Pain in my right side above my hip

Sometimes hip bone pain may not always be what it seems. The sensation you feel may actually come from structures/joints other than the hip joint. It means that while the hip hurts, the problem may in reality, be elsewhere. Conversely, hip problems may also radiate pain to other parts of the body, which can be just as misleading when you’re aiming to find relief. 

When pain originates from the hip joint itself, the common symptoms include groin pain on the affected side. It’s because the joint lies just behind the groin on each side of the body. 

A fractured hip is an obvious reason for hip pain. The sensation is felt directly at the hip, but it also radiates to nearby areas like the groin or thighs – these are traditionally accepted referral areas for hip issues. 

Besides recent trauma, a painful hip is also associated with some form of arthritis. An arthritic hip limits hip motion since movement is accompanied by a dull and aching pain, and again, it’s felt on the groin and outer thighs when attempting to get up from a chair or bed.  

Sometimes, pain is also caused by viral or bacterial infections, such as  Lyme disease and Septic Arthritis, which leads to hip inflammation. Meanwhile, the pain felt from the side of the hip is usually caused by bursitis. This is an inflammation of the small, jelly-like sacs that act as a cushion in the hip joint.

However, diagnosing the cause of hip pain can be a challenge because it’s a nonspecific chief complaint. This means that the source is not always apparent, compared to fractures where an x-ray is enough to reveal the problem. Since pain doesn’t always point to accurate sources, healthcare professionals must trace the underlying cause of different potential injuries or disease. This is why referred pain is also a consideration in any effort to find relief. 

Referred pain – the reason for the confusion

Pain can sometimes be a red herring because the sensation may radiate to or from other areas. Its distribution has often led to confusion in healthcare workers. Therefore, to properly diagnose the cause behind hip pain, it’s not enough to focus on the ball-and-socket joint alone, but also its surrounding areas. 

The hips do lie!

Besides the groin and thighs, the distribution of pain in hip joint issues may also run down the front of the leg, the lower back, or the buttocks. This pain can even radiate all the way to the knee or the foot where it can be mistaken as a knee or foot problem instead of a hip issue. This is common in patients with hip arthritis, congenital hip dysplasia(a condition where the hip socket doesn’t fully cover the ball portion of the upper thigh bone) and avascular necrosisof the hip (death of bone tissue due to lack of blood supply). 

So, it’s possible that while you’re kneading that painful knee, hoping to achieve some form of relief, the problem could be in the hips all along.

It’s HIP, but it’s not?

In some cases, nagging hip pain may actually be caused by a problem somewhere else. If you’re familiar with this frustrating discomfort, below are possible reasons causing it. 

• Nerve compression

A pinched nerve in the hip can be excruciating that you’d want immediate relief. Nerve compression occurs when the nerve receives excessive pressure from surrounding bones, muscles, tendons and cartilage. Once a nerve is pinched, it sends warning signals to the brain and then to the entire nerve string. What’s so tricky is that the pain will not always radiate from the point of compression, but it may be felt in distant parts of the body. These pain signals can be aggravated by pressure or rubbing that can send shooting pain down the lower extremities.

Pinched nerves are often caused by: 

• Osteoarthritis
• Pregnancy
• Overuse
• Fractures
• Obesity

Compression in any of the nerves that comprise the sacral plexus (the network of nerves that provide motor and sensory function to the posterior thigh, most of the lower leg, part of the pelvis and the entire foot) can radiate pain to the hips. 

• Nerve Irritation

Sometimes, peripheral nerves become inflamed that it sends pain signals to the hips. An example is meralgia paresthetica, which is a sensation caused by an irritation of the nerve that runs along the thigh (lateral femoral cutaneous nerve). It can cause tingling, burning, and numbing pain to the hips. Those who are prone to develop this condition include those who are pregnant, diabetic, obese, or those who wear tight clothing (e.g. girdles, tight stockings, or utility belts). 

On another hand, chronic hip pain may also be linked to sciatica. It is a collective term that describes symptoms of pain, numbness, and/or weakness that radiate along the sciatic nerve. The pain follows the sciatic nerve pathway, which is extensive since it is the longest and largest nerve in the body. It runs from the lower back, through the back of the leg, and down to the toes. Any pain it causes shoots into the hips, buttocks, and legs. This is usually linked to lower back disorders that put pressure on or irritate a nerve root.  It is triggered when a herniated disc presses against a nerve root, or when a degenerated disc releases inflammatory proteins that irritate the adjacent nerve. 

Piriformis syndrome is also another painful condition that occurs when the sciatic nerve is irritated by the piriformis muscle. This causes pain, numbness and tingling that shoots through the buttocks and hips. To check if the discomfort is indeed caused by this condition, doctors will usually check for any difficulty when sitting or putting weight on the affected side, and if the patient has sciatica-type pain when the hip is moved and rotated outward against resistance.

How can we get past the confusion?

Due to the wide distribution of pain, which could originate from other adjacent structures such as the lower spine or knee, a general musculoskeletal examination is important to avoid unnecessary investigations that may delay diagnosis.

If there is no improvement to your hip pain after two weeks, it is important that you seek medical attention. Prior to doing so, it would be wise to take note of all your symptoms – when they started and how it affected your usual activities. This information is crucial for doctors while they evaluate physical symptoms. This involves a physical examination of your hips to find out how well it moves. 

To strengthen a diagnosis, doctors will also prescribe diagnostic tests which include X-rays, CT scans, MRI scans, and even blood tests.

So, if your hip pain doesn’t seem to tell the right story, it’s prudent to seek help from the right professionals and get it sorted out before further damage is sustained. Come in for a consultation with Dr. Andrew Quoc Dutton, today.

About Dr Andrew Quoc Dutton

A/Professor Dutton, also known as, has been in clinical practice since 1996 after graduating from Marist College, Canberra and the University of New South Wales, Sydney, Australia. A/Professor Dutton has worked at the Prince of Wales Hospital, Sydney, and the St. George Hospital, Sydney, before completing his orthopaedic surgery training in Singapore. He is currently an associate professor of orthopaedic surgery at the National University of Singapore (NUS).

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