What Could Cause Terrible Hip Pains?

QUESTION: Please help. I am a senior, senior citizen, and can't always
afford medical care all the time. Perhaps you can diagnose my problem. What
could cause terrible pains in my hip?
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ANSWER: For one of the most difficult of all diagnosis to make, you have
provided me with far too little information. There are many causes of
"terrible" pains in the hips and, unfortunately, many of them mimic each
other. That made it difficult for doctors to diagnose exact cause of those
pains in the past.
Even with modern technology, accurate diagnoses still rely upon careful
examination and observation by your physician. X-rays are helpful but many
causes relate to the soft tissues which surround your hip joint. All
possibilities must be considered carefully when searching for the cause of
your pain.
Before we discuss some of the possible origins of your pain, here's a
quick description of the hip itself. It is the only true ball and socket
joint in the human body and, except for the knee, is the largest joint. It is
a major source of symptoms of pains in several parts of the body including the
back, legs and buttocks. When you take a step or rise from a sitting
position, a force of 2.5 to 3 times the weight of the body is exerted to the
weight-bearing dome of the hip. So, our hips take a "beating" as we live long
lives.
Arthritis is immediately suspected when a patient goes to a doctor
complaining of pain in the hip area. But there are many clinical conditions
that can affect, or be affected by, the hip that do not stem from arthritis.
Nevertheless, osteoarthritis and rheumatoid arthritis cause more than 90
percent of such diagnoses.
The most common causes of hip pain after a fall or some other trauma are
fractures. Next in frequency are synovitis, necrosis (death of cells in the
lining of joints), and avascular necrosis (death of cells caused by a
deficiency of blood supply).
Occult (difficult to see) fractures most frequently occur in elderly
patients with osteoporosis. They are more common in women than they are in
men and usually follow a rather minor fall. Avascular necrosis happens in all
ages and may result from huge corticosteroid intake, excessive alcohol
consumption, drugs that cause the immune system to become weakened, trauma,
and sickle cell anemia. There are, of course, other less frequently occurring
reasons for hip pain such as untreated congenital dislocation of the hip,
metabolic hormonal conditions in children, and other less well understood
conditions.
There are three major conditions that mimic hip disease. These include
pain caused by pressure on nerve roots, trochanteric bursitis (affects the
upper part of the hip bone), and vascular insufficiency.
Hip disease treatments usually are conservative, using medication to
reduce the pain symptom for as long as patients can tolerate the discomfort
and inconvenience. Using a cane can help relieve some of the pressure from
your hip and reduce the pain.
Though I would love to be a "miracle doctor" for you and my many other
readers, it simply can't be done by answering a question in this column. In
cases such as yours, only the careful examination by a caring physician can
start you on the road to relief.