Hip pain

Being the largest joint in the human body, the hip joint supports the body weight and experiences daily stress due to physical activity. Many people think that joints only hurt in old age. Of course, as we age, when the joint bends, the cartilage that performs the function of shock absorption thins and the amount of fluid inside the joint decreases, which causes pain. However, not only age, but also a number of diseases contribute to the occurrence of pain of varying intensity, from mild to unbearable. Hip pain can be dull, sharp, pressing or aching. 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. Analgesics and lower extremity rest are recommended until diagnosis.

Causes of pain in the hip joint

Soft tissue injuries

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

The pain syndrome gradually fades 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 an acute pain syndrome with a cracking sensation. Due to swelling, the pain often increases again, moving to the groin and thigh.

In the case of ligament injuries, motor functions suffer from the inability to stand due to a sharp limitation of the movement of the lower limbs and depend on the severity of the injuries: sprain, tear, tear. The pain intensifies when the body bends in the opposite direction to the damaged ligament.

Bone and joint injuries

Fractures of the femoral neck usually occur as a result of trauma in the elderly. A characteristic feature of osteoporosis is mild swelling in the absence of severe pain at rest. Painful sensations increase sharply with movement. A pinched heel sign is a typical sign of inability to raise a straight leg while lying down.

Due to high-energy injuries, young and middle-aged people often develop pertrochanteric fractures, which are often 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 detected in children and young people due to falls, direct impact, acute muscle contraction, and are accompanied by sharp, intense pain localized outside the joint. In this regard, patients avoid active movements.

Before the occurrence of hip dislocation with unbearable acute pain, there are falls from a height, industrial and traffic injuries.

As a result of joint deformation, the leg may be bent or extended. When trying to stand or make movements, a springy gait appears against the background of severe pain that does not subside until the joint is reduced. Acetabular fractures develop independently or can occur as a result of hip dislocation. They are characterized by sharp explosive pain deep in the hip joint, which makes any movement difficult. The leg may be shortened and turned to the side so that it cannot be supported.

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 pains that spread to the hip or knee joint with slight stiffness of movement. Increased pain is noted not only during movements, but also during rest.

Patients with severe coxarthrosis rely on a cane. Movements are limited, the affected leg is shortened, which causes an increased load on the joint. The pain worsens not only when walking, but also when standing. Chondromatosis of the hip joint occurs as subacute arthritis. Moderate, transient pain is accompanied by crunching and limitation of mobility. When the nerve endings are compressed in a joint, there is a strong sharp pain that limits movement. Trochanteritis with arthrosis of the hip joint is usually 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 intensifies when trying to move the hip to the side.

Bone nutrition problems

In children and adolescents, dull, deep pain in the knee and thigh area develops against the background of Perthes disease, characterized by necrosis of the femoral head. After a few months, the pain becomes stronger, constant, sharp and weak. There is swelling of the joint, limitation of movements, lameness. Later, the pain syndrome decreases and motor functions are restored in different ways.

In adults, aseptic necrosis of the femoral head occurs due to impaired blood circulation and proceeds like Perthes' disease, but is less favorable because it is bilateral in half of the cases.

At first, nagging pains occur from time to time, then intensify, so much so that a person loses the ability to stand completely on the leg due to the destruction of the joint due to insufficient blood circulation. Gradually, the pain syndrome decreases. Progressive movement limitations over two years are the result of arthrosis of the hip joint and shortening of the lower limbs.

In 10-15-year-old boys, solitary bone cysts are formed in the proximal metaphysis of the femur, accompanied by periodic, mild pain in the femur joint. There is no swelling in young children. The reason for consulting a doctor due to unexpressed symptoms is a pathological fracture or increased limitation of movement.

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

Arthritis

Mild to severe and constant undulating pain is a characteristic symptom of aseptic arthritis that limits motor activity in the hip joint in the morning. Symptoms include stiffness, swelling, redness, increased body temperature, and pain when pressed.

Rheumatoid arthritis is characterized by periodic pain, seasonal changes in weather, hormonal changes after childbirth or menopause. Pain can be moderate and weak, nagging and painful, sharply increases with palpation, which is accompanied by synovitis, edema, hyperemia, hyperthermia and limited movement.

Strong, crushing, predatory 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 takes a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, redness of the joint and an increase in temperature. If left untreated, bacterial infectious arthritis can turn into panarthritis - severe purulent inflammation of the hip joint with sharp throbbing pains, hectic fever, weakness, fainting, hyperemia and hyperthermia.

Other inflammatory diseases

On the background of an open fracture, a postoperative wound, due to the appearance of pus, pain in the hip joint with osteomyelitis increases for 1-2 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 may increase due to swelling and increased fluid. Chronic synovitis is accompanied by mild aching pain. During intermittent hydroarthrosis, the hip joint hurts a little, accompanied by limited mobility, which disappears within 3-5 days due to the accumulation of fluid in the joint and recovers again after a certain period of time.

Specific infections

With tuberculosis of the hip joint, weakness and fatigue first appear, then a weak pull or painful muscle pain appears in the joint when walking. The patient begins to spare a limb. As it progresses, it spreads to the knee along with pain, swelling, redness and synovitis. In acute brucellosis, fever, lymphadenopathy, and skin rash may be accompanied by pulling and twisting pains. In the chronic course of the disease, deformations occur over time.

Congenital diseases

Hip dysplasia is defined by the degree of discrepancy between the femoral head and the acetabulum. With a congenital dislocation, the pain appears from the moment the child begins to walk, accompanied by a limp. With moderate subluxation, the pain that occurs at the age of 5-6 is associated with the load on the foot. Pathology with subluxation occurs without symptoms for a long time, with the development of dysplastic coxarthrosis at the age of 25-30, pain that worsens with movement occurs at rest. All forms of dysplasia are accompanied by asymmetry of skin folds and limited mobility. In case of dislocation, shortening of the leg is noted.

Neoplasms

The first pain symptoms of benign tumors are small and unstable, they do not progress for a long time. The growth of the tumor causes a gradual increase in pain in the hip area. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by small, short-term pains, sometimes worse at night. Subsequently, pain manifestations are sharp, constant, cutting, enveloping, swollen and deformed throughout the joint. Patients experience weight loss, weakness, and low-grade fever. In advanced cases, the pain becomes so unbearable and unbearable that it can only be eliminated with the help of drugs.

Other reasons

Pain in the hip joint sometimes appears in the lower back, due to neuropathy of the sciatic nerve in the lower back, but strong pains in the back of the hip and thigh fade into the background compared to weakness in the lower limb with sensory disturbances. . Dull and aching pain occurs with osteochondrosis, disc herniation, spondylitis, deforming spondyloarthrosis and joint overload, coxarthrosis development, and curvature of the spine as a result of mental illnesses.

Diagnostics

A general practitioner attends for initial diagnosis. Diagnostic measures for injuries are carried out by traumatologists of the clinic. For degenerative and inflammatory diseases - orthopedists and rheumatologists. To treat purulent processes, the participation of surgeons is necessary. Examination consists of collection of complaints, study of anamnesis, physical examination and additional hardware research methods. Taking into account the characteristics of the pathological process, the following methods are used:

• Radiography of the sacrolumbar spine, hip joint and femur 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 growths and narrowings. joint space.
• Ultrasound diagnostics (ultrasound) is the most informative method for identifying areas of calcification, inflammatory and degenerative processes in soft tissues.
• Magnetic resonance 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 method to remove effusion, study the composition of fluid inside the joint, and determine infection using laboratory tests.
• Arthroscopy is a visual examination method to assess the state of bone structures and soft tissues, and if necessary, take a biopsy sample for histological examination.
• Laboratory clinical blood tests to determine the markers of inflammation and rheumatological diseases to evaluate 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 physiotherapy 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 mild injuries, it is enough to rest the foot by applying cold. If the pain is severe, an analgesic is given. It is strictly forbidden to remove the dislocation yourself by making active movements with your leg. Small manifestations of non-traumatic diseases should be treated with the use of pain relievers and anti-inflammatory drugs, providing rest of the lower limb. If you experience fever, weakness, severe pain, rapid increase in swelling and hyperemia, it is recommended to consult a doctor immediately.

Conservative therapy

Severe dislocations should be reduced immediately. For leg fractures, skeletal traction is applied, then patients are operated on, or casts are applied after the callus appears. In elderly patients with femoral neck fractures, immobilization with a derotational cast is allowed to prevent rotation of the joint. For other patients, using orthoses or additional devices such as crutches or a cane is recommended to free the hip joint. Physiotherapy methods, including massage, therapeutic exercises, manual therapy, as well as procedures are prescribed:

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

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

Joint punctures, intra-articular blockades with hormonal drugs, intra-articular injections of chondroprotectors, synovial fluid substitutes are performed according to the doctors' instructions.

Surgery

Surgical intervention in 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.
• Restoration, arthroplasty and arthrodesis are performed for ankylosis and scars of periarticular tissues. Endoprostheses are an effective way to restore the motor function of the lower limb due to joint destruction.

Prevention

A sedentary lifestyle has a negative effect on the musculoskeletal system of each person and increases the development of discomfort in the hip joint, therefore, for preventive measures, it is recommended to do special physical exercises and control body weight through diet, as the weight is normalized, first of all, relieve stress on the hip jointhelps to lift. joints. A complex of individual physical therapy (physical therapy) and a rehabilitation medicine program will help restore the joints to a normal state, and aims to improve the quality of life and health of both men and women.