Hip / pelvis – causes, diagnosis and treatment in Hamburg

Anatomy of the hip and pelvis – explained clearly

The hip joint is a ball-and-socket joint: the head of the thigh bone (femoral head) moves in the socket of the pelvic bone (acetabulum). The joint is surrounded by stable ligaments and a joint capsule; Cartilage enables low-friction gliding. A fibrous ring (labrum) seals the socket and increases stability.

The pelvis includes the ilium, ischium and pubic bone. It connects to the sacrum at the front via the pubic symphysis (symphysis) and at the back via the sacroiliac joints (SIJ). Numerous muscles stabilize and move the region: gluteal muscles ensure stability and abduction, the hip flexors (iliopsoas) lift the thigh, and the adductors lead it to the center of the body. Bursae reduce friction, e.g. B. above the greater trochanter.

• Joint structures: cartilage, labrum, capsule, ligaments
• Muscles/Tendons: Gluteals, Iliopsoas, Adductors, Hamstrings
• Bursa: trochanter, iliopsoas
• Bones/junctions: hip joint, pelvic ring, symphysis, sacroiliac joint
• Nerves: sciatic nerve, femoral nerve, sensory nerve on the thigh (lateral cutaneous femoris nerve)
• Functional unit: pelvic floor and trunk stability

Sub-areas and in-depth topics

For precise information, you can find detailed profiles on structures, symptoms and therapies on our subpages. This overview will help you choose the right site for your concerns.

• Muscles, tendons, ligaments (e.g. adductor pain, hip flexor problems, hamstrings)
• Bursa (e.g. trochanteric bursitis, iliopsoas bursa)
• Joints / cartilage (e.g. hip osteoarthritis, impingement, labrum)
• Bones (e.g. stress fractures, femoral head necrosis)
• Nerves (e.g. piriformis syndrome, meralgia paraesthetica)
• Pelvic floor/soft tissues (e.g. myofascial pain, pelvic floor dysfunction)
• Trauma/injuries (e.g. strains, bruises, fractures)
• Systemic/inflammatory causes (e.g. rheumatic diseases)
• Functional/chronic pain syndromes

Typical symptoms of hip and pelvic pain

The location and type of pain provide valuable information. A precise anamnesis - when, where, how long, how severe - is the first step to the correct diagnosis.

• Groin pain, often dependent on stress (indication of joint structures, hip flexors, adductors)
• Lateral hip pain over the greater trochanter, typically when lying on the side (often bursa/tendons)
• Deep buttock pain, possibly radiating into the leg (e.g. myofascial, piriformis, sacroiliac joint)
• Anterior hip pain with snapping or rubbing (e.g. iliopsoas, labrum)
• Pubic bone pain, starting pain or pulling when sprinting (adductors/symphysis)
• Restricted movement, stiffness in the morning or after sitting
• Cracking, snapping, feeling of blockage
• Numbness, tingling or burning on the side of the thigh (e.g. meralgia paraesthetica)
• Swelling, hematoma, sudden pain after a misstep or fall

Common causes and diagnoses at a glance

Hip and pelvic pain has many faces. We encounter the following groups particularly frequently in practice.

• Muscles, tendons, ligaments: adductor tendinopathy (“groin strain”), hip flexor problems (iliopsoas), gluteal tendon irritation, hamstring strain
• Bursa: trochanteric bursitis (GTPS), iliopsoas bursitis
• Joints/cartilage: Hip osteoarthritis (coxarthrosis), femoroacetabular impingement (FAI), labral lesion
• Bones: Stress reactions/fractures in the femoral neck or pelvis, femoral head necrosis
• Nerves: irritation near the piriformis, meralgia paraesthetica, referred pain from the lumbar spine
• Pelvic floor/soft tissues: myofascial trigger points, pelvic floor dysfunction
• Trauma: Bruises, strains, torn muscle fibers, pelvic ring injuries
• Systemic/inflammatory: rheumatic diseases, crystal arthropathies, rarely infections
• Functional/chronic: complex pain syndromes, incorrect and overload patterns

Detailed information, tests and therapy options can be found on the respective subpages.

Diagnostics: step by step to the cause

We start with a structured conversation (anamnesis) and a careful clinical examination. In this way, many causes can be narrowed down - often without immediate, complex imaging.

• Anamnesis: pain history, stress, sport, previous illnesses, medication
• Clinical: Inspection, gait, mobility, strength, provocation tests (e.g. FADIR, FABER), palpation
• Functional chains: trunk and pelvic stability, pelvic floor, leg axis
• Ultrasound: assessment of bursa, tendons, effusions, dynamic tests
• X-ray: bony structures, joint space, axes – used with radiation awareness
• MRI: soft tissue, cartilage, labrum, bone edema - for unclear or therapy-resistant symptoms
• Laboratory: if inflammation/infection is suspected
• Diagnostic infiltrations: ultrasound or image-guided to assign the source of pain

In Hamburg, if necessary, we coordinate across disciplines (radiology, sports medicine, pain medicine). The goal is a clear, comprehensible diagnosis as the basis for your treatment decision.

Conservative therapy – our first and most important approach

Most hip and pelvic problems can be treated without surgery. We will develop an individualized, step-by-step treatment plan with you – based on guidelines and your goals.

• Stress control: temporary reduction of triggering activities, pain-adapted progression
• Physiotherapy: mobility, strength (especially gluteus medius/maximus), pelvic and trunk stability, coordination
• Manual techniques: joint and soft tissue techniques, nerve mobilizing measures
• Therapeutic exercise program: close to everyday life, dosed, with home exercises and regular review
• Pain management: short-term NSAIDs or analgesics, local/topical, with benefit-risk assessment
• Infiltrations if necessary: ​​targeted corticosteroid injection for bursitis; strictly indexed and time-limited
• Shock wave therapy (ESWT): e.g. B. in gluteal tendinopathies - evidence-based in selected cases
• Aids/shoe technology: insoles, buffer heels, limited use of sticks
• Everyday life/ergonomics: seat heights, sleeping position (pillow between knees), bike adjustment
• Lifestyle: weight management, sleep, stress reduction; Avoiding tobacco to promote tissue healing

We regularly evaluate the progress. If symptoms persist despite adequate conservative therapy, we carefully discuss further options.

Interventional and regenerative procedures – selective and enlightened

Some procedures may be useful for certain diagnoses. We use them specifically and discuss the benefits, risks, costs and evidence transparently.

• PRP (platelet-rich plasma): option for tendinopathies or chronic trochanteric pain; Evidence under construction, individual indication
• Viscosupplementation (hyaluronic acid) for hip osteoarthritis: can relieve pain; Effect varies between individuals
• Image-guided injections (US/MRI-guided): precise placement in the bursa or joint
• Radiofrequency or denervation procedures: in selected, treatment-refractory cases - only after strict examination

These measures do not replace active therapy. If chosen correctly, they can open up time windows for training and healing.

Surgical options – when conservative is not enough

Operations are considered when structural problems exist and conservative measures have been exhausted. We provide neutral advice and, if necessary, coordinate with specialized clinics in Hamburg.

• Hip arthroscopy: e.g. B. with selected FAI/labral lesion
• Endoprosthesis (TKA): for advanced, painful osteoarthritis after conservative pretreatment
• Fracture care: surgical stabilization of hip and pelvic fractures in the clinic
• Tenotomy/tendon suturing: very selective for persistent tendon problems

Rehabilitation and aftercare are crucial to the outcome. We provide conservative pre- and post-operative care.

Prevention and training: Hips and pelvis strong in the long term

Targeted training and clever load control are the best remedies for recurring complaints. Small everyday adjustments often have a big impact.

• Strength focus: hip abductors, extensors, deep core and pelvic floor muscles
• Progression: Increase stress slowly, plan for regeneration
• Technique: running and jumping technique, bicycle adjustment, dumbbell technique in strength training
• Mobility: Maintain hip extension and rotation, but use stretching in a measured manner
• Everyday life: stop sitting, choose stairs instead of elevators, choose a sleeping position that relieves stress
• Fall prevention: balance training, if necessary check vitamin D status in consultation with your doctor

Warning signs: When should you seek medical advice quickly?

Not every pain is an emergency. The following signs suggest a quick orthopedic evaluation.

• Sudden, severe pain after a fall or misstep; Inability to bear weight
• Visible misalignment, leg shortening or pronounced swelling
• Fever, redness, severe overheating, pain at night when resting
• New numbness, tingling, weakness in the leg
• Pain with known risks of osteoporosis or with long-term cortisone therapy
• Persistent symptoms > 4–6 weeks despite appropriate rest/exercises

Your visit to our practice in Hamburg

Our practice is centrally located at Dorotheenstraße 48, 22301 Hamburg. Please bring any existing findings and imaging with you - we will review everything together and discuss the next steps in an understandable and transparent manner.

Our goal is a stable hip that is suitable for everyday use with as few interventions as possible - accompanied by clear information without unrealistic promises.