Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature

Abstract

Objectives The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the hip joint, and the distribution of sensory receptors within its capsule. Methods Five electronic databases were queried, between January 1945 and June 2019. Twenty-one original articles providing a detailed description of sensory receptors about the hip joint capsule (13) and its articular branches (8) were reviewed. Results The superior portions of the anterior capsule and the labrum were found to be the area of densest nociceptive innervation. Similar to the distribution of nociceptors, mechanoreceptor density was found to be higher anteriorly than posteriorly. Hip joint capsular innervation was found to consistently involve the femoral and obturator nerves, which supply the anterior capsule, and the nerve to the quadratus femoris which supplies the posterior capsule. The femoral and obturator and superior gluteal nerves supply articular branches to the most nociceptor-rich region of the hip capsule. Conclusions The femoral, obturator, and nerve to the quadratus femoris were found to consistently supply articular branches to both the anterior and posterior capsule of the hip joint. The anterior capsule, primarily supplied by the femoral and obturator nerves, and superior labrum appear to be the primary pain generators of the hip joint given their higher density of nociceptors and mechanoreceptors

Intraneural ganglion cysts at the hip: The next celestial frontier

“…The Kim et al and Shin et al 1,2 studies also confirmed the geography of articular branches to specific (and partially overlapping) capsular areas (quadrants) 17 through labrocapsular tears‐‐‐consistent with hip articular anatomy and Hilton's law 6,7 . This application allows bidirectional predictions: If an IGC is observed, the quadrant in which the labral tear is located can be predicted.…”

A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework

“…For the remaining 30% patients who responded suboptimally to anterior neurolysis, one of the postulations is the contribution and sensitization of the posterior hip capsule as supported by our recent case series on posterior hip pericapsular neurolysis [ 12 ]. Anatomically, this is explained by the presence of nociceptors in the superoposterior labrum, which is predominantly innervated by the nerve to the quadratus femoris with contributions from the superior gluteal and sciatic nerves [ 14 , 15 , 16 ]. The concept of silent nociceptor activation secondary to fracture hip can explain the augmented pain intensity over posterior hip capsule [ 17 , 18 ].…”

Physical impairments in Adults with Developmental Dysplasia of the Hip (DDH) undergoing Periacetabular osteotomy (PAO): A Systematic Review and Meta-Analysis

“…Painful structures could include the iliopsoas muscle which sits immediately anteriorly to the hip joint and has been found to be painful in almost half of people with DDH pre-PAO 7 and/ or the anterosuperior aspect of the hip capsule and labrum which have been found to have dense nociceptive innervation. 57 Future studies need to confirm whether these changes can be modified, and whether improvements in these impairments are related to improvements in pain and the progression to hip OA and total hip joint replacement.…”