The hip joint, the largest joint in the human body, experiences daily stress as a result of weight-bearing physical activity. Many people think that joints hurt only in old age. Of course, as we age, the cartilage that performs the shock-absorbing function when the joint flexes becomes thinner and the amount of fluid within the joint decreases, causing pain to occur. However, not only age, but also a series of diseases contribute to the appearance of pain of varying intensity, from mild to unbearable. Pain in the hip joint can be dull, sharp, squeezing or aching in nature. They often depend on load, time of day and other factors. The causes of pain are determined using x-ray, CT, MRI, ultrasound, arthroscopy and other studies. Until the diagnosis is made, pain relievers and rest of the lower extremities are recommended.
Causes of pain in the hip joint.
Soft tissue injuries
The most common cause of acute pain is a bruise in the hip joint, as a result of a side fall or a direct blow, movement is slightly limited. Possible swelling.
The pain syndrome gradually decreases and disappears after a week. Damage to the ligaments of the hip joint usually occurs as a result of road traffic accidents and sports injuries, accompanied by acute pain syndrome with a crunching sensation. The pain due to swelling often increases again and moves to the groin and thigh.
In case of ligament injuries, motor functions suffer from a severe limitation of movement of the lower extremities to the inability to stand and depend on the severity of the injuries such as: sprain, tear, break. The pain intensifies when the body tilts away from the damaged ligament.
Bone and joint injuries.
Femoral neck fractures usually occur in older people due to trauma. A characteristic feature of osteoporosis is the presence of slight swelling in the absence of severe pain at rest. Painful sensations increase sharply with movement. The stuck heel symptom is a typical sign in which it is impossible to lift the straight leg while lying down.
Due to high-energy injuries, young and middle-aged people often develop pertrochanteric fractures, which are accompanied by sharp and deep pain. Movement is limited, it is impossible to stand on the lower extremities due to severe swelling of the affected joint.
Isolated fractures of the greater trochanter are rarely found in children and young people due to a fall, a direct blow, a sudden muscle contraction and are accompanied by sharp and intense pain that is located outside the joint. In this sense, patients avoid active movements.
The appearance of hip dislocations with acute unbearable pain is preceded by falls from a height, industrial and traffic injuries.
The leg may be bent or extended as a result of a joint deformity. When trying to stand or make movements, an elastic gait appears, in a context of intense pain, which does not decrease until the joint is reduced. Acetabular fractures develop independently or may be caused by hip dislocations. They are characterized by sharp, explosive pain deep in the hip joint, making any movement difficult. The leg may shorten and turn outward, making it impossible to put any weight on it.
Degenerative processes
In the initial stage of coxarthrosis, after significant exertion or at the end of the day, patients begin to limp due to the appearance of periodic dull pain that radiates to the hip or knee joint with slight stiffness. of movement. Increasing further, the pain is noticeable not only during movements, but also at rest.
In severe coxarthrosis, patients rely on a cane. Movements are limited, the affected leg becomes shorter, which increases the load on the joint. The pain intensifies not only when walking, but also when standing. Chondromatosis of the hip joint occurs like subacute arthritis. Moderate, transient pain is accompanied by crunching and limited mobility. When nerve endings within a joint are pinched, intense, sharp pain occurs that limits movement. With osteoarthritis of the hip joint, trochanteritis is usually formed, accompanied by inflammatory and degenerative damage to the tendons of the gluteal muscles in the area of attachment to the greater trochanter. Pain syndrome appears when lying on the painful side, the pain intensifies when trying to move the hip to the side.
Bone nutrition problems
In children and adolescents, a dull, deep pain in the knee and hip develops against the background of Perthes disease, which is characterized by necrosis of the femoral head. The pain intensifies after a few months, becoming constant, sharp and debilitating. There is swelling of the joint, limitation of movement and lameness. Subsequently, the pain syndrome decreases and motor functions are restored in different ways.
Aseptic necrosis of the femoral head in adults is caused by circulatory disorders and develops like Perthes disease, but less favorable, since in half of the cases it is bilateral.
At first, persistent pain appears periodically, then intensifies, to the point that the person loses the ability to fully stand on his leg due to the destruction of the joint due to insufficient blood circulation. Little by little the pain syndrome decreases. Progressive restrictions of movement over two years become the result of osteoarthritis of the hip joint and shortening of the lower extremities.
In the proximal metaphysis of the femur in children 10-15 years old, solitary bone cysts form, accompanied by mild, periodic pain in the hip joint. In small children there is no swelling. Due to unexpressed symptoms, the reason for visiting the doctor is a pathological fracture or increasing limitation of movements.
Hip pain may be due to avascular necrosis of the femoral head. The disease arises due to circulatory disorders in the joint associated with long-term use of glucocorticoid hormones (they are prescribed for bronchial asthma, rheumatoid arthritis and other diseases), alcohol dependence and severe diabetes mellitus. 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 when trying to stand on the affected leg.
Arthritis
Mild to severe and constant undulating pain, which limits motor activity in the hip joint in the morning, is a characteristic sign of aseptic arthritis. Symptoms such as stiffness, swelling, redness, increased body temperature and pain when pressing are noted.
Periodic pain in rheumatoid arthritis appears due to changes in weather conditions due to the change of seasons, as a result of hormonal changes after childbirth or during menopause. The pain can be moderate and weak, annoying and painful, increasing sharply with palpation, which is accompanied by synovitis, edema, hyperemia, hyperthermia and limited mobility.
Severe, spasmodic, tearing pain syndrome, both at rest and during movement, develops as a result of the spread of infection against the background of infectious arthritis. Therefore, the limb adopts a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, redness of the joints and an increase in temperature. If left untreated, bacterial infectious arthritis can develop into panarthritis - a severe purulent inflammation of the hip joint with sharp stabbing pain, agitated fever, weakness, fainting, hyperemia and hyperthermia.
Other inflammatory disorders
Against the background of an open fracture, a postoperative wound, due to the appearance of pus, pain in the hip joint with osteomyelitis increases for 1 to 2 weeks with signs of inflammation. Synovitis, tendinitis and bursitis develop with injuries and other diseases of the hip joint and, less often, become a manifestation of allergies. In acute synovitis, the joint hurts slightly, but the pain may intensify due to increased swelling and fluid inside the joint. Chronic synovitis is accompanied by mild pain. With intermittent hydroarthrosis, the hip joint hurts slightly, accompanied by limited mobility, which disappears within 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, weakness and fatigue first occur, then a weak pulling or muscle pain appears in the joint when walking. The patient begins to preserve the limb. As it progresses, the pain radiates to the knee in combination with swelling, redness and synovitis. In acute brucellosis, drawing and twisting pains may occur along with fever, lymphadenopathy, and skin rashes. In the chronic course of the disease, deformities form over time.
congenital diseases
Hip dysplasia is determined by the degree of incongruity between the femoral head and the acetabulum. In congenital dislocation, pain appears from the moment the child begins to walk, accompanied by limping. With moderate subluxation, pain that arises between 5 and 6 years of age is associated with loading on the leg. With subluxation, pathology occurs without symptoms for a long time, with the development of dysplastic coxarthrosis at the age of 25-30, pain occurs at rest, which intensifies with movement. All forms of dysplasia are accompanied by asymmetry of the skin folds and limited mobility. In case of dislocation, a shortening of the leg is observed.
Neoplasms
The first pain symptoms of benign tumors are mild and unstable and do not progress for a long time. The growth of the tumor causes the pain in the hip area to slowly increase. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by mild, short-lasting pain, sometimes worse at night. Subsequently, the pain manifestations become sharp, constant, cutting, enveloping, extending to the entire joint, which swells and deforms. Patients experience weight loss, weakness, and a low-grade fever. In advanced cases, the pain becomes so excruciating and unbearable that it can only be eliminated with the help of narcotic drugs.
Other reasons
Pain in the hip joint sometimes appears in the lower back, in the back due to neuropathy of the sciatic nerve, but takes a backseat compared to severe pain in the back of the buttocks and thigh, weakness in the lower extremities with sensory disturbances. . Dull aching pain occurs with osteochondrosis, herniated disc, spondylitis, deforming spondyloarthrosis and curvature of the spine due to overload of the joints, the development of coxarthrosis and mental illness.
Diagnosis
For the initial diagnosis, a general practitioner is involved. Injury diagnostic measures are carried out by the clinic's traumatologists. For degenerative and inflammatory diseases: orthopedists and rheumatologists. For the treatment of purulent processes, the participation of surgeons is necessary. The examination consists of collecting complaints, studying the anamnesis, physical examination and additional hardware investigation methods. Taking into account the characteristics of the pathological process, the following methods are used:
- X-ray of the lumbosacral spine, hip joint and femur is the main method for most diseases, including for detecting fractures, dislocations, changes in the contours of the acetabulum and femoral head, marginal and intraosseous defects, growths bones and narrowing of the joint space.
- Ultrasound diagnostics (ultrasound) is the most informative technique for identifying areas of calcification, inflammatory and degenerative processes in soft tissues.
- Magnetic resonance imaging and computed 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.
- Joint puncture is a therapeutic and diagnostic technique to remove the effusion, study the composition of the fluid inside the joint, and determine infection using laboratory tests.
- Arthroscopy is a method of visual examination to assess the condition of bone structures and soft tissues, if necessary, taking a biopsy sample for histological examination.
- Clinical laboratory blood tests to determine inflammation and markers of rheumatological diseases in order 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 the diagnosis: doctors of physiotherapy and surgery, neurologists.
Complex treatment
Help before diagnosis
In case of various serious traumatic injuries, it is necessary to fix the joint by applying a splint from the foot to the armpit. In case of minor injuries, it is enough to rest the leg by applying cold. If the pain is intense, an analgesic is administered. It is strictly prohibited to eliminate a dislocation on your own by performing active actions with the foot. Minor manifestations of non-traumatic diseases should be treated with the use of analgesics and anti-inflammatories, ensuring rest of the lower limb. If you experience fever, weakness, severe pain, rapid increase in swelling and hyperemia, it is recommended to seek medical help immediately.
Conservative therapy
Severe dislocations should be reduced immediately. For leg fractures, skeletal traction is used, then patients are operated on or placed in a cast after the appearance of calluses. In elderly patients with a femoral neck fracture, immobilization with a derotation boot is allowed to prevent rotational movements in the joint. For other patients, it is recommended to unload the hip joint using orthoses or additional devices such as crutches or a cane. Physiotherapeutic methods are prescribed, including massage, therapeutic exercises, manual therapy, as well as procedures such as:
- laser therapy;
- magnetic therapy;
- ultrahigh frequency;
- ultrasound;
- reflexology;
- drug electrophoresis;
- UVT.
To reduce pain, pharmacological treatment is possible with the use of medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and antibacterial substances. To strengthen the cartilaginous tissue of the pelvis, chondroprotectors and muscle relaxants are prescribed to eliminate muscle spasms. Local agents are widely used: ointments, creams with analgesic and anti-inflammatory effects.
According to the doctors' instructions, joint punctures, intra- and peri-articular blocks with hormonal drugs, intra-articular injections of chondroprotectors and synovial fluid substitutes are performed.
Surgery
Surgical intervention on the hip joint is performed both using open access and using arthroscopic equipment. The operations are performed taking into account the type of pathology:
- Traumatic injuries: reconstruction of the acetabulum, osteosynthesis of the neck, trochanteric fractures.
- Degenerative processes: arthrotomy, arthroscopy, removal of loose intra-articular bodies.
- Tumors: removal, bone resection, disarticulation of the hip joint.
- For ankylosis and healing of periarticular tissues, repairs, arthroplasty and arthrodesis are performed. Endoprosthesis is an effective way to restore motor function of the lower limb due to destruction of the joint.
Prevention
A sedentary lifestyle negatively affects the musculoskeletal system of each person and aggravates the development of discomfort in the hip joint, therefore, as a preventive measure, it is recommended to perform special physical exercises and control body weight through diet, since normalize weight, First of all, it helps relieve stress on the hip joints. An individual complex of physiotherapy (physiotherapy) and a program of rehabilitation medicine will help the joints return to a normal state, are aimed at increasing the quality of life and improving the health of both men and women.