- Labrum tears
- Femoroacetabular impingement (FAI)
- Trochanteric bursitis
- Abductor tears
- Hamstring tears
- Deep gluteal pain syndrome
- Sciatic neuritis
The hip socket has an O-ring around it called the labrum. The labrum can tear from repetitive motion in the setting of impingement, or in the setting of a sudden force on the hip. Many tears can be managed nonoperatively, but those that do not respond do well with repair.
The ball and socket of the hip joint should normally look like a light bulb articulating with a saucer. Sometimes, as a result of how the hip develops, there is extra bone on either the ball or socket side, leading to impingement. This can cause pain and lead to labrum tears from repetitively squeezing the labrum between the ball and the socket rim. In these cases, the bone impingement should be trimmed in addition to the labrum repair.
The trochanteric bursa is a lubricating sac that lives between the IT band on the side of the leg and an outcropping of the thigh bone called the greater trochanter. Occasionally, this bursa gets inflamed and can cause pain on the side of the thigh overlying the hip.
The tendons on the side of the hip that connect the pelvis to the thigh bone can tear from an acute injury or from chronic overuse. In these cases, patients will have chronic pain in this area that responds to tendon repair.
The hamstring tendons attach to a bone protuberance of the pelvis called the ischial tuberosity on the back of the thigh. This bony bulge is also known as the “sit” bone since it is the bone on which we sit. Tears in the hamstring are manifested by weakness with knee flexion and pain with running and sitting.
The area deep to the gluteus maximus (the strong butt muscle) is rich with nerves and small muscles and tendons. There are many sources of pain in this area. Patients will often have difficulty getting a correct diagnosis because of all the possibilities. A judicious and systematic approach to diagnosis and then treatment can lead to successful pain relief.
The sciatic nerve resides next to the hamstring tendons and travels through the deep gluteal space. Occasionally, fibrous bands may surround the nerve, causing “sciatica-like” symptoms. Releasing the nerve resolves the symptoms.