Historically, the underlying causes of hip pain were often difficult to diagnose. Pain originating from the hip joint is typically felt in the front of the hip and described in the groin area, sometimes wrapping toward the side of the hip. Patients often use the “C sign,” placing their hand in a C shape on their hip to indicate where they feel the pain. The pain is usually deep in the hip socket and can be associated with femoroacetabular impingement (FAI) or related conditions, occurring during activities such as sitting, standing, or walking. Typical symptoms include groin pain, clicking, or deep aching. The pain usually worsens with flexion, bringing the knee and thigh toward the chest and with internal rotation, rotating the knee and thigh inward. Movements involving hip rotation and external rotation can also provoke symptoms. Pain may also occur over the side of the hip, often near the greater trochanter, consistent with bursitis or abductor muscle pathology.
The treatment of the hip is an emerging field within orthopedics. Over the past decade, orthopedic surgeons have developed new technologies and tests to accurately diagnose hip disorders and successfully treat them with non-surgical and surgical options. It is very important to see an orthopedic surgeon who specializes in the hip for any source of hip pain to correctly identify the issue and develop the right treatment plan.
The labrum is a cartilage ring that outlines the bony socket of the hip joint (called the acetabulum). The labrum can be torn due to injury or underlying hip anatomy impinging or applying pressure over time. Labral tears are often associated with femoroacetabular impingement (FAI), a condition where the bony anatomy of the hip joint impinges on underlying structures. The socket (acetabulum) may have more overhang (pincer impingement), the femur may have extra bone known as cam impingement, or a combination of both. Athletes and active individuals are often predisposed to this disorder, especially in activities requiring extensive hip motion such as dance, hockey, soccer, baseball catching, figure skating, or gymnastics.
Getting to the Right Doctor
It is crucial to see a trained orthopedic hip specialist as soon as possible for any hip pain or condition. Many patients have been misdiagnosed and improperly treated for years by their primary care doctor, physical therapist, athletic trainer, or general orthopedic doctor (for example, the “groin pull” that never seems to get better).
To evaluate and diagnose the source of hip pain, the doctor should start with a thorough medical history, physical examination, clinical assessment, and specialty x-rays, which can show impingement. If a labral tear is suspected, an MRI arthrogram may be ordered to evaluate the interior structures of the hip. Imaging can help rule out other conditions and assess bony abnormalities, including femoral head–neck offset and cam lesions. Proper imaging of the femoral neck, femoral head, and acetabulum is important to identify abnormal shape, bony overgrowth, and cam-type femoroacetabular impingement. The acetabular labrum and articular cartilage can also be damaged in FAI.
Treatment for a labral tear begins with conservative therapy to relieve pain and improve function. This may include activity modification, anti-inflammatory medications, and physical therapy to strengthen and activate the muscles of the hip, pelvic girdle, and core. Physical therapists can play a key role in rehabilitation and return to activity. Ultrasound-guided injections can also be used for diagnostic and therapeutic purposes and be performed by an orthopedic specialist.
For patients who do not improve with nonoperative treatments, surgery may be indicated. Surgical intervention addresses the underlying pathology using advanced techniques such as arthroscopy and femoroacetabular impingement surgery. Hip surgery may involve reshaping the acetabular rim, removing bony overgrowth, and restoring normal anatomy of the femoral head–neck junction and proximal femur. Postoperative weight-bearing protocols are important for recovery. FAI pain is often relieved after successful surgical intervention, and outcomes are generally excellent, especially for athletes and young adults.
If you or someone you know is experiencing hip pain, don’t wait. Consult a trained hip specialist to review your options and start the path to recovery. For optimal outcomes, seek care from orthopedic surgeons with expertise in sports medicine and orthopedic sports physical therapy.
Dr. Kevin Myers is an orthopedic surgeon who specializes in sports medicine at OrthoTexas in Carrollton.
Femoroacetabular Impingement Syndrome
Femoroacetabular impingement (FAI) syndrome is a common source of hip pain, particularly in young adults who lead active lives or participate in sports. This condition develops when there is abnormal contact between the femoral head—the ball at the top of the thigh bone—and the acetabulum, the hip socket. Over time, this abnormal contact can cause the bones to rub against each other, leading to irritation and damage within the hip.
People with FAI syndrome often notice groin pain that may radiate to the lateral hip or down the thigh. The pain is frequently triggered by activities involving hip flexion or rotation, such as squatting, running, or prolonged sitting. In addition to pain, many individuals experience a noticeable decrease in hip range of motion, making it difficult to move freely or participate in sports.
FAI syndrome is especially prevalent among young adults and athletes, as repetitive hip motion can exacerbate the abnormal contact between the femoral head and hip socket. If left untreated, this ongoing impingement can accelerate joint wear and increase the risk of early osteoarthritis.
Recognizing femoroacetabular impingement early is crucial for preventing further damage and preserving hip function. If you experience persistent hip or groin pain or limited hip motion, consult an orthopedic specialist who can accurately diagnose and manage FAI syndrome.
