found during examination due to back pain without the primary tumor being known. With any imaging diagnosis due to back pain, the doctor will rule out a metastasis before further treatment.

Injuries to the spine

Spinal injuries only happen through accidents of any kind.

The patient feels severe pain immediately after the event and may notice neurological deficits.

Spinal injuries are divided into three classes.

• Type A describes compression injuries after an axial force, including a compression fracture.
• Type B describes distraction injuries caused by excessive flexion or extension. This includes tearing the posterior ligament structures.
• Type C summarizes all injuries due to twisting and combined injuries.

Localization of the pain

The localization of the pain gives an important indication of the cause. For this reason, the pain is discussed below according to its location.

Right side pain

Right-sided pain above the hip can have various causes. If the pain is more likely to be felt at the back of the back above the hip, it is usually a muscular or neurological problem. Unilateral tension in the muscles or inflammation of the nerves can be responsible here.

If the pain is more likely to be felt at the back, the right kidney or the right ureter may be diseased. A large number of different diseases can be present: For example, kidney stones, kidney inflammation, kidney inflammation, kidney cysts, renal artery or vein stenosis and many other diseases can trigger pain above the hip. Sometimes it can lead to very severe pain. If the kidney is inflamed, tapping the flanks can cause severe pain. Ureter stones, ureter inflammation and ureter congestion on the right can also lead to pain in this area.

If the pain is more noticeable on the front right above the hip, it is also appendicitis (appendicitis) possible as the cause. The symptoms of appendicitis can present themselves in different ways. This can be explained by the fact that the appendix, which is actually affected by the inflammation in appendicitis, can assume a very variable position in the abdominal cavity. If a fever occurs in addition to the pain, a doctor should be consulted. Rarely, the pain can also be caused by the right large intestine. This right part of the intestine is called the ascending colon and describes the ascending part of the large intestine. For example, an infection of the right part of the intestine can then be responsible for the symptoms.

Left side pain

On the left side, too, pain that tends to come from the back can be triggered by muscles and nerves located there. But internal organs on the left side can also trigger pain above the hip, or they can radiate there.

The pain emanating from organs is usually spasmodic and diffuse. This means that it is often not possible to tell exactly where the pain is coming from. If the pain is more likely to be felt in the flanks - that is, to the side and back - the left kidney or the left ureter may be affected. Here, too, various clinical pictures such as inflammation, stones or cysts are possible causes. More in the front above the hip, left-sided pain can also be triggered by so-called diverticulitis - also known as "left appendicitis". This is an inflammation of acquired, small protrusions of the intestinal wall (diverticulosis). With diverticulitis, the pain usually gets worse over time. Mostly there is also a fever, changes in stool such as diarrhea or constipation, gas, nausea and vomiting.

Bilateral pain

Pain on both sides above the hip is rather not organ-related but mostly has a muscular or bony background. Blocking the vertebrae of the lumbar spine can lead to pain in the lower back on both sides. This often happens when heavy loads have been lifted incorrectly, but vertebrae can also block after an accident or fall. The pain can radiate into the groin or the legs, movement restrictions in the lower spine are also possible.

Herniated discs can also cause pain on both sides. This pain can also radiate into the buttocks or legs and cause sensory disturbances. It is important to see a doctor if muscle weakness in the legs or sudden weakness of the urinary bladder - i.e. when the urine can no longer be held - occurs. Muscle tension also often occurs on both sides and can cause pain in the lumbar area. Often people are affected who sit a lot, for example when doing office work.

Causes burning pain above the hip

Burning pain suggests nerve pain (neuralgia). Possible causes are, for example, entrapment and inflammation of the nerves. If the pain occurs in the hip area, the sciatic nerve may be affected. If this is affected at the level of the spine - for example as a result of a herniated disc or a blockage of the vertebral body - the burning pain in the lower back can radiate into the buttocks.

Piriformis syndrome, in which the sciatic nerve is affected deeper in its course, can also cause burning pain above the hip. This is a bottleneck syndrome in which the sciatic nerve is pinched between the pelvic bone and the piriformis muscle. The pain occurs mainly in the buttocks, but can also radiate to the hips or legs. Piriformis syndrome can be triggered, for example, by incorrect posture, one-sided sitting or jerky movements.