Hip tendon/muscle/nerve injuries

Muscle, tendon and nerve injuries of the hip are normally the result of overuse, due to making repetitive movements that can damage soft tissues – for example during sports or exercise –or because of tightness in the muscle which places stress on the surrounding muscles and tendons. Injuries can also occur as a result of trauma, such as an accident, fall or collision. There is a large number of muscles, tendons, ligaments and nerves in the hip and pelvis, helping to control movement and provide stability and strength. In between the bones and tendons are bursae, which are small fluid-filled sacs that support smooth movement. These can also become painful and inflamed (see hip bursitis).

Muscle, tendon and nerve injuries cause varying levels of pain, depending how severe they are and where they are located. Specific symptoms to look out for include:

• Snapping hip: this causes pain on the outside of the hip due to tightness in the iliotibial band which produces a snapping sensation whenever the leg is moved backwards and forwards. It may also cause pain in the front of the hip due to the hip flexor tendon snapping over the front of the hip. The bursa is also likely to be affected.
• Gluteus medius syndrome: this causes pain in the outer part of the hip and may also produce a limp. You may experience pain or weakness when lifting the leg.
• Piriformis syndrome: this causes pain deep in the back of the hip and buttocks, and may also cause pain down the back of the leg. You may experience tightness or a feeling of weakness during hip rotation stretches.

Your consultant will conduct a physical examination and may ask you to perform particular movements or stretches to identify where the pain is located. In addition you may be referred for further tests to diagnose the precise nature of the injury and to rule out other conditions or fractures. These may include:

• X-ray – this is used to rule out fractures
• MRI scans use strong magnetic fields and radio waves to produce detailed images of the inside of the body. They are used to diagnose soft tissue damage and injuries
• Ultrasound scans use high frequency sound waves to create an image of part of the inside of the body. They can be used to diagnose muscle, tendon and nerve damage.

Treatment will depend on the nature and severity of the injury. For a mild injury we recommend resting the affected area, using a cold compress and taking anti-inflammatories to reduce inflammation and relieve pain.

• Physiotherapy may be recommended to help to strengthen weak muscles and improve flexibility and movement.
• Dry needling is a non-surgical technique that may help to relieve pain and improve muscle function. It involves inserting a fine filament needle into the affected area to release myofascial trigger points (knots in the muscle) in order to relieve pain. Myofascial trigger points can develop in response to injury, sustained posture or unexpected movements.
• Platelet rich plasma injections help to encourage healing. A concentration of platelets and growth factors taken from the patient’s own blood is injected and placed into a centrifuge to separate them from the remainder of the blood, is injected into the site of injury using ultrasound to guide the procedure. Platelets contain many elements that are essential for cell recruitment, multiplication and specialisation that is essential for healing.
• Arthroscopic hip surgery is a minimally invasive form of surgery that involves a small incision in the skin through which the consultant inserts an arthroscope, which is a thin instrument with a camera at one end. This allows a clear view inside your joint and tiny surgical instruments can be passed through the arthroscope to carry out repairs to soft tissue.