Common complaints of those presenting with this problem include tenderness directly above the side of the hip, pain lying on that side and pain worsened by activity. The relative lack of information available about this condition can lead to extensive workups and delay in appropriate treatment. But as understanding of this syndrome increases, so do the possible treatments and answers for patients suffering with chronic hip pain.
A little understanding of the anatomy in this area is very helpful. The bony bump over the side of the hip is called the greater trochanter. A tight band about two inches wide, called the IT band, passes over this bump from the pelvis on its way down the leg. There is a slippery membrane called a bursa, which is sandwiched between the IT band and the greater trochanter to reduce the friction between the two structures.
Occasionally the bursa becomes irritated or inflamed (bursitis). These symptoms can develop in younger people, particularly runners, but symptoms more commonly appear spontaneously after middle age.
Non-surgical treatment including stretching exercises and an occasional anti-inflammatory steroid injection will usually solve the problem, although at times the symptoms persist and can be quite debilitating. In this circumstance, a minimally invasive approach with arthroscopic surgery can be used to release the tension on the IT band and relieve the painful symptoms.
Usually in younger individuals, a tight IT band at the level of the hip can also cause a repetitive loud, painful snapping sensation over the side of the hip. Again, if the condition is not relieved by physical rehabilitation, then surgical relaxation of the IT band tightness will predictably remedy the problem.
Hip Abductor Muscle Tears
The large muscles that attach to the greater trochanter on the side of the hip are very important to comfortable strong hip function and are called the hip abductors. As we age, the attachments of these muscles weaken, and an estimated one in four women and one in six men develop tears at the attachment sites of these muscles during or after middle age. Some individuals with abductor tears develop significant activity-limiting pain and weakness. Only in the last decade has this condition been recognized as a significant cause of pain and disability. The problem is most accurately identified with MRI imaging of the hip and shows detachment of the muscles from the greater trochanter.
Much like the rotator cuff in the shoulder, the abductor muscle attachments to the greater trochanter have been called the “rotator cuff of the hip” due to similar anatomy and approach to repair. The repair of these torn attachments back to the bone can be accomplished as an open surgical procedure, but increasingly is accomplished with less invasive arthroscopic techniques. The early reported outcomes during the last several years are promising with high rates of success in relieving painful symptoms and restoring lost hip strength.
Until fairly recently, hip conditions that did not involve arthritis of the hip have been poorly recognized, leaving both younger and older patients frustrated by an apparent lack of treatment options. The increased awareness of these conditions in the physician community and in the population at large is slowly offering the possibility of improved quality of life to those seeking understanding and treatment for these conditions. To find an orthopedic surgeon near you, we invite you to visit IntermountainMedicalGroup.org.