Hip pain

The hip joint, the largest joint in the human body, is subjected to daily physical activity and supports the weight of the body. Many people think that joints only hurt as they get older. Of course, with age, the cartilage, which performs the shock-absorbing function when the joint flexes, becomes thinner and the amount of fluid in the joint decreases, which leads to 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. Often depends on the strain, time of day and other factors. The causes of pain are determined using X-rays, CT, MRI, ultrasound, arthroscopy and other examinations. Painkillers and rest of the lower extremities are recommended until diagnosis is made.

Causes of pain in the hip joint

Soft tissue injuries

The most common cause of acute pain is a bruised hip joint, which occurs as a result of a fall on the side or a direct blow and movement is slightly restricted. Possible swelling.

The pain syndrome gradually subsides 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 stabbing pain syndrome with a clicking sensation. The pain caused by the swelling often increases again and travels to the groin and thigh.

In the case of ligament injuries, the motor functions suffer from severe restrictions in movement of the lower extremities, including the inability to stand on the legs, and depend on the severity of the injuries such as: sprain, tear, rupture. The pain increases when the body is tilted in the opposite direction to 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 mild swelling without severe pain at rest. Pain sensations increase sharply with movement. The symptom of a stuck heel is a typical sign that it is impossible to lift a straight leg while lying down.

High-energy injuries often cause pertrochanteric fractures in young and middle-aged people, which are accompanied by stabbing and deep pain. Movement is limited, standing on the lower limbs is not possible due to the severe swelling of the affected joint.

Isolated fractures of the greater trochanter are rare in children and adolescents due to a fall, direct blow, or severe muscle contraction and are associated with acute, intense pain localized outside the joint. In this regard, patients avoid active movements.

The occurrence of hip dislocations with unbearable acute pain is preceded by falls from a height, work and traffic accidents.

Due to joint deformity, the leg may be bent or straightened. When trying to stand on your feet or perform movements, against the background of severe pain, a springy gait appears that does not subside until the joint contracts. Acetabular fractures develop independently or can be caused by hip dislocations. They are characterized by acute, explosive pain deep in the hip joint, which makes any movement difficult. The leg may be shortened and turned outward, making it impossible to support 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 periodic dull pain that radiates to the hip or knee joint and has a slight stiffness of movement. As the intensity increases, the pain is noted not only during movement but also at rest.

In severe coxarthrosis, patients are dependent on a walking stick. Movements are restricted and the affected leg is shortened, which leads to increased stress on the joint. The pain increases not only when walking, but also when standing. Chondromatosis of the hip joint occurs like subacute arthritis. Moderate, temporary pain is accompanied by grinding and limited mobility. When nerve endings become pinched in a joint, severe, stabbing pain occurs that limits movement. Osteoarthritis of the hip joint usually leads to trochanteritis, accompanied by inflammatory and degenerative damage to the tendons of the gluteal muscles in the insertion area of the greater trochanter. The pain syndrome occurs when lying on the painful side, the pain increases when trying to move the hip to the side.

Problems with bone nutrition

In children and adolescents, 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 increases after a few months and becomes constant, acute and debilitating. Joint swelling, restricted movement and lameness occur. Subsequently, the pain syndrome subsides and motor functions are restored in different ways.

Aseptic necrosis of the femoral head in adults occurs due to circulatory disorders and has a similar course to Perthes disease, but is less favorable because it occurs bilaterally in half of the cases.

The stabbing pain initially occurs periodically and then intensifies to such an extent that the person loses the ability to stand completely on his leg due to the destruction of the joint due to insufficient blood circulation. Gradually the pain syndrome subsides. Progressive restrictions on movement over two years are the result of osteoarthritis of the hip joint and shortening of the lower extremities.

Single bone cysts form in the proximal metaphysis of the femur in boys aged 10-15 years, accompanied by periodic, mild pain in the hip joint. In young children there is no swelling. The reason for a visit to the doctor is a pathological fracture or increasing restriction of movement due to unspoken symptoms.

Hip pain can be caused by avascular necrosis of the femoral head. The disease arises due to impaired blood circulation in the joint, which is associated with long-term use of glucocorticoid hormones (they are prescribed for bronchial asthma, rheumatoid arthritis and a number of other diseases), alcohol addiction 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 severe and occurs when walking and trying to stand on the affected leg.

arthritis

Wave-like pain from mild to severe and persistent, limiting 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 pressed are noted.

Periodic pain in rheumatoid arthritis occurs due to weather changes due to changing seasons, as a result of hormonal changes after childbirth or during menopause. Pain can be moderate and mild, nagging and aching, and sharply increasing on palpation, accompanied by synovitis, edema, hyperemia, hyperthermia, and limited mobility.

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

Other inflammatory diseases

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 1-2 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 increase due to the increased swelling and fluid in the joint. Chronic synovitis is associated with mild, aching pain. With intermittent hydroarthrosis, the hip joint hurts slightly, accompanied by limited mobility, which disappears within 3-5 days due to the accumulation of fluid in the joint and reappears after a certain period of time.

Specific infections

With tuberculosis of the hip joint, weakness and fatigue initially appear, then there is a weak pulling or aching muscle pain in the joint when walking. The patient begins to rest the limb. As it progresses, the pain radiates into the knee and is accompanied by swelling, redness and synovitis. In acute brucellosis, pulling, twisting pain may occur along with fever, lymphadenopathy, and skin rashes. In the chronic course of the disease, malformations develop over time.

Congenital diseases

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

neoplasms

The initial pain symptoms of benign tumors are minor and unstable and do not progress over a long period of time. As the tumor grows, the pain in the hip area slowly increases. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by mild, short-term pain that sometimes worsens at night. Subsequently, the pain symptoms become acute, constant, cutting, enveloping and spread to the entire joint, which swells and deforms. Patients experience weight loss, weakness and low-grade fever. In advanced cases, the pain becomes so severe and unbearable that it can only be eliminated with the help of anesthetics.

Different reasons

Pain in the hip joint sometimes occurs in the lower back, in the back due to neuropathy of the sciatic nerve, but fades into the background in comparison with severe pain in the back of the buttocks and thighs, as well as weakness in the lower extremity with sensory disorders. Dull and aching pain occurs with osteochondrosis, herniated disc, spondylitis, deforming spondyloarthrosis and curvature of the spine due to joint overload, the development of coxarthrosis and mental illness.

diagnosis

A family doctor is consulted for the 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 involvement of surgeons is required. The examination includes collecting complaints, studying anamnesis, physical examination and other methods of hardware research. Taking into account the peculiarities of the pathological process, the following methods are used:

• X-ray of the sacrolumbar spine, hip joint and femur is the main method for most diseases, including detecting fractures, dislocations, changes in the contours of the acetabulum and femoral head, marginal and intraosseous defects, bone growth and narrowing of the hip joint space.
• Ultrasound diagnostics (ultrasound) is the most informative technique for identifying areas of calcification, inflammatory and degenerative processes in soft tissue.
• Magnetic resonance imaging and computed tomography (MRI and CT) are diagnostic procedures that can be carried out with a contrast agent to clarify the type, extent and location of the pathological focus.
• Joint puncture is a therapeutic and diagnostic technique used to remove effusions, examine the composition of fluid in the joint and detect 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, to assess the general condition of the body and the activity of organs in infectious or systemic diseases.

In the future, even more specialized specialists could be involved in diagnostics: doctors for physiotherapy and surgery, neurologists.

Complex treatment

Help before diagnosis

In case of severe traumatic injuries of various types, it is necessary to fix the joint by applying a splint from the foot to the armpit. For minor injuries, it is sufficient to protect the leg from the cold. If the pain is severe, a painkiller is given. It is strictly forbidden to eliminate a dislocation yourself through active actions with the foot. Minor manifestations of nontraumatic conditions should be treated with painkillers and anti-inflammatory medications to ensure protection of the lower extremity. If you experience fever, weakness, severe pain, rapid increase in swelling and hyperemia, it is recommended to seek medical attention immediately.

Conservative therapy

Severe dislocations should be reduced immediately. For leg fractures, skeletal traction is used, then patients undergo surgery or are placed in a plaster cast after the appearance of callus. In older patients with a femoral neck fracture, immobilization with a derotation cuff is permitted to prevent rotational movements in the joint. For other patients, it is recommended to relieve the pressure on the hip joint using orthoses or additional devices such as crutches or a walking stick. Physiotherapeutic methods are prescribed, including massage, healing exercises, manual therapy, as well as procedures such as:

• laser therapy;
• magnetic field therapy;
• UHF;
• Ultrasonic;
• reflexology;
• electrophoresis with medication;
• UVT.

To relieve pain, medical treatment with medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and antibacterial substances is possible. To strengthen the cartilage tissue of the pelvis, chondroprotectors and muscle relaxants are prescribed to eliminate muscle spasms. Local active ingredients are widely used - ointments, creams with analgesic and anti-inflammatory effects.

According to the doctor's instructions, joint punctures, intra- and periarticular blocks with hormonal preparations, intra-articular injections of chondroprotectors and synovial fluid replacement are carried out.

surgery

Surgical interventions on the hip joint are carried out both in the open approach and with the help of arthroscopic devices. Operations are performed taking into account the type of pathology:

• Traumatic injuries: reconstruction of the acetabulum, osteosynthesis of the neck, trochanter fractures.
• Degenerative processes: arthrotomy, arthroscopy, removal of loose intra-articular bodies.
• Tumors: removal, bone resection, disarticulation of the hip joint.
• In case of ankylosis and scarring of the periarticular tissue, redressing, arthroplasty and arthrodesis are performed. Endoprosthetics is an effective method for restoring motor function of the lower extremity due to joint destruction.

prevention

A sedentary lifestyle has a negative impact on every person's musculoskeletal system and worsens the development of problems in the hip joint. Therefore, for preventive purposes, it is recommended to perform special physical exercises and control body weight through a diet, since the normalization of weight helps, first of all, to relieve the load on the hip joint. Joints. An individual complex of physiotherapy (physiotherapy) and a rehabilitation medicine program will help bring the joints to a normal state; they aim to increase the quality of life and improve the health of men and women.