Materiały źródłowe

• #1 Hip Pain in Adults: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p81.html

  Hip pain is common in adults of all ages and activity levels. In adults older than 45 years, 6.7% to 9.7% have osteoarthritis of the hip, and one in four adults will develop symptomatic hip osteoarthritis in their lifetime. […] Femoroacetabular impingement is one of the most common causes of hip pain in young adults. It can be caused by a cam deformity, which is bony overgrowth of the femoral head and neck, a pincer deformity of the acetabulum (too much coverage of the femoral head), or both. Femoroacetabular impingement often has a gradual onset without a specific injury. […] Patients with labral tears may present with anterior hip pain and a history of a sports-related or traumatic injury. […] Avascular necrosis of the femoral head most commonly presents in middle-aged to older adults. Risk factors include alcohol use, smoking, systemic corticosteroid use, hemoglobinopathies, chemotherapy, metabolic syndrome, and obesity.

• #1 Hip Pain in Adults: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p81.html

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy.

• #1 Hip pain

  https://www.mayoclinic.org/symptoms/hip-pain/basics/definition/sym-20050684

  Hip pain is a common complaint that can be caused by a wide variety of problems. The precise location of hip pain can provide clues about the underlying cause. […] Problems within the hip joint itself tend to result in pain on the inside of the hip or the groin. Hip pain on the outside of the hip, upper thigh or outer buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround the hip joint. […] Hip pain can sometimes be caused by diseases and conditions in other areas of the body, such as the lower back. This type of pain is called referred pain.

• #1 Chronic hip pain in adults: Current knowledge and future prospective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8022067/

  Chronic pain involves nociceptive or/and neuropathic pain. Nociceptive pain originates from the bone, synovium, and other tissues. In nociceptive pain, initially there is only peripheral sensitization and pain can be controlled with systemic or topical drugs as they decrease the release of peripheral inflammatory mediators. Neuropathic pain is due to injury in the path of somatosensory nervous system. For example, in piriformis syndrome, there is stretching of nerves or due to lumbar disc prolapse there is radiculopathy. In chronic conditions such as OA or RA, neural sensitization will not be confined only to the periphery. Due to persistent tissue inflammation around the nerve, pain mediators are released which increase the excitability of pain pathways, and hence lead to neuroplasticity pain.

• #1 Hip Pain in Adults: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p81.html

  In older adults, osteoarthritis of the femoroacetabular joint is the most common cause of anterior hip pain. It can lead to significant morbidity and decrease in physical activity. […] The most common cause of lateral hip pain is greater trochanteric pain syndrome (previously called greater trochanteric bursitis). […] The cause of posterior hip pain can be difficult to diagnose. The differential diagnosis includes musculoskeletal causes and referred pain from intrapelvic and gynecologic issues.

• #1 Osteoarthritis of the hip: aetiology, pathophysiology and current aspects of management – Sandiford – Annals of Joint

  https://aoj.amegroups.org/article/view/5539/html

  The incidence of osteoarthritis (OA) of the hip is constantly increasing. […] Understanding of the disease process and modern evidence-based approaches to its management enables us to instigate appropriate, efficient therapy and maximize the resources available to us in managing this often underestimated disease. […] It is the constellation of changes in the subchondral bone, the joint margins and the para-articular tissues which result in the familiar symptoms typical of OA of the hip such as pain, stiffness and joint deformity. […] Cartilage damage occurs from a combination of biomechanical as well as biochemical factors but ultimately the clinical disease results from an imbalance between damage and repair of this tissue. […] OA is characterised by loss of structural integrity of cartilage lining the articular surface.

• #1 Osteoarthritis of the hip: aetiology, pathophysiology and current aspects of management – Sandiford – Annals of Joint

  https://aoj.amegroups.org/article/view/5539/html

  A combination of decreased matrix synthesis, increased matrix degradation and wear and tear of the weight bearing joints leads to irreparable destruction of the articular cartilage. […] Destructive processes lead to swelling, decreased shock absorbing properties (compliance), softening, fracturing, fibrillation, ulceration and ultimately erosion of the cartilage with exposure of the subchondral bone. […] Genetic factors also contribute to the pathogenesis of OA. […] A healing response does occur during which type-3 collagen is laid down. […] From this point onwards in the disease process, forces are transmitted to the subchondral bone leading to increased bone turnover with sclerosis and the formation of cysts and osteophytes. […] This is associated with significant pain of sudden onset resulting in decreased use of the limb, loss of muscle bulk and strength around the joint allowing abnormal biomechanical forces through the joint and surrounding soft tissues and thus disrupting the joint organ as a whole.

• #1 Osteoarthritis of the hip: aetiology, pathophysiology and current aspects of management – Sandiford – Annals of Joint

  https://aoj.amegroups.org/article/view/5539/html

  The existing aggrecan and collagen within the cartilage are degraded by proteases. […] Activity of proteases is modulated by cytokines and growth factors. […] Harrison et al. published a remarkably in-depth study in 1953 examining the effects of OA on the hip joint. […] They showed that the earliest cartilage damage and osteophyte formation occurs in areas of low stress, suggesting that loading might have a role in cartilage preservation. […] The initiating event in primary OA is unknown but is believed to be due to at least one or a combination of the following: Genetic factorsnamely genes which code for inflammatory cytokines such as IL-6; Age related changes in chondrocytes e.g., apoptosis along with decreased rates of cell division; Mechanical factors (wear and tear) due to repetitive trauma e.g., athletes involved in high impact sports or persons with abnormal joint alignment; Biochemical factors e.g., decreased levels of prostaglandins.

• #1 Hip Impingement: Identifying and Treating a Common Cause of Hip Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1215/p1429.html

  Femoroacetabular impingement, also known as hip impingement, is the abutment of the acetabular rim and the proximal femur. Hip impingement is increasingly recognized as a common etiology of hip pain in athletes, adolescents, and adults. It injures the labrum and articular cartilage, and can lead to osteoarthritis of the hip if left untreated. Patients with hip impingement often report anterolateral hip pain. Common aggravating activities include prolonged sitting, leaning forward, getting in or out of a car, and pivoting in sports. The use of flexion, adduction, and internal rotation of the supine hip typically reproduces the pain. […] FAI is recognized as a common etiology of hip injury. […] FAI can begin in adolescence or adulthood. It usually progresses gradually and can injure the labrum and the articular cartilage of the hip, potentially limiting patients’ ability to exercise and causing pain with daily activities. FAI is a common cause of labral injury, and FAI with or without labral injury has been identified as an early cause of hip osteoarthritis.

• #1 Associations Between Hip Pathology, Hip and Groin Pain, and Injuries in Hockey Athletes: A Clinical Commentary | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/116580-associations-between-hip-pathology-hip-and-groin-pain-and-injuries-in-hockey-athletes-a-clinical-commentary

  It is clinically characterized by symptoms of pain, clicking, catching and stiffness, as well as signs of limited hip range-of-motion (ROM), a positive impingement test, and radiographic evidence of cam or pincer morphology. […] Concerningly, Lerebours et al. identified that approximately 70% of elite hockey athletes fit the criteria for cam morphology. […] While there is evidence that the presence of cam morphology does not impact on-ice skating performance, such compensatory movements may alter the mechanics of the hip, thereby changing the mechanical forces experienced in this region and increasing the opportunity for future hip and groin injuries. […] The exact mechanism for the development of FAI in athletes, and particularly hockey athletes, is yet to be fully understood. […] However, the most commonly proposed theory for the cause of cam morphologies in hockey athletes is the abutment of the femoral neck on the anterior aspect of the acetabular rim during the unique skating mechanics.

• #1 Hip & Groin Pain: Recommended Treatment To Ease Pain

  https://thehouseclinics.co.uk/conditions/hips-groin-pain

  The labrum is the circular cartilage that surrounds your hip socket. It can tear because of trauma, an overuse injury, or due to femoroacetabular impingement. […] As you get older, cartilage which helps the bones of a joint move smoothly wears away. This can lead to osteoarthritis, which causes painful inflammation in the joint. […] A stress fracture happens when the bones in your hip joint gradually weaken from repetitive movements, such as regular running. If it is not diagnosed, it eventually becomes a true fracture. […] Tendonitis is when a tendon, which connects muscle to bones, becomes inflamed from overusing the muscle. Because tendons are attached to the bone in the hip and the muscle in the groin, the pain can also start in your hip and radiate to your groin. […] Avascular necrosis happens when the top of the femur doesn’t get enough blood supply, so the bones die. Dead bone is weak and can break easily.

• #1 Hip Pain in Young Adults – Common Causes – Dr. Geoffrey Van Thiel

  https://www.vanthielmd.com/blog/hip-pain-in-young-adults/?bp=39910

  The added wear inside the joint also means its a lot more likely arthritis will develop in later years. […] FAI is a common cause of hip pain in teenage athletes. […] In addition to causing pain and increasing the risk of arthritis, FAI can also damage the hip labrum. […] In FAI, the malformation increases pressure and friction on the labrum, weakening and sometimes tearing it. […] Labrum damage typically causes pain in the front of the hip. […] Hip dysplasia is another type of hip deformity that can cause hip pain in young adults, although its more commonly associated with pain in older patients. […] Over time, the added pressure degrades the cartilage on the rim, resulting in pain and, eventually, arthritis. […] No matter what causes hip pain in young adults, scheduling an evaluation with Dr. Van Thiel is critical. […] Left untreated, hip pain can lead to arthritis in later life.

• #1 Associations Between Hip Pathology, Hip and Groin Pain, and Injuries in Hockey Athletes: A Clinical Commentary | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/116580-associations-between-hip-pathology-hip-and-groin-pain-and-injuries-in-hockey-athletes-a-clinical-commentary

  Femoroacetabular impingement (FAI), particularly cam morphology, is highly prevalent among elite hockey athletes. […] Recent research suggests that the development of cam morphology is related to the repetitive shear stresses experienced at the hip joint during adolescence from skating. This condition likely increases the potential for intra-articular and extra-articular injuries in these athletes later in their careers. […] Research also indicates that the hip joint mechanics during forward skating substantially increase the possibility of sustaining a labral tear compared to other sports. Such an injury can increase femoral head movement within the joint, potentially causing secondary damage to the iliofemoral ligament, ligamentum teres and joint capsule. […] These injuries and the high density of nociceptors in the affected structures may explain the high prevalence of hip and groin pain in hockey athletes.

• #1 Associations Between Hip Pathology, Hip and Groin Pain, and Injuries in Hockey Athletes: A Clinical Commentary | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/116580-associations-between-hip-pathology-hip-and-groin-pain-and-injuries-in-hockey-athletes-a-clinical-commentary

  The combination of a labrum tear and IFL lengthening is reported to allow for significantly greater femoral head translation (~2mm), compared to one of these injuries in isolation. […] Therefore, the reduced hip strength and muscle strength imbalances associated with cam morphology, intra-articular hip injuries, and the presence of hip and groin pain may increase the opportunity of adductor injuries in hockey athletes.

• #1 Hip pain | Causes, exercises, treatments | Versus Arthritis

  https://versusarthritis.org/about-arthritis/conditions/hip-pain/

  Femoroacetabular impingement (FAI), is a condition where the ball and socket dont move freely through their normal range of movement. […] In some cases, surgery can improve the range of movement in the hip, but its not clear whether this helps prevent arthritis developing in the long-term. […] Trochanteric bursitis is caused by inflammation of the bursa at the top of the thighbone. […] Its a very common condition, but theres usually no obvious cause. […] Trochanteric bursitis often happens in both hips. It usually improves with rest, painkillers and physiotherapy. […] A torn acetabular labrum can be repaired by surgical reshaping of the hip. […] We dont yet know what the long-term effects of acetabular labrum surgery are, but you may get better hip movement as a result of it.

• #1 Chronic hip pain in adults: Current knowledge and future prospective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8022067/

  Management of individual chronic hip pain conditions […] The term greater trochanteric pain syndrome encompasses gluteal medius and minimus tendinopathy/tears, trochanteric bursitis, and external coxa saltans. […] Ultrasound will show increased fluid signal with trochanteric bursa. […] Conservative treatment is gold standard for 90% success rate. The initial treatment of trochanteric bursitis is conservative with rest, physical therapy, and NSAIDs. […] For iliopsoas tendinopathy, the patient is positioned supine and a linear probe is placed along iliopsoas tendon lateral to the neurovascular bundle. The needle is advanced from the lateral side of the thigh, in plane, and a mixture of steroid and local anaesthetic is injected in the peritendon area. […] Treatment of piriformis syndrome is mainly conservative methods, such as stretching exercises, injections, NSAIDs, muscle relaxants, ice, and activity modifications.

• #1 Avascular Necrosis of the Hip > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/avascular-necrosis-of-the-hip

  Avascular necrosis (AVN), also known as osteonecrosis, is the death of bone tissue caused by a disruption of blood flow within a bone. The condition usually affects the ends of bones where they terminate in a joint. Though AVN can occur in the ankle, elbow, shoulder, and jaw, it most commonly affects the hip joint. […] AVN of the hip occurs when the blood supply to the femoral head is interrupted, leading to death of bone tissue. There are two general types of AVN of the hip: traumatic and nontraumatic. […] When AVN occurs in the hip joint, it affects the femoral head. Blood supply to the femoral head gets disrupted, leading to the death of bone tissue. […] In most cases, AVN is a progressive condition. As the condition worsens over time, the affected bone tissue degenerates. Without effective treatment, the femoral head can collapse.

• #1 Hip pain | Causes, exercises, treatments | Versus Arthritis

  https://versusarthritis.org/about-arthritis/conditions/hip-pain/

  Osteoarthritis is one of the most common causes of hip pain in adults. It mainly affects the joints in the fingers, knees and hips. […] Your hip joint can become painful, swollen and stiff because OA thins the cartilage that stops your bones rubbing together and causes bony lumps known as osteophytes to form on the bones of the joint. […] You can feel a great deal of pain from osteoarthritis of the hip which can restrict your movement and sometimes makes you limp. […] Avascular necrosis is a rare and painful condition that can affect any joint in the body in young-to-middle-aged adults. It occurs in the hip when the blood supply to the ball at the end of the thigh bone is lost. […] This loss of blood flow causes the bone and the tissue around it to gradually die changing the shape of the ball at the end of the bone and making your hip painful and stiff.

• #1 Osteonecrosis of the Hip – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteonecrosis-of-the-hip/

  Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is disrupted. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis. […] Osteonecrosis of the hip develops when the blood supply to the femoral head is disrupted. Without adequate nourishment, the bone in the head of the femur dies and gradually collapses. As a result, the articular cartilage covering the hip bones also collapses, leading to disabling arthritis. […] Osteonecrosis is associated with other diseases, including Caisson disease (diver’s disease, or „the bends”), sickle cell disease, myeloproliferative disorders, Gaucher’s disease, systemic lupus erythematosus, Crohn’s disease, arterial embolism, thrombosis, and vasculitis.

• #1 Hip Pain: Causes and Treatment

  https://www.webmd.com/pain-management/hip-pain-causes-and-treatment

  Osteoarthritis is one of the most common causes of hip pain in older people. With osteoarthritis, either an injury or normal wear and tear damages the cartilage that cushions your hip bones, and that lack of cushioning causes pain and stiffness. You may also have a reduced range of motion in your hip. […] Hip fractures can be caused by this type of injury or by repetitive stress. You can get a stress fracture when pressure is repeatedly placed on the bone, such as during sports. […] Bursae ease the friction from these tissues rubbing together. When bursae get inflamed, they can cause pain. This usually happens because of repetitive activities that overwork or irritate the hip joint. […] Tendinitis is inflammation or irritation of the tendons. It’s usually caused by repetitive stress from overuse.

• #1

  https://link.springer.com/article/10.1007/s00330-006-0491-z

  To determine the exact origin of hip pain can be challenging. Symptoms apparently originating from the hip may arise from the pelvis, the sacroiliac joint, the lumbar spine, periarticular structures such as muscles and bursae, or from unexpected sites such as the abdominal wall, the genitourinary tract, or the retroperitoneal space. […] This article reviews the differential diagnosis of hip pain arising from the hip and surrounding structures and the role of different imaging methods with emphasis on magnetic resonance imaging where most recent advances have occurred. […] Pathogenesis and natural history of osteonecrosis. […] Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. […] Femoroacetabular impingement: a cause for osteoarthritis of the hip. […] Anterior femoroacetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. […] Retroversion of the acetabulum. A cause of hip pain.

• #1 The low back pain in patients with hip osteoarthritis: current knowledge on the diagnosis, mechanism and treatment outcome – Wang – Annals of Joint

  https://aoj.amegroups.org/article/view/3544/html

  The low back pain (LBP) might be the most common comorbidity of hip osteoarthritis (HOA), with reported incidence of 21.2% to 100%. […] The LBP secondary to HOA could be relieved by the treatment of HOA, such as total hip arthroplasty. […] The identification that whether the LBP was caused by spinal disorders or secondary to the HOA is critical for further treatment strategy making. […] According to Offierski and MacNab, the patients experienced symptoms in both the hip joint and the spine but only showed pathology in the hip joint was described as secondary HSS. […] The authors proposed that the mechanism of secondary HSS might be due to the fixed flexion deformity of the hip, result in pelvis forwards inclination and exaggerate the lumbar lordosis, which subsequently results in further subluxation of the posterior facets and may trigger LBP.

• #1 The low back pain in patients with hip osteoarthritis: current knowledge on the diagnosis, mechanism and treatment outcome – Wang – Annals of Joint

  https://aoj.amegroups.org/article/view/3544/html

  The reduced range of motion in hip joint was also found be involved in the mechanism of LBP. […] Hence it has been proposed by previous studies that reduced ROM of the hip might contribute to the pathogenesis of LBP, by leading to a greater lumbopelvic rotation in compensation, subsequently inducing increased mechanical stress in the lumbopelvic region. […] Despite the high prevalence of LBP in patients with HOA, its luckily to note that the LBP in these patients have high chance to be relieved by THA. […] Offierski and MacNab believed that by correcting the flexion deformity of the hip, the pelvic rotation and the hyperlordosis of the lumbar spine in patients with HOA would be overcome, resulting in the relief of spinal symptoms. […] The LBP is very common in patients suffering HOA. Its critical to diagnose the course of LBP in these patients so that proper treatment protocol could be made.

• #1 Think that hip pain is bursitis? Think again. – Harvard Health

  https://www.health.harvard.edu/pain/think-that-hip-pain-is-bursitis-think-again

  Hip bursitis an inflammation between your thighbone and nearby tendons is commonly diagnosed when patients have pain on the outer side of the hip. However, several other conditions can cause similar pain, and require different treatments. „Doctors often assume that pain on the outer side of the hip is due to bursitis. But 90% of the time, it’s not bursitis,” says Dr. Lauren Elson, a physiatrist with Harvard-affiliated Massachusetts General Hospital. […] Dr. Elson says pain in the side of your hip most often results from one of the following conditions: […] Tendinitis. This is an inflammation of the tendons (fibrous bands of tissue) that connect the gluteal muscles in your buttocks to the hip bone. „Tendinitis develops because of muscle imbalance. It could be from a lack of activity, crossing your legs, or even sitting on a wallet,” Dr. Elson says.

• #1 Think that hip pain is bursitis? Think again. – Harvard Health

  https://www.health.harvard.edu/pain/think-that-hip-pain-is-bursitis-think-again

  Overuse injury. When you walk or run, weak hip and buttock muscles can tighten and irritate the iliotibial (IT) band a long band of connective tissue that runs from the knee to the hip. It merges with the gluteal muscles to stabilize the leg. […] Tight muscles in the buttocks and hip. If the gluteal muscles and IT band are too tight, they pull at the thighbone where they attach, and that causes pain on the side. […] Spine problems. „The body isn’t always smart in recognizing where the pain is coming from,” Dr. Elson explains, „and spine arthritis, a pinched nerve, or bones in the spine rubbing together can create pain in the side of your hip.” […] „Pain comes on because of an imbalance from tight or weak muscles,” Dr. Elson says. „If you can restore balance, you can help the body function better and eliminate pain.”

• #1 5 Common Causes of Hip Pain in Women | Everyday Health

  https://www.everydayhealth.com/hip-pain/five-common-causes-of-hip-pain-in-women.aspx

  Chronic hip pain in women is often due to arthritis, particularly osteoarthritis, the wear-and-tear kind that affects many people as they age. The ball-and-socket joint starts to wear out, Siegrist says. Arthritis pain is often felt in the front of your thigh or in the groin, because of stiffness or swelling in the joint. […] Another common cause of hip pain in women is bursitis, says Marc Philippon, MD, an orthopedic surgeon in Vail, Colorado. Fluid-filled sacs called bursae cushion the bony part of the hip that is close to the surface. Like the tendons, these sacs can become inflamed from irritation or overuse and cause pain whenever you move the hip joint. […] Hip pain in women can have gynecological causes, Siegrist says. Its important not to just assume that the pain is caused by arthritis, bursitis, or tendinitis. Depending on your age and other health issues, the pain in your hip could be coming from some other system. […] Sciatica, a pinched nerve, typically affects one side of the body and can cause pain in the back of the right or left hip the pain from sciatica can start in your lower back and travel down to your buttocks and legs.

• #1 Pathophysiology and Treatment of Gout Arthritis; including Gout Arthritis of Hip Joint: A Literature Review

  https://www.hipandpelvis.or.kr/journal/view.html?uid=752&vmd=Full

  Gout is triggered by the accumulation of uric acid in the body, leading to hyperuricemia. Genetic, metabolic, and environmental factors can influence this condition. Excessive uric acid buildup results in the formation of monosodium urate (MSU) crystals, which precipitate in specific areas of the body, including the joints, where they can cause symptoms of gout. […] Hyperuricemia is considered a primary cause of arthritis symptoms, and comprehensive guidelines for treatment are available. Therefore, the choice of medication is straightforward, and moderate effectiveness of treatment has been demonstrated. Gout is a chronic disease, requiring lifelong uric acid-lowering medications, thus application of a treatment strategy based on the target blood uric acid concentration is necessary. […] Hyperuricemia is regarded as the main pathogenesis of gout. However, development of gout does not occur in every person with hyperuricemia. According to previous studies, development of gout occurred in only 5% of individuals with serum uric acid levels above 9 mg/dL. This finding suggests that factors other than hyperuricemia also contribute to development of gout, including genetic predisposition.

• #1 Pathophysiology and Treatment of Gout Arthritis; including Gout Arthritis of Hip Joint: A Literature Review

  https://www.hipandpelvis.or.kr/journal/view.html?uid=752&vmd=Full

  Necroinflammation is a key aspect in the pathophysiology of acute gout. Supersaturation and crystallization of uric acid within the joint causes direct damage to synovial epithelial cells, leading to the release of damage-associated molecular patterns or alarmins from the dead cells. MSU crystals are taken up by mononuclear phagocytes within the joint, leading to activation of the NLR family pyrin domain-containing 3 (NLRP3)/interleukin (IL)-1 inflammasome, resulting in local secretion of mature IL-1 and IL-1. […] Tophi, which are observed in cases of chronic gout, are similar to granulomas and can be divided into three layers. The first layer consists of a core composed of MSU crystals. The second layer surrounding the central core contains dense populations of innate immune cells, including CD68+ macrophages, plasma cells, and an abundance of neutrophil extracellular traps. The third layer is the fibrovascular outer region, which contains smaller numbers of T and B lymphocytes.

• #1 The Pathophysiology of Primary Hip Osteoarthritis may Originate from Bone Alterations

  https://openrheumatologyjournal.com/VOLUME/7/PAGE/112/FULLTEXT/

  The aim of this study was to investigate whether bone alterations detected by hip magnetic resonance imaging (MRI) were associated with subsequent primary hip OA. […] Our findings suggest that bone abnormalities in the proximal femur might be involved in the pathogenesis of primary hip OA. […] We showed that bone alterations confirmed by MRI in patients with joint pain were associated with subsequent progression to further-stage OA. […] Our findings suggest that one of the causes of hip OA may be pathological bone changes, which can be revealed by MRI. […] In this study, we revealed that, in cases without OA or with early hip OA, hip pain occurred without traumatic events, and bone alterations were detected by hip MRI. […] Therefore, we propose that OA classification can be evaluated not only by radiographic KL grading scale, but also by a new methodology including MRI findings and joint pain.

• #1 The Pathophysiology and Progression of Hip Osteoarthritis Accompanied with Joint Pain are Potentially Due to Bone Alterations – Follow-up Study of Hip OA Patients

  https://openrheumatologyjournal.com/VOLUME/8/PAGE/46/FULLTEXT/

  This study uncovered the following observations: 1) hip OA with joint pain had bone alterations that were detectable by MRI, 2) these bone alterations disappeared when joint pain improved, 3) bone alterations remained when joint pain continued, and 4) radiographic OA progressed to a more advanced stage over a short time period. These findings indicate that the pathophysiology of OA, joint pain, and OA progression may primarily be due to bone changes. […] In this follow-up study, MRI bone signal changes were initially observed in the proximal femoral head of all hip OA patients with joint pain, regardless of KL grading. In Group A, MRI signal changes had disappeared in all but 1 patient (case 5) at the final follow-up a minimum of 6 months after pain onset. On the other hand, in Group B with persistent joint pain, all subjects continued to exhibit MRI bone changes at the study end point. OA progressed radiographically in all but 1 patient in both groups. […] Therefore, the pathophysiology of OA and joint pain and the progression of OA may be due primarily to bone alterations.

• #1 Chronic hip pain in adults: Current knowledge and future prospective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8022067/

  Chronic hip pain is distressing to the patient as it not only impairs the daily activities of life but also affects the quality of life. Chronic hip pain is difficult to diagnose as patients often present with associated chronic lumbar spine and/or knee joint pain. Moreover, nonorthopaedic causes may also present as chronic hip pain. The accurate diagnosis of chronic hip pain starts with a detailed history of the patient and thorough knowledge of anatomy of the hip joint. Various physical tests are performed to look for the causes of hip pain and investigations to confirm the diagnosis. Management of chronic hip pain should be mechanistic-based multimodal therapy targeting the pain pathway. […] The diagnosis of hip pain can be challenging at times due to referred pain from spine or knee, trauma, tumor, abdomen, hernial sites, joint arthropathies, muscular, and neuropathies.

• #1 Hip Pain in Adults: Symptoms, Causes & Treatment | Thomson Medical

  https://www.thomsonmedical.com/blog/orthopaedic/hip-pain

  This can result in pain and eventually joint collapse. […] Also referred to as femoroacetabular impingement, this is a condition that occurs when there is abnormal contact between the bones of the femoroacetabular joint. […] This usually leads to pain and restricted movement. […] Hip infections or infections in surrounding tissues (like septic arthritis or osteomyelitis) can cause pain, swelling, and fever. […] Depending on the underlying condition, the pain can manifest in many different ways. […] Pain causes joint dysfunction, making it difficult to walk or stand. […] It sometimes also causes a noticeable limp. […] Some conditions, like arthritis or bursitis, can cause posterior hip pain that persists even when resting or lying down. […] Pain at night is also commonly seen.

• #1 Hip Pain in Adults: Evaluation and Differential Diagnosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33448767/

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. […] Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.

• #2 Approach to the adult with unspecified hip pain – UpToDate

  https://www.uptodate.com/contents/approach-to-the-adult-with-unspecified-hip-pain

  Hip pain is common in adults and often causes functional disability. Among adults who play sports, the incidence of chronic hip pain is 30 to 40 percent; among all adults over 60, the incidence of hip pain is 12 to 15 percent. Hip joint labral injuries and synovitis are common causes of hip pain in younger adults, while trochanteric pain syndrome and osteoarthritis become more common with aging. Important medical causes include referred pain from lumbosacral radiculopathy and aortoiliac arterial insufficiency. […] This topic will provide a general approach to the adult with a chief complaint of hip pain. Evaluation of the athlete and active adult with a likely musculoskeletal cause of hip pain, the diagnosis and treatment of specific disorders of the hip, and evaluation of hip pain in children are all discussed separately. […] Pain is the most common complaint among adults with hip problems. Identifying the location of the hip pain can help narrow the differential diagnoses and direct the history and examination.

• #2 Hip Pain in Adults: Evaluation and Differential Diagnosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33448767/

  Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. […] Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.

• #2

  https://link.springer.com/article/10.1007/s00330-006-0491-z

  To determine the exact origin of hip pain can be challenging. Symptoms apparently originating from the hip may arise from the pelvis, the sacroiliac joint, the lumbar spine, periarticular structures such as muscles and bursae, or from unexpected sites such as the abdominal wall, the genitourinary tract, or the retroperitoneal space. […] This article reviews the differential diagnosis of hip pain arising from the hip and surrounding structures and the role of different imaging methods with emphasis on magnetic resonance imaging where most recent advances have occurred. […] Pathogenesis and natural history of osteonecrosis. […] Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. […] Femoroacetabular impingement: a cause for osteoarthritis of the hip. […] Anterior femoroacetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. […] Retroversion of the acetabulum. A cause of hip pain.

• #2 The low back pain in patients with hip osteoarthritis: current knowledge on the diagnosis, mechanism and treatment outcome – Wang – Annals of Joint

  https://aoj.amegroups.org/article/view/3544/html

  The low back pain (LBP) might be the most common comorbidity of hip osteoarthritis (HOA), with reported incidence of 21.2% to 100%. […] The LBP secondary to HOA could be relieved by the treatment of HOA, such as total hip arthroplasty. […] The identification that whether the LBP was caused by spinal disorders or secondary to the HOA is critical for further treatment strategy making. […] According to Offierski and MacNab, the patients experienced symptoms in both the hip joint and the spine but only showed pathology in the hip joint was described as secondary HSS. […] The authors proposed that the mechanism of secondary HSS might be due to the fixed flexion deformity of the hip, result in pelvis forwards inclination and exaggerate the lumbar lordosis, which subsequently results in further subluxation of the posterior facets and may trigger LBP.

• #2 Hip pain | Causes, exercises, treatments | Versus Arthritis

  https://versusarthritis.org/about-arthritis/conditions/hip-pain/

  Osteoarthritis is one of the most common causes of hip pain in adults. It mainly affects the joints in the fingers, knees and hips. […] Your hip joint can become painful, swollen and stiff because OA thins the cartilage that stops your bones rubbing together and causes bony lumps known as osteophytes to form on the bones of the joint. […] You can feel a great deal of pain from osteoarthritis of the hip which can restrict your movement and sometimes makes you limp. […] Avascular necrosis is a rare and painful condition that can affect any joint in the body in young-to-middle-aged adults. It occurs in the hip when the blood supply to the ball at the end of the thigh bone is lost. […] This loss of blood flow causes the bone and the tissue around it to gradually die changing the shape of the ball at the end of the bone and making your hip painful and stiff.

• #2 Hip pain in adults | nidirect

  https://www.nidirect.gov.uk/conditions/hip-pain-adults

  Hip pain often gets better on its own, and can be managed with rest and over-the-counter painkillers. […] The symptoms of osteoarthritis can vary greatly from person to person, but if it affects the hip, it will typically cause: mild inflammation of the tissues in and around the hip joint, damage to cartilage the strong, flexible tissue that lines the bones, bony growths (osteophytes) that develop around the edge of the hip joint. […] This can lead to pain, stiffness and difficulty doing certain activities. […] Less commonly, hip pain may be caused by: the bones of the hip rubbing together because they’re abnormally shaped, a tear in the ring of cartilage surrounding the socket of the hip joint known as a hip labral tear, hip dysplasia where the hip joint is the wrong shape, or the hip socket isn’t in the right position to completely cover and support the top of the leg bone, a hip fracture this will cause sudden hip pain and is more common in older people with weaker bones, an infection in the bone or joint, such as septic arthritis or osteomyelitis see your GP immediately if you have hip pain and fever, reduced blood flow to the hip joint, causing the bone to break down a condition known as osteonecrosis, inflammation and swelling of the fluid-filled sac (bursa) over your hip joint a condition called bursitis, a hamstring injury, an inflamed ligament in the thigh, often caused by too much running known as iliotibial band syndrome, this is treated with rest.

• #2 Hip Arthritis | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/orthopaedic-surgery/osteoarthritis-of-the-hip

  Osteoarthritis in the hips results from wear and tear that degrades the protective cartilage on your bones. Several factors can affect your likelihood of degrading this protective layer and developing hip osteoarthritis: […] The risk of developing osteoarthritis increases with age. It’s most common in individuals over 50. […] Having a family member with hip osteoarthritis means you’re more likely to develop the condition. […] The stress of carrying extra weight on joints increases wear and tear on the joint. You take four to seven pounds of pressure off the hip for every pound you lose. […] Accidents or injuries that damage cartilage and other hip joint structures may lead to additional degeneration. […] Women are more likely to develop osteoarthritis than men. […] The shape of your bones and joints can lead to increased cartilage deterioration.

• #2 Hip Impingement: Identifying and Treating a Common Cause of Hip Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1215/p1429.html

  Femoroacetabular impingement, also known as hip impingement, is the abutment of the acetabular rim and the proximal femur. Hip impingement is increasingly recognized as a common etiology of hip pain in athletes, adolescents, and adults. It injures the labrum and articular cartilage, and can lead to osteoarthritis of the hip if left untreated. Patients with hip impingement often report anterolateral hip pain. Common aggravating activities include prolonged sitting, leaning forward, getting in or out of a car, and pivoting in sports. The use of flexion, adduction, and internal rotation of the supine hip typically reproduces the pain. […] FAI is recognized as a common etiology of hip injury. […] FAI can begin in adolescence or adulthood. It usually progresses gradually and can injure the labrum and the articular cartilage of the hip, potentially limiting patients’ ability to exercise and causing pain with daily activities. FAI is a common cause of labral injury, and FAI with or without labral injury has been identified as an early cause of hip osteoarthritis.

• #2 Hip Impingement: Identifying and Treating a Common Cause of Hip Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1215/p1429.html

  Some persons are predisposed to impingement by bony abnormalities, which can be congenital or developmental. Excessive overhang of the anterior acetabulum causes pincer impingement, which generally occurs during flexion or internal rotation. Exostosis or bony overgrowth of the femoral head and neck causes cam impingement. […] The goals of arthroscopy are to alleviate impingement, to repair or remove injured tissue, and to prevent or delay osteoarthritis. To alleviate impingement, pincer and cam lesions are removed and femoral offset is corrected, restoring bony alignment. Injured labral tissue is repaired or debrided. […] It is hypothesized that arthroscopic treatment of FAI can prevent or delay the onset or progression of osteoarthritis of the hip, but this has yet to be demonstrated with long-term clinical follow-up.

• #2 Hip Pain in Young Adults – Common Causes – Dr. Geoffrey Van Thiel

  https://www.vanthielmd.com/blog/hip-pain-in-young-adults/?bp=39910

  The added wear inside the joint also means its a lot more likely arthritis will develop in later years. […] FAI is a common cause of hip pain in teenage athletes. […] In addition to causing pain and increasing the risk of arthritis, FAI can also damage the hip labrum. […] In FAI, the malformation increases pressure and friction on the labrum, weakening and sometimes tearing it. […] Labrum damage typically causes pain in the front of the hip. […] Hip dysplasia is another type of hip deformity that can cause hip pain in young adults, although its more commonly associated with pain in older patients. […] Over time, the added pressure degrades the cartilage on the rim, resulting in pain and, eventually, arthritis. […] No matter what causes hip pain in young adults, scheduling an evaluation with Dr. Van Thiel is critical. […] Left untreated, hip pain can lead to arthritis in later life.

• #2 Chronic hip pain in adults: Current knowledge and future prospective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8022067/

  Management of individual chronic hip pain conditions […] The term greater trochanteric pain syndrome encompasses gluteal medius and minimus tendinopathy/tears, trochanteric bursitis, and external coxa saltans. […] Ultrasound will show increased fluid signal with trochanteric bursa. […] Conservative treatment is gold standard for 90% success rate. The initial treatment of trochanteric bursitis is conservative with rest, physical therapy, and NSAIDs. […] For iliopsoas tendinopathy, the patient is positioned supine and a linear probe is placed along iliopsoas tendon lateral to the neurovascular bundle. The needle is advanced from the lateral side of the thigh, in plane, and a mixture of steroid and local anaesthetic is injected in the peritendon area. […] Treatment of piriformis syndrome is mainly conservative methods, such as stretching exercises, injections, NSAIDs, muscle relaxants, ice, and activity modifications.

• #2 Osteonecrosis of the Hip – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteonecrosis-of-the-hip/

  Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is disrupted. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis. […] Osteonecrosis of the hip develops when the blood supply to the femoral head is disrupted. Without adequate nourishment, the bone in the head of the femur dies and gradually collapses. As a result, the articular cartilage covering the hip bones also collapses, leading to disabling arthritis. […] Osteonecrosis is associated with other diseases, including Caisson disease (diver’s disease, or „the bends”), sickle cell disease, myeloproliferative disorders, Gaucher’s disease, systemic lupus erythematosus, Crohn’s disease, arterial embolism, thrombosis, and vasculitis.

• #2 Osteonecrosis of the Hip – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteonecrosis-of-the-hip

  Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is disrupted. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis. […] Osteonecrosis of the hip develops when the blood supply to the femoral head is disrupted. Without adequate nourishment, the bone in the head of the femur dies and gradually collapses. As a result, the articular cartilage covering the hip bones also collapses, leading to disabling arthritis. […] Osteonecrosis develops in stages. Hip pain is typically the first symptom. This may lead to a dull ache or throbbing pain in the groin or buttock area. As the disease progresses, it becomes more difficult to stand and put weight on the affected hip, and moving the hip joint is painful.

• #2 Hip Pain When Walking: 12 Common Causes | Alexander Orthopaedics

  https://alexanderorthopaedics.com/blog/hip-pain-when-walking/

  A hip flexor strain occurs when the muscles or tendons in the front of your hip are stretched or torn. […] Snapping hip syndrome is a condition characterized by a popping or snapping sensation in the hip, often felt during walking. […] Sciatica refers to pain that radiates along the path of the sciatic nerve, which runs from the lower back through the hips and down each leg. […] An inguinal hernia can cause pain in the front of the hip joint and happens when tissue (part of the intestine, for example) protrudes through a weak spot in the abdominal wall. […] What feels like hip pain can sometimes originate from other areas. For women, gynecological conditions like fibroids or endometriosis can trigger groin pain during ovulation or menstruation. […] Doctors determine the source of hip pain using a number of different diagnostic techniques, from medical history to medical imaging. […] Treatment for hip pain depends on the underlying cause and can range from conservative measures like lifestyle modifications or physical therapy for mild injuries to surgical intervention for severe cases.

• #3 Hip pain

  https://www.mayoclinic.org/symptoms/hip-pain/basics/definition/sym-20050684

  Hip pain is a common complaint that can be caused by a wide variety of problems. The precise location of hip pain can provide clues about the underlying cause. […] Problems within the hip joint itself tend to result in pain on the inside of the hip or the groin. Hip pain on the outside of the hip, upper thigh or outer buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround the hip joint. […] Hip pain can sometimes be caused by diseases and conditions in other areas of the body, such as the lower back. This type of pain is called referred pain.

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