40 Years of Hip Pain

A 61 year-old woman who came into our office with right hip pain that had plagued her since the age of 19 following a traumatic skiing. She said the pain was low grade for most of life, but in the past four years it began to get progressively worse. She then went on to visit an orthopedic specialist where an MRI of the hip was ordered and revealed moderately advanced osteoarthritis of the right hip, severe atrophy of the right gluteus minimus, and osteoarthritis of the left hip.

She was subsequently treated with a synvisc injection into her right hip, and given percocet and oxycontin, with some improvement in pain.

When she visited us at the Darrow Sports & Wellness Institute she described her right hip pain as constant, aggravated with prolonged sitting, and driving, and also worsened at night- preventing her from getting a good night’s sleep.

Given the patient’s history of right hip pain and osteoarthritis patient was an appropriate candidate for prolotherapy.

She received her first treatment on 5-13-2010 into the right hip joint, anterior and lateral.

On 5-20-2010 patient returned for her second treatment and reported that since her first treatment, she was able to drive and walk without pain. She quantified that her pain had been improved by 50% after her first injection.

On 5-27-2010 patient presented for her 3rd prolotherapy session, where she reported being completely pain free in the right hip since her second treatme

Treating Hip Pain with Platelet Rich Plasma Therapy

The platelets contain growth factors that will stimulate the immune system to bring cells to the area that will grow back new tissue, stabilize the area, and eliminate painMuch like Prolotherapy, PRP can be used anywhere in ligaments, tendons, muscles, joints from the head to the toe.I use ultrasound guidance to insure that the maximum number of platelets are delivered to the exact injury area. Ultrasound is very safe in guiding the needle to the exact area where the solution is needed.

 

A medical assistant is withdrawing blood from a patient’s arm, you can see the syring that the blood is being withdrawn into – here the blood is placed into the PRP kit and it is going to be centrafused, the platelets are going to be spun down, The platelet poor solution is removed and a small portion is mixed with the platelets to create a platelet rich plasma solution

You are looking at me injecting this patient’s hip under ultrasound guidance, you can see the needle coming into the area of the joint, I have turned on the dopler to look for blood vessels which indicates that there is a nerve nearby, that is the fermoral artery that is pulsating in red.

Ultrasound is very safe in guiding needles to the exact area the solution is needed.

In this image you can see the hip joint and the hip capsule
where you will see a needle being placed depositing solution

This patient is a 31 one year old female who has a preexisting history of juvenile rheumatoid arthritis, she has been in remission for several years but as a result she has severe osteoarthritis of both hips, what we call bone on bone arthritis, she is an excellent candidate for PRP because of her condition.

Hip pain and PRP

One of the most commonly used joints in the human body sits in the seat of your pants. The hip is a “ball and socket” joint, meaning it’s formed by the pelvic bone: acetabulum (the socket) and the end of the femur bone (the ball or head of the femur). Both bones are covered with a smooth layer of slippery cartilage.

This anatomic design allows for incredible movement, form, and function, but it also allows for wear and tear, which can result in incredible pain. Many people think that the hip bones are just those bones that jut out on either side of the body below and around the abdomen; however, the hip actually extends from your thigh and into the groin. Meaning an injury in this area can have a far-reaching affect.

Hip pain is common, and its causes are many, although not all come from the joint but can masquerade as joint pain.

Arthritis: One of the most frequent causes of hip pain is caused by loss of cartilage from wear and tear, inflammation, or injury.

Pyriformis Syndrome: This syndrome may cause pain in the buttocks, lower back, or down the leg. Your hip has some very powerful muscles. Among them is the piriformis, which is in the back of the hip and helps rotate the leg outwards. The sciatic nerve is just underneath it; in some people, the nerve is impinged under the piriformis muscle. When the muscle contracts, it acts like a pincer on the nerve, which causes the discomfort.

Lumbar Pain: Many back or spine issues can radiate to areas around the hips. Most common are herniated discs and sciatica.

Greater trochanteric Bursitis & Ischial bursitis: The hip joint and the large muscles that cover it are protected by several bursal sacs. There is also a small amount of fluid contained in the hip joint. Each bursa produces lubricating fluid and functions to reduce pressure and friction around the joint. These bursa sacs can become irritated from injury, excessive pressure, and overuse. Inflammation of a bursa is called bursitis.

Hip tendonitis or tears: Tendinitis occurs when a muscle is overused and pulls on the tendon that attaches it to the bone. In your hip, tendons perform an important role by keeping strong muscles attached to the femur (thigh bone) as your legs move. One kind of tendinitis that occurs as a result of overuse is called iliacus tendinitis or iliopsoas tendinitis. The iliac muscle, which starts at your hip bone, and the psoas muscle, which starts in your lower spine, are used when lifting the leg toward the chest to keep you stable. They come together in a tendon at the top of the femur, and that is the point where tendinitis occurs.

Hip and Knee Joints of Former Elite Marathon Runners

Researchers writing in the medical journal Der Orthopäde sought to find what degenerative changes were present in the hip and knee joints of former elite marathon runners and how these subjects’ joints differ from those of control persons.

Schmitt H, Rohs C, Schneider S, Clarius M. [Is competitive running associated with osteoarthritis of the hip or the knee?] Orthopade. 2006 Oct;35(10):1087-92.

 

BACKGROUND: The aim of the study was to find what degenerative changes were present in the hip and knee joints of former elite marathon runners and how these subjects’ joints differ from those of control persons.

METHODS: Twenty former elite German marathon runners (active careers 1972-86) underwent clinical (FFbH-OA [hip joint] and AKSS [knee joint]) and radiographic (hip and knee joints, Kellgren and Lawrence classification) examination. X-Rays of the hip joints were compared with those of controls matched for age, gender and BMI who did not engage in much sport.

RESULTS: In the group of former elite marathon runners, 3 of the 38 knee joints for which comparison with control joints was possible were found to be affected by grade 2 osteoarthritis. In the same group, severe osteoarthritis (Kellgren and Lawrence grade 3) was documented in 1 and moderate osteoarthritis (grade 2) in 6 of the 28 hips for which direct comparison against the controls was possible, as against 1 hip affected by grade 2 osteoarthritis in the entire control group. The clinical evaluation showed high scores in all athletes.

CONCLUSIONS: Osteoarthritis of the knee joint is rare in former elite marathon runners. The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport.

Hip and Groin Pain

Researchers writing in the Journal of Science and Medicine in Sport say hip stiffness is associated with later development of chronic groin injury.

Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport. 2007 Feb 28;

Although a restricted hip range of motion has been previously associated with chronic groin injury the temporal course of this association remains unclear. Accordingly the purpose of this prospective cohort study was to report preliminary findings examining whether hip joint range of motion restriction is associated with subsequent onset of athletic chronic groin injury.

End-range internal and external hip joint range of motion was determined in 29 elite Australian football players, without previous history of groin injury. The players were followed for two subsequent playing seasons for the development of chronic groin injury. Four athletes developed chronic groin injury defined as at least 6 weeks of groin pain and missing match playing time. In athletes that developed chronic groin injury a lower body weight (p=0.02) and reduced total hip joint range of motion (p=0.03) were found to be associated.

This study suggests that hip stiffness is associated with later development of chronic groin injury and as such may be a risk factor for this condition. This work should be viewed as preliminary and caution is advised in applying the conclusion to clinical practice as the numbers in this study were small.

Gluteus, Hip, and Neck Pain

Discussions from our Radio Show:

Caller: I have been having this pain in my hip right where my gluteus and my hip are, and it is really sharp, hot, piercing pain, and I have been told that it is related to a pain I get in the nape of my neck, can you explain to me why I am having this type of pain?

Dr. Darrow: In both places you mean?

Caller: That is what I have been told from one of my doctors.

Dr. Darrow: Well the reason that it could be related is that the spine, if you hurt one end of it, the other end can have a reaction from it. So very often we find people have neck pain and sometimes the neck pain will go away and reappear into the lower back, or vice versa, so it is hard to know without (examining) you.

You can have hypolordosis or loss of lordosis, (lordosis meaning the curve) and if it effects the upper back or the lower back, that means it can affect the neck also.

The fact that you are calling this a piercing type pain is a good thing because it is localized, meaning that it is probably not from a pinched nerve it is probably just mechanical back pain which can be fixed by Prolotherapy.

The pain in the hip near the gluteus, that really is where the pelvis attaches to the vertebrae in the back, it is not really the hip, people call it the hip, hip joint pain is usually felt in the front of the body, in the groin area.

Bursitis of the Greater Trochanter

Discussions From the Marc Darrow, M.D.,J.D. Radio Show:

Caller: I have been having pain in my right hip joint, and it gets worse when I walk a long distance or when I exercise, what can I do for that?

Dr. Darrow: First of all let’s try to localize what you call your right hip joint, is it next to your groin in the front or is it on the side of your side or in your back.

Caller: It is on the side.

Dr. Darrow: Typically it is not the hip joint that causes that type of problem, it is more of what we call a bursitis of the Greater Trochanter which is a piece of the thigh bone or the femur which juts out a little bit.

A bursa, which is a little, fluid filled sac, sits on top of that and protects the muscles from rubbing on the bone, and people who walk a lot, get a little inflammation there.

There are several things that can be done, there are studies that show that B-12 injections daily, a very small amount can help.

It is a fairly conservative way to go because B-12 is excreted through the urine if there is too much.

Some people take anti-inflammatories medications, I am not a believer in them because I like to see the body restructure and heal itself rather than just “put the flame out.”

What I like to do with that area is use Prolotherapy which is the stimulation, naturally to produce more collagen and bring the tissue back to its pre-injury state and rejuvenate it.

Hip and Pelvic Pain

One of the most interesting parts of the body to treat with Prolotherapy is the hip. The reason is that most people mistakenly call different parts of the body, the hip.

The “hip” could be the back of the pelvis where the iliolumbar ligament attaches to the L4 and L5 vertebrae, The “hip” can also be the greater trochanteric bursa, where there is a lump on the side of the femur (the thigh bone). Or “the hip” may be the thick fascia that attaches the quadraceps muscle on the front of the thigh to the pelvis, The “hip” may actually be the hip joint or the ligaments that hold the hip in place in the pelvis (in the acetabulum).

Sometimes it is a herniated disc that can refer pain to the area of the hip, or a mixture of some, or all of the above, depending on the patient’s condition. So, a very complete examination of all of these areas with my hands must be made to determine the hip pain source. I can’t depend on an X-Ray or MRI to tell me where to do the Prolotherapy treatment.

Actual hip arthritis in the joint is no different in the way a Prolotherapist treats it than any other part of the body. Often, the hip pain is felt in the groin and there is limited range of motion of the femur. I typically use Prolotherapy injections in two areas.

The first- below the pelvis at its intersection with the upper limit of the pubic bone, and then laterally just above the greater trochanter. Patients will tell me that they have a little stiffness, and then feel better or pain free for a day or so in the beginning. Then, the days of “freedom from pain” usually increase till full healing is achieved.

The main goal is to avoid needless hip replacement or resurfacing. The side effects from hip replacement are often disastrous. There can be dislocation, short leg syndrome or infection. Prolotherapy is a great and less invasive alternative in which a patient walks out of my office and goes back to work.

Bone-on-bone

Discussions from our Radio Show:

Caller: I have this bone-on-bone arthritic hip and I was wondering how you would treat that.

Dr. Darrow: What we do with people who have bone-on-bone arthritis in the hips is work on the supporting ligaments of the hip, there are some very large ligaments that support that big joint. Many times by stabilizing those ligaments the pain will go away.

We can do a diagnostic injection around the ligaments to see if that reduces your pain, if it does, then we know the Prolotherapy will help you.