Understanding Hip Pain and Hip Arthritis
Hip pain is one of the most functionally limiting musculoskeletal complaints — affecting the ability to walk, climb stairs, get in and out of vehicles, and perform basic daily activities. It affects people of all ages, from athletes with labral tears to older adults with progressive osteoarthritis. Accurate anatomic diagnosis is the essential first step, because hip pain can arise from multiple overlapping sources requiring very different treatments.
The hip joint itself (intra-articular) is one pain source — osteoarthritis, labral tears, and synovitis cause deep groin pain worsening with hip loading and rotation. Periarticular structures also contribute — trochanteric bursitis and gluteal tendinopathy cause lateral hip pain, especially lying on the affected side. Referred pain from the lumbar spine and SI joint frequently mimics hip pathology. Dr. Qureshi's evaluation systematically identifies which structure is generating pain, often using diagnostic injections to confirm the source definitively.
Common Causes of Hip Pain
- Hip osteoarthritis — the most common cause of progressive hip pain in adults over 50; cartilage loss leads to bone-on-bone contact; typically causes deep groin pain worsening with loading activities
- Greater trochanteric pain syndrome — inflammation of the bursa and gluteal tendinopathy at the greater trochanter; causes lateral hip pain especially with side-lying and single-leg stance
- Hip labral tear — damage to the fibrocartilaginous labrum; common in younger active patients; causes groin pain with deep hip flexion and rotation, often with clicking
- Hip flexor tendinopathy — degeneration of the iliopsoas tendon causing anterior hip and groin pain with resisted hip flexion
- Femoral acetabular impingement (FAI) — abnormal bony morphology creating mechanical conflict; common in younger athletic patients
- Referred pain from lumbar spine or SI joint — very common and frequently misattributed to the hip itself
- Piriformis syndrome — deep buttock pain from piriformis muscle tightness or spasm compressing the sciatic nerve; often responds well to trigger point injections
Symptoms
- Deep groin or anterior thigh pain with weight-bearing (classic hip joint pattern)
- Pain getting in and out of low chairs, cars, and bending to put on shoes
- Outer hip pain, especially when lying on the affected side at night
- Stiffness with reduced internal rotation — the earliest consistent sign of hip OA
- A limp or altered gait when pain is severe
- Pain referred to the knee (hip pathology commonly radiates distally)
- Clicking, catching, or locking sensations (labral tear pattern)
Diagnostic Approach
Dr. Qureshi's evaluation includes a focused hip and lumbar spine examination, provocative testing (FABER, FADIR, log roll test, Trendelenburg test), and review of X-rays and MRI. When the source is unclear between the hip joint, bursa, lumbar spine, and SI joint, diagnostic injections provide definitive confirmation. An intra-articular hip joint injection under fluoroscopic guidance that produces 50%+ relief confirms the hip joint is the pain source, distinguishing it from referred lumbar or SI joint pain.
Treatment Options
- Fluoroscopic-guided hip joint injections — rapid anti-inflammatory relief for hip OA and synovitis; performed under fluoroscopic guidance with contrast confirmation given the deep anatomy of the hip joint; typically provides 1–4 months of relief per injection
- PRP therapy for hip OA — regenerative injections offering longer-lasting benefit (6–12+ months) with growing evidence of disease-modifying effects; particularly valuable in younger patients wanting to preserve the joint and delay replacement. Learn more about PRP therapy for joint pain
- Ultrasound-guided trochanteric bursa injection — targeted corticosteroid delivery to the inflamed bursa for greater trochanteric pain syndrome; ultrasound guidance significantly improves accuracy
- Gluteal tendon PRP injection — for chronic gluteal tendinopathy not responding to conservative care and corticosteroid injection
- Activity modification and physical therapy — gluteal strengthening, hip stabilization, and load management protocols directed by Dr. Qureshi
Will a Hip Injection Delay Surgery?
For many patients, yes — significantly. Hip injections combined with physical therapy, activity modification, and weight management can provide meaningful symptom control for months to years. This is particularly valuable for patients who want to time surgery optimally, need to lose weight before surgery, or have medical conditions that increase surgical risk. Some patients manage well without surgery indefinitely.