Hip/Pelvis Conditions

Hip/Pelvis Conditions

Piriformis Syndrome

Overview: The piriformis muscle is a small gluteal muscle that helps with external rotation of the thigh. When this muscle spasms or shortens, it can cause local pain. The sciatic nerve is nearby and can often become irritated as well.

Causes: Local trauma or injury to nearby structures can lead to irritation and spasm of the piriformis muscle.

Symptoms: Local gluteal pain is common with potential radiation into the leg if the sciatic nerve is also affected. In more severe cases, weakness may occur.

Treatment: Physical therapy is very helpful in teaching a stretching program and helping with local strengthening. Ultrasound-guided trigger point injections into the piriformis muscle and a sciatic nerve block can both be very helpful in decreasing symptoms.

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Greater Trochanteric Bursitis

Overview: Bursa are fluid-filled sacs that are found in several places within the body. They are placed to reduce friction and improve movement. The greater trochanter is the bony point that protrudes on the side of the hip. The greater trochanteric bursa sits directly over the greater trochanter to protect the bone and decrease friction in the region.

Causes: Bursa may become irritated and inflamed when excessive stress is placed on them or following direct trauma. Trauma to the hip, repetitive hip movements and direct pressure (such as sleeping on the affected side) are some major causes of greater trochanteric bursitis. Altered biomechanics of the spine, hip, knee or foot/ankle can lead to bursitis as well.

Symptoms: Swelling over the greater trochanter and tenderness of the region may be felt. Most commonly, there is pain when sleeping on the affected side or with prolonged walking.

Treatment: Oral or topical anti-inflammatory medication can be used to decrease inflammation. Physical therapy can help to localize mechanical imbalances and correct them. A PRF or steroid injection into the bursa under ultrasound guidance may be pursued. Surgical removal of the bursa is reserved for severe cases of bursitis that have failed more conservative measures.

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Labrum Tear

Overview: The hip joint is created by the femur (leg bone) and the acetabulum (socket). Within the hip joint is a cartilage lining over the bones called the labrum. The labrum serves to seal the joint and balance the load of the joint and is the attachment site for the joint capsule. Labrum tears can occur, which alters the stability and function of the hip joint.

Causes: Trauma is a common cause of labrum damage and can include a single major event or cumulative minor events. Mechanical imbalances, such as femoral acetabular impingement (FAI), can also predispose a person to developing a labrum tear.

Symptoms: Pain in the groin with popping or clicking of the joint are common complaints.

Treatment: Patients that have the clinical signs and symptoms of labrum damage may be further evaluated with advanced imaging, such as MRI or CT scan. When an accurate diagnosis has been made, treatment options depend on the severity of the labrum tear. For those with mild to moderate symptoms, anti-inflammatory medications and physical therapy can be very helpful. Regenerative Medicine can be used to heal the cartilage tear. Surgical intervention is reserved for cases that don’t respond to more conservative measures or those with significant functional impairment.

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Ischial Bursitis

Overview: Bursa are fluid-filled sacs that are found in several places within the body. They are placed to reduce friction and improve movement. The ischial tuberosities are the portion of the pelvis that we sit upon. They are the bony points that protrude in the gluteal region. The ischial bursa sits directly over the ischial tuberosities to protect the bone and decrease friction in the region.

Causes: Bursa may become irritated and inflamed when excessive stress is placed on them. Sitting on hard surfaces for prolonged periods and activities such as running, jumping and kicking all place stress on the bursa.

Symptoms: Gluteal tenderness, pain directly over the ischial tuberositis and pain with sitting are frequent. Discomfort while stretching the hamstrings may be experienced due to their attachment to the pelvis at the ishial tuberosity.

Treatment: Oral or topical anti-inflammatory medication can be used to decrease inflammation. Physical therapy can help to localize mechanical imbalances and correct them. A PRF or steroid injection into the bursa under ultrasound guidance may be pursued. Surgical removal of the bursa is reserved for severe cases of bursitis that have failed more conservative measures.

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