General

Hip Pain: Causes of Right and Left Hip Pain and Treatment Options

Hip pain is primarily caused by musculoskeletal disorders, joint degeneration, soft tissue injuries, or inflammatory conditions affecting the hip joint and surrounding structures. Common etiologies include osteoarthritis, bursitis, tendonitis, fractures, and nerve compression syndromes.

Degenerative joint disease of the hip develops due to cartilage breakdown, leading to pain, stiffness, and reduced mobility over time. Osteoarthritis is the most prevalent cause, especially in older adults, and is associated with mechanical wear, obesity, and genetic predisposition.

Soft tissue injuries around the hip involve muscles, tendons, and bursae, often resulting from overuse, trauma, or repetitive strain. Trochanteric bursitis and hip flexor tendonitis frequently present with localized pain that worsens with movement or prolonged activity.

Referred pain and systemic conditions contribute to hip discomfort through indirect mechanisms affecting nearby anatomical regions. Lumbar spine disorders, sacroiliac joint dysfunction, infections, and inflammatory diseases such as rheumatoid arthritis may manifest as persistent or radiating hip pain.

What Causes Hip Pain and Which Areas Does It Affect?

When patients mention hip pain, most of them place their hands on the lateral or posterior aspect of their hips. However, from a medical standpoint, true hip joint pain is usually felt in the groin region. This distinction is the most important diagnostic clue for us. The source of pain may be the bones, cartilage, ligaments surrounding the joint, muscles, or nerves. Sometimes, there may be no actual problem in the hip at all; pain originating from intra-abdominal organs or the lower back can mimic hip pain.

The character, duration, and triggering factors of the pain provide us with a roadmap. Sometimes it is the result of years of wear and tear, sometimes a sudden awkward movement, and sometimes a silently progressing circulatory disorder.

Risk factors that predispose to hip pain include:

  • Advanced age
  • Excess body weight
  • Heavy sports activities
  • Previous trauma
  • History of congenital hip dislocation
  • Corticosteroid use
  • Genetic predisposition
  • Rheumatic diseases

What Are the Symptoms of Hip Osteoarthritis (Coxarthrosis)?

Osteoarthritis, commonly known as calcification, is one of the most frequent causes of hip pain. Over time, the smooth and slippery cartilage tissue covering the joint surfaces wears down, thins, and may disappear in certain areas. When cartilage loses its protective function, the underlying bone surfaces begin to rub against each other. This friction not only causes pain but also restricts joint movement.

Pain due to osteoarthritis typically has a “mechanical” character. In other words, it increases with use of the joint and decreases with rest. Patients usually experience significant stiffness when they wake up in the morning or when they first stand up after sitting for a long time. After taking a few steps, this stiffness partially resolves (the “warm-up phenomenon”), but if activity continues throughout the day, pain intensifies in the evening. As the disease progresses, pain persists even at rest and may become severe enough to disturb sleep at night.

Complaints observed in patients with advanced-stage osteoarthritis include:

  • Groin pain
  • Pain radiating to the front of the thigh
  • Limited range of motion
  • Difficulty putting on socks
  • Limping
  • Sounds coming from the joint
  • Sensation of leg length discrepancy

At this stage, Interventional Radiology methods come into play. For patients who are not suitable candidates for surgery or who wish to postpone joint replacement, image-guided ablation of the pain-transmitting nerves (branches of the obturator and femoral nerves) using Radiofrequency Ablation allows patients to continue their lives pain-free.

Does Avascular Necrosis (Bone Death) Cause Hip Pain?

Avascular Necrosis (AVN), as it is medically termed, is a serious and rapidly progressive condition. Simply put, it is the “heart attack” of the bone tissue, caused by blockage or damage to the blood vessels supplying the head of the femur. Bone tissue deprived of blood loses its vitality and dies.

The most dangerous aspect of this condition is that nothing may be visible on X-rays in the early stages. However, the patient experiences very severe, throbbing pain in the groin. If not diagnosed early, the dead bone tissue cannot bear body weight and collapses. This collapse leads to complete deterioration of the joint surface and results in severe osteoarthritis at a very young age.

Factors involved in the development of avascular necrosis include:

  • High-dose corticosteroid use
  • Excessive alcohol consumption
  • Hip fracture or dislocation
  • Sickle cell anemia
  • Lupus
  • Coagulation disorders
  • History of radiotherapy
  • Smoking

In patients diagnosed at an early stage, the bone can be salvaged through image-guided decompression (drilling) and stem cell applications performed by Interventional Radiology. However, if treatment is delayed, prosthetic surgery becomes inevitable.

What Is Hip Impingement Syndrome (FAI) Seen in Young Individuals?

It is a major misconception to consider hip pain as a problem exclusive to older individuals. Mechanical problems seen particularly in young people and active athletes are precursors of future osteoarthritis. Hip Impingement Syndrome (Femoroacetabular Impingement – FAI) results from structural incongruity between the “ball” (femoral head) and the “socket” (acetabulum) forming the hip joint.

Under normal circumstances, these two structures should glide over each other in perfect harmony. However, if there are congenital or acquired excesses or protrusions in the bones, they collide during hip flexion. This chronic collision tears the cartilage ring called the “labrum,” which surrounds the joint rim and acts as a seal.

Patients typically describe the pain by placing their hand in a “C” shape over the side of their hip (the “C sign”). The pain is usually deep, sharp, and stabbing.

Movements that trigger pain include:

  • Sitting cross-legged
  • Deep squatting
  • Getting in and out of a car
  • Prolonged sitting
  • Taking high steps
  • Cycling
  • Crossing the legs
  • Walking uphill

What Causes Lateral Hip Pain and Bursitis?

Many patients present with the complaint “my hip hurts,” but the area they indicate is not the groin—it is the exact outer side of the hip. They complain of burning, stabbing pain that worsens when lying on that side. This condition usually originates not from within the joint but from the soft tissues surrounding it. The most common diagnosis we encounter is “Trochanteric Bursitis.”

Bursae are small, fluid-filled sacs located between bony prominences and tendons, and their function is to reduce friction. However, due to overuse, repetitive movements, or trauma, these sacs become inflamed and swollen. As a result, the patient becomes unable to lie on that side.

Similarly, inflammation of the tendons (tendinitis) of the muscles around the hip can cause comparable complaints. These conditions are often expected to “go away on their own,” but if left untreated, they can become chronic and last for months.

Causes of bursitis and tendinitis include:

  • Long-distance walking
  • Climbing stairs
  • Falls or impacts
  • Leg length discrepancy
  • Incorrect footwear selection
  • Excessive running training
  • Scoliosis
  • Muscle imbalance

In such soft tissue conditions, ultrasound-guided targeted injections into the inflamed area (local anesthetic and steroid mixtures) provide an extremely rapid and effective treatment.

Are the Causes of Right and Left Hip Pain Different?

The side on which hip pain occurs is an important piece of information that guides us diagnostically. Of course, osteoarthritis, muscle strain, or bursitis can occur on either side. However, in certain situations—especially when “referred pain” is involved—the right and left sides may signal different diseases.

Right Hip Pain: This is generally of musculoskeletal origin. Since the right side may be dominant in the body’s load-bearing dynamics, mechanical problems are more common.

Left Hip Pain: This region is anatomically more complex in terms of neighboring structures. Left hip and groin pain can sometimes mimic diseases of organs outside the musculoskeletal system or be referred from these organs.

Visceral conditions that may cause left hip pain include:

  • Diverticulitis
  • Kidney stones
  • Ovarian cyst
  • Inguinal hernia
  • Urinary tract infection
  • Constipation
  • Uterine disorders
  • Testicular disorders

If the pain does not increase with movement, does not improve with rest, and is accompanied by other systemic symptoms (fever, burning during urination, changes in bowel habits), visceral causes must be investigated. Interventional Radiology uses “diagnostic blocks” to make this distinction. For example, if the nerves originating from internal organs are temporarily anesthetized and the pain subsides, it becomes clear that the source is not the hip joint but the abdomen.

Can Sciatica and Piriformis Syndrome Be Confused with Hip Pain?

“Sciatic pain” is one of the most commonly used terms by patients, but it is often misunderstood. Sciatica is not a disease; it is a symptom. It occurs as a result of compression of the sciatic nerve, which exits the lower back and travels through the back of the hip down the leg. If a lumbar disc herniation compresses this nerve, the patient feels pain not so much in the lower back but in the center of the hip and down the leg.

However, not every pain in the back of the hip is due to a lumbar disc herniation. There is a frequently overlooked condition called “Piriformis Syndrome.” The piriformis is a small, pear-shaped muscle located deep in the buttock. The sciatic nerve passes just beneath (or sometimes through) this muscle. If the muscle goes into spasm, swells, or shortens, it compresses the nerve underneath. The result is pain radiating down the leg, numbness, and tingling—just like a disc herniation.

Symptoms of piriformis syndrome include:

  • Pain in the back of the hip
  • Numbness radiating down the leg
  • Pain that increases while sitting
  • Inability to sit on hard surfaces
  • Difficulty climbing stairs
  • Restricted hip movements

Treatment involves image-guided (ultrasound or CT) injections of muscle relaxants or Botulinum toxin into this muscle. When the muscle relaxes, pressure on the nerve is relieved and the patient experiences relief.

How Is Hip Pain Diagnosed and What Is a Block Procedure?

Proper management of hip pain is based on accurately identifying the “pain generator.” Physical examination and patient history are very important, but they may not be sufficient on their own. X-rays show bone structure, and MRI reveals soft tissues and edema. However, sometimes even if abnormalities are seen on imaging, they may not be the true source of pain.

At this point, Interventional Radiology’s “Diagnostic Block” methods come into play. This procedure is essentially detective work. We inject a very low dose of local anesthetic into the suspected area (intra-articular, around a nerve, or into a bursa) with millimetric precision under imaging guidance.

Diagnostic blocks answer the following questions:

  • Is the pain coming from the joint?
  • Is the pain referred from the spine?
  • Is the pain muscle-related?

If the patient’s pain disappears “like a knife cut” immediately after the procedure, it means we have hit the target precisely. This both confirms the diagnosis and allows us to predict the success of definitive treatments (such as ablation or surgery).

Is Cancer-Related Hip Pain Treatable?

Unfortunately, the hip region and the femur are among the most common sites for metastasis from other cancers in the body (breast, prostate, lung, etc.). In addition, primary bone tumors (such as Osteoid Osteoma) can also cause severe pain.

Oncologic pain typically persists at rest and wakes patients from sleep at night. Pain control is of vital importance for this group of patients. Interventional Radiology offers highly effective solutions for cancer patients through “Ablation” (heating/freezing) therapies.

The ablation methods used include:

  • Radiofrequency Ablation (RFA)
  • Cryoablation (Freezing)
  • Microwave Ablation

Using special needles placed into the tumor under imaging guidance, the tumor tissue is destroyed by heating or freezing. This procedure also ablates the pain-sensitive nerves in the bone lining, resulting in a dramatic reduction in pain immediately after the procedure.

How Is Non-Surgical Hip Pain Treatment Performed with Interventional Radiology?

Modern medicine is moving away from procedures involving large incisions, long recovery periods, and high risks. Interventional Radiology represents the point where medicine meets technology. Our non-surgical treatment methods have become the gold standard for patients who are not suitable for open surgery, who are awaiting surgery, or who are afraid of surgical procedures.

All of these procedures are performed “under imaging guidance.” Using ultrasound, computed tomography, or fluoroscopy (live X-ray), we do not enter the body blindly but with visualization. We monitor the tip of the needle on the screen, which minimizes error and prevents damage to surrounding tissues.

The main treatment methods applied include:

  • Intra-articular injections
  • Nerve blocks
  • Pulsed Radiofrequency (PRF)
  • Dry needling
  • Hydrodissection
  • Cyst aspiration

Pulsed Radiofrequency (PRF), in particular, has revolutionized the treatment of chronic pain. In this method, nerves are neither burned nor cut. Instead, a specific energy wave is delivered to the nerve to “modulate” pain transmission—preventing the nerve from sending pain signals. This provides long-term pain relief without the risk of sensory loss or paralysis.

The advantages of interventional procedures include:

  • No hospital stay required
  • No general anesthesia
  • Very low risk of infection
  • Short recovery time
  • Repeatable procedures
  • No surgical scars
  • Low risk of bleeding
  • Safe for elderly patients

Frequently Asked Questions

Hip pain can result from arthritis, muscle strains, tendon injuries, bursitis, nerve compression, fractures, or joint disorders. Medical evaluation is recommended when pain is severe, persistent, or affects mobility.
Right hip pain may be caused by osteoarthritis, bursitis, tendon inflammation, muscle injuries, or overuse. In some cases, pain from abdominal or pelvic conditions may also be felt in the right hip region.
Left hip pain can develop due to joint degeneration, tendon disorders, muscle strain, bursitis, or nerve-related conditions. Certain spinal problems may also cause pain that radiates into the left hip area.
Arthritis causes inflammation and gradual wear of the hip joint, leading to pain, stiffness, reduced range of motion, and difficulty with walking, climbing stairs, or performing everyday activities.
Yes, conditions such as herniated discs, spinal stenosis, or nerve compression can cause referred pain that radiates from the lower back into the hip, buttock, or upper leg regions.
Warning signs include inability to bear weight, severe swelling, deformity, fever, sudden intense pain, numbness, or pain following trauma. These symptoms may require urgent medical assessment.
Diagnosis typically includes a physical examination, medical history review, X-rays, MRI, CT scans, ultrasound, and occasionally laboratory tests to identify joint, muscle, bone, or nerve abnormalities.
Treatment may include rest, physical therapy, medications, activity modification, injections, weight management, or surgery. The best treatment depends on the specific diagnosis and severity of symptoms.
Many hip conditions respond successfully to conservative treatments such as exercise therapy, anti-inflammatory medications, stretching programs, and lifestyle modifications. Surgery is generally reserved for more advanced cases.
Many patients report improved mobility, reduced pain, better sleep quality, and increased participation in daily activities. Outcomes vary depending on the underlying cause, treatment method, and rehabilitation efforts.
Updated Date: 13/10/2026

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