hip pain

The hip joint, the largest joint in the human body, experiences daily stress from physical activity by supporting the body's weight. Many people think that joints only hurt in old age. Of course, as we age, the cartilage that acts as a shock absorber when the joint flexes thins and the amount of fluid inside the joint decreases, causing pain. However, not only age, but also a number of diseases contribute to the occurrence of pain of varying intensity from mild to unbearable. Pain in the hip joint can be dull, sharp, pressing or aching in nature. It often depends on the load, time of day and other factors. The causes of pain are determined using radiography, CT, MRI, ultrasound, arthroscopy and other studies. Painkillers and rest of the lower limbs are recommended before diagnosis.

Causes of pain in the hip joint

Soft tissue injuries

The most common cause of acute pain is a bruise of the hip joint, caused by a fall on the side or a direct blow, the movement is slightly limited. Possible swelling.

The pain syndrome gradually disappears and disappears after a week. Damage to the ligaments in the hip joint usually occurs as a result of traffic accidents and sports injuries, accompanied by a sharp pain syndrome with a cracking sensation. Due to the swelling, the pain often increases again, moving to the groin and thigh.

In case of damage to the ligaments, the motor functions suffer from a sharp limitation of the movement of the lower limbs to the inability to stand up and depend on the severity of the injuries, such as: stretching, rupture, rupture. The pain intensifies when the body is bent in the opposite direction of the damaged ligament.

Bone and joint injuries

Fractures of the femoral neck usually occur in older people due to trauma. A characteristic feature of osteoporosis is the presence of mild swelling in the absence of severe pain at rest. Painful sensations increase sharply during movement. A stuck heel symptom is a typical sign in which it is impossible to raise a straight leg while lying down.

Due to high-energy injuries, young and middle-aged people often develop pertrochanteric fractures, which are accompanied by acute and deep pain. Movement is limited, due to severe swelling of the affected joint it is impossible to stand on the lower limbs.

Isolated fractures of the greater trochanter rarely occur in children and young adults due to falls, direct blows, sharp muscle contractions, and are accompanied by acute, intense pain localized outside the joint. In this regard, patients avoid active movements.

Occurrence of hip dislocation with unbearable acute pain is preceded by a fall from a height, industrial and traffic injuries.

The leg may be bent or extended as a result of the deformity of the joint. When trying to stand or perform movements, a springy gait appears against the background of severe pain, which does not subside until the joint is shortened. Acetabular fractures develop independently or can be caused by hip dislocations. They are characterized by sharp, explosive pain in the hip joint, which makes any movement difficult. The leg may be shortened and turned outward, so that it is impossible to lean on it.

Degenerative processes

In the initial stage of coxarthrosis, after significant effort or at the end of the day, patients begin to limp due to periodic, dull pain radiating to the hip or knee joint, little stiffness of movement. Further increase, pain is observed not only during movement, but also at rest.

In case of severe coxarthrosis, patients rely on a crutch. Movements are limited, the injured leg is deprived, this leads to an increase in the load on the joint. The pain worsens not only when walking, but also when standing. Chondromatosis of the hip joint occurs like subacute arthritis. Moderate, transient pain is accompanied by cramping and limited mobility. When the nerve endings inside the joint are pinched, there is a sharp pain that limits movement. With arthrosis of the hip joint, trochanteritis is usually formed, which is accompanied by inflammatory and degenerative damage to the tendons of the gluteal muscles in the area of attachment to the greater trochanter. The pain syndrome appears when lying on the painful side, the pain worsens when trying to move the hip to the side.

Bone nutrition problems

In children and adolescents, Perthes disease develops a dull, deep pain in the knee and thigh, characterized by necrosis of the femoral head. The pain worsens after several months, becoming constant, acute and debilitating. Swelling of the joint, limitation of movement and lameness are noted. Subsequently, the pain syndrome decreases and motor functions are restored in different ways.

Aseptic necrosis of the femoral head in adults occurs due to circulatory disorders and proceeds like Perthes' disease, but is less favorable because it is bilateral in half of the cases.

At first, there is a sharp pain periodically, then it becomes stronger, so much so that a person loses the ability to fully stand on his feet due to insufficient blood circulation due to the destruction of the joint. The pain syndrome gradually decreases. Progressive limitation of movement within two years occurs as a result of arthrosis of the hip joint and shortening of the lower limbs.

In 10-15-year-old boys, solitary bone cysts form at the proximal metaphysis of the femur, accompanied by periodic, mild pain in the hip joint. There is no swelling in young children. The reason for visiting a doctor due to undetected symptoms is a pathological fracture or increasing limitation of movement.

Hip pain can be caused by avascular necrosis of the femoral head. The disease develops due to blood circulation disorders in the joint associated with long-term use of glucocorticoid hormones (they are prescribed for bronchial asthma, rheumatoid arthritis and many other diseases), alcohol addiction and severe diabetes. Joint necrosis may be preceded by trauma, but in some cases the true cause cannot be determined. The pain in this case is intense and occurs when walking and trying to stand on the affected leg.

Arthritis

Wave-like pain ranging from mild to severe and constant, limiting motor activity in the hip joint in the morning is a hallmark of aseptic arthritis. Symptoms include stiffness, swelling, redness, increased body temperature, and pain when pressed.

Periodic pain in rheumatoid arthritis occurs due to changes in weather conditions, due to the change of seasons, as a result of hormonal changes after childbirth or menopause. Pain can be moderate and weak, aching and painful, sharply increases with palpation, which is accompanied by synovitis, swelling, hyperemia, hyperthermia and limitation of movement.

As a result of the spread of infection against the background of infectious arthritis, an intense, thundering pain syndrome develops, both at rest and during movement. Therefore, the limb takes a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, joint redness and temperature increase. If left untreated, bacterial infectious arthritis can turn into panarthritis - severe purulent inflammation of the hip joint with acute pulsating pain, acute fever, weakness, weakness, hyperemia and hyperthermia.

Other inflammatory disorders

Against the background of an open fracture, postoperative wound, due to the appearance of pus, pain in the hip joint with osteomyelitis increases for 1-2 weeks with signs of inflammation. Synovitis, tendinitis, and bursitis develop with injuries and other diseases of the hip joint, and are less often a manifestation of allergies. In acute synovitis, the joint hurts a little, but the pain can be aggravated by increased swelling and fluid in it. Chronic synovitis is accompanied by mild aching pain. In intermittent hydroarthrosis, the hip joint hurts a little, accompanied by a limitation of movement, which disappears in 3-5 days and resumes after a certain period of time due to the accumulation of fluid in the joint.

specific infections

With tuberculosis of the hip joint, first there is weakness and fatigue, and then there is a weak stretch or aching muscle pain when walking in the joint. The patient begins to disintegrate the limb. As it progresses, the pain spreads to the knee along with swelling, redness and synovitis. Acute brucellosis may present with cramping, cramping pain along with fever, lymphadenopathy, and a skin rash. During the chronic course of the disease, deformations are formed over time.

Congenital diseases

Hip dysplasia is defined by the degree of discrepancy between the femoral head and the acetabulum. In case of congenital dislocation, pain appears from the moment the child begins to walk, accompanied by lameness. In case of moderate subluxation, the pain that appears at the age of 5-6 years is associated with loading on the leg. In the case of subluxation, the pathology proceeds for a long time without symptoms, with the development of dysplastic coxarthrosis at the age of 25-30, pain appears at rest, which intensifies with movement. All forms of dysplasia are accompanied by asymmetry of skin folds and limited mobility. In case of dislocation, the leg is shortened.

neoplasms

The first pain symptoms of benign tumors are insignificant and unstable, which do not progress for a long time. The growth of the tumor causes the pain in the hip area to gradually increase. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by slight, short-term pain, which sometimes worsens at night. Subsequently, the manifestations of pain become acute, constant, cutting, limited, spread over the entire joint, which is swollen and deformed. Patients present with weight loss, weakness, and low-grade fever. In advanced cases, the pain becomes so excruciating and unbearable that it can only be eliminated with drugs.

other reasons

Pain in the hip joint sometimes occurs in the lower back due to neuropathy of the sciatic nerve, but fades into the background compared to severe pain in the buttock and thigh, weakness in the lower limb with sensory disturbances. . Dull and aching pain occurs due to osteochondrosis, disc herniation, spondylitis, deformed spondylarthrosis and spinal curvature due to overloading of joints, development of coxarthrosis, and mental illnesses.

diagnosis

A general practitioner is involved for initial diagnosis. Traumatologists of the clinic carry out diagnostic measures of injuries. In degenerative and inflammatory diseases - orthopedists and rheumatologists. The participation of surgeons is necessary for the treatment of purulent processes. The examination includes collection of complaints, anamnesis study, physical examination and additional technical research methods. Taking into account the characteristics of the pathological process, the following methods are used:

• X-ray of the sacroiliac spine, hip joint and hip is the main method for detecting most diseases, including fractures, dislocations, changes in the contours of the acetabulum and femoral head, marginal and intraosseous defects, bone formations and narrowing. shared space.
• Ultrasound diagnostics (ultrasound) is the most informative technique for detecting areas of calcification, inflammatory and degenerative processes in soft tissues.
• Magnetic resonance and computer tomography (MRI and CT) are clarifying methods that can be performed with a contrast agent to clarify the nature, extent and location of the pathological focus.
• Puncture of the joint is a therapeutic and diagnostic technique to remove the rash, to study the composition of the fluid inside the joint and to determine the infection using laboratory tests.
• Arthroscopy is a method of visual examination to assess the state of bone structures and soft tissues, if necessary, to take a biopsy sample for histological examination.
• Laboratory clinical blood tests to determine inflammation and markers of rheumatological diseases, to assess the general condition of the body, the activity of organs in infectious or systemic pathologies.

In the future, more specialized specialists may be involved in diagnostics: doctors of physical therapy and surgery, neurologists.

Complex treatment

Help before diagnosis

In severe traumatic injuries, it is necessary to fix the joint by applying a splint from the leg to the armpit. In case of minor injuries, it is enough to rest the foot by applying cold. If the pain is severe, an analgesic is prescribed. It is strictly forbidden to independently eliminate the dislocation by performing active activities on foot. Small manifestations of non-traumatic diseases should be treated with the use of analgesics and anti-inflammatory drugs, which provide rest of the lower limb. If you suffer from fever, weakness, severe pain, rapid swelling and hyperemia, it is recommended to seek medical help immediately.

conservative therapy

Severe dislocations should be reduced immediately. Skeletal traction is used for leg fractures, and patients are then operated on or placed in plaster after callus formation. In elderly patients with femoral neck fractures, immobilization with a derotational boot is allowed to prevent rotational movement of the joint. For other patients, it is recommended to unload the hip joint using orthoses or additional devices such as crutches or crutches. Physiotherapy methods are prescribed, including massage, therapeutic exercises, manual therapy, as well as procedures such as:

• laser therapy;
• magnetic therapy;
• UHF;
• ultrasound;
• reflexology;
• electrophoresis with drugs;
• UVT.

To reduce pain, drug treatment can be done using drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), antibacterial substances. Chondroprotectors are prescribed to strengthen the cartilage tissue of the pelvis, muscle relaxants to eliminate muscle spasms. Local agents - ointments, creams with analgesic and anti-inflammatory effects are widely used.

Puncture of the joint, intra- and peri-articular blockade with hormonal drugs, intra-articular injections of chondroprotectors and synovial fluid replacement are performed according to doctors' instructions.

surgery

Surgical intervention on the hip joint is performed both with open access and with the help of arthroscopic equipment. Operations are performed taking into account the type of pathology:

• Traumatic injuries: acetabulum reconstruction, neck osteosynthesis, trochanteric fractures.
• Degenerative processes: arthrotomy, arthroscopy, removal of loose intra-articular bodies.
• Tumors: removal, bone resection, hip joint disarticulation.
• Retracing, arthroplasty and arthrodesis are performed in case of ankylosis and scars of periarticular tissues. Endoprosthesis is an effective way to restore motor function of the lower limb due to joint destruction.

Prevention

A sedentary lifestyle negatively affects the musculoskeletal system of each person and aggravates the development of discomfort in the hip joint, therefore, for the purpose of preventive measures, it is recommended to perform special physical exercises and control body weight through diet, as the weight is normalized. First of all, it helps relieve stress on the hip joint. An individual complex of physical therapy (physical therapy) and a program of rehabilitation medicine will help bring the joints back to normal; They aim to increase the quality of life and improve the health of both men and women.