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Hip Pain

Causes and Treatments

There are many causes of hip pain.  Most individuals who experience hip pain believe that it comes from the hip.  As a pain physician, I encounter a significant number of patients who have hip pain and who have been told they need either minimally invasive hip surgery, hip resurfacing surgery, or total hip surgery.  Unfortunately that this is not always the case.

The term referred to pain is one most of us know through TV or the movies.   The most common is an individual who presents to the ER with severe arm or jaw pain.  They don’t need to see a dentist or an orthopedist.  They are having a heart attack.  Referred pain is the phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injury’s origin.

The same concept applies to hip pain causes.  Common causes of pain that refer to the hip include sacroiliac joint dysfunction, bursitis, myofascial pain syndrome, and lumbar degenerative disc disease.

All to often an individual goes to their physician with complaints of hip pain only to get an injection of cortisone or an x-ray of the hip.  At the Centeno-Schultz Clinic, we evaluate all possible sources of hip pain prior to focusing our attention on the hip joint.  Regrettably in 2008, Medicare only requires an x-ray of the hip in order for a patient to be a candidate for minimally invasive hip surgery, arthroscopic hip surgery, or total hip replacement surgery. An MRI is essential to evaluate structures in the hip which include the cartilage, ligaments, and bone.

If therapy is required one of the newest options is the use of your own bone marrow concentrate (BMC) containing stem cells.  At Regenexx expanded BMC have been injected into the hip joint with success.  Patients will attest to their reduced pain and increased function.

Hip Labral / Labrum tear

A tear in the hip labrum can cause a number of different symptoms.  The most common is anterior hip or groin pain which may radiate down to the level of the knee (3).  Pain develops gradually and typically is dull in character made worse with walking, pivoting and running.  Hip labral tears are easily seen on MRI.  Unfortunately, it’s importance as a source of pain must be questioned.  Why?  Research has demonstrated that many patients with no hip pain have labral tears on MRI (4-5).   In one study, Duthon et al demonstrated that 69% of patients without hip pain had labral tears.

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Interstitial Cystitis

Interstitial Cystitis has been called many names, such as Painful Bladder Syndrome, Urethral Syndrome, Trigonitis, and Bladder Pain Syndrome. Some characterize it into Hunner Lesion Interstitial Cystitis, which is described as having irritating lesions on the bladder wall seen with cystoscopy (scope looking into the bladder) or Non-Hunner Lesion Interstitial Cystitis, in which no such lesions on cystoscopy. The cause or etiology of the disease is not known or not clearly recognized.IC or BPS predominantly affects women with an average age of onset of 40 years or older. It does affect men, but it’s less common, and very rarely would affect children.

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