The hip joint, the largest joint in the human body, experiences daily stress as a result of physical activity, maintaining body weight. Many people think that joints only hurt in old age. Of course, with age, the cartilage that performs the shock-absorbing function when bending the joint thins and the amount of fluid in the joint decreases, which leads to the appearance of pain. But not only age, but also a number of diseases contribute to the appearance of pain of varying intensity from mild to unbearable. Hip pain can be dull, sharp, pressing, or aching. They often depend on the load, time of day and other factors. The causes of the pain are determined with the help of radiography, CT, MRI, ultrasound, arthroscopy and other studies. Painkillers and rest of the lower extremities are recommended until the diagnosis is made.
Causes of hip pain
Soft tissue injuries
The most common cause of acute pain is a bruise on the hip joint, as a result of a fall from the side or from 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 popping sensation. Pain due to swelling often increases again, moving to the groin and thigh.
In the case of ligament injuries, the motor functions suffer from a severe limitation of the movement of the lower limbs to the inability to stand on their feet and depend on the severity of the injuries such as: sprain, laceration, laceration. The pain intensifies when the body is tilted in the direction opposite to the damaged joint.
Bone and joint injuries
Fractures of the neck of the femur 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 with movement. A stuck heel symptom is a typical sign in which it is impossible to raise a straight leg in a supine position.
Because of 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 limbs due to severe swelling of the affected joint.
Isolated fractures of the greater trochanter rarely occur in children and young people due to a fall, direct blow, sharp muscle contraction and are accompanied by sharp, intense pain that is localized outside the joint. In this regard, patients avoid active movements.
Occurrence of luxation of the hip joint with unbearable acute pain is preceded by a fall from a height, industrial and road injuries.
The leg may be bent or stretched as a result of joint deformity. When you try to stand on your feet or make movements, a springy gait appears against the background of severe pain that does not decrease until the joint is reduced. Acetabulum fractures develop independently or can be caused by dislocations of the hip joint. They are characterized by sharp, explosive pain deep in the hip joint that makes any movement difficult. The leg may be shortened and turned outward so that support on it is impossible.
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 radiating to the hip or knee joint with slight stiffness of movements. Further increase, pain is noted not only during movements, but also at rest.
With severe coxarthrosis, patients rely on a cane. Movements are limited, the affected leg is shortened, which leads to an increased load on the joint. The pain increases not only when walking, but also when standing up. Chondromatosis of the hip joint occurs as subacute arthritis. Moderate, transient pain is accompanied by crunching and limited mobility. When the nerve endings inside the joint are compressed, a severe, sharp pain occurs that limits movement. In arthrosis 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. The pain syndrome occurs when you lie on the painful side, the pain intensifies when you try 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 intensifies after a few months, becomes constant, sharp and debilitating. There is swelling of the joint, limitation of movements and lameness. 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 less favorable, as it is bilateral in half of the cases.
At first, unpleasant pain appears periodically, then it 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 decreases. Progressive movement limitations over two years resulted from hip arthrosis and shortening of the lower limbs.
In the proximal metaphysis of the femur in boys aged 10-15 years, single bone cysts are formed, accompanied by periodic, mild pain in the hip joint. In small children, there is no swelling. Due to unexpressed symptoms, the reason for visiting a doctor is a pathological fracture or increasing limitation of movements.
Hip pain may result from avascular necrosis of the femoral head. The disease occurs due to a violation of blood circulation in the joint associated with long-term use of glucocorticoid hormones (they are prescribed for bronchial asthma, rheumatoid arthritis and a number of 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
Wave-like pain from mild to severe and constant, 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 on pressure are noted.
Recurrent 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 during menopause. Pain can be moderate and weak, nagging and painful, sharply increasing with palpation, which is accompanied by synovitis, edema, hyperemia, hyperthermia and limited mobility.
The syndrome of intense, twitching, tearing pain, both at rest and during movement, develops as a result of the spread of infection against the background of infectious arthritis. Because of this, the limb assumes a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, redness of the joint and fever. If left untreated, bacterial infectious arthritis can develop into panarthritis - severe purulent inflammation of the hip joint with sharp throbbing pain, 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. With acute synovitis, the joint hurts slightly, but the pain may increase due to increased swelling and fluid in it. Chronic synovitis is accompanied by mild pain. In 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 appear, then there is a slight pulling or pain in the muscles of the joint when walking. The patient begins to spare the limb. As it progresses, the pain radiates to the knee in combination with swelling, redness and synovitis. Drawing, twisting pain along with fever, lymphadenopathy, and skin rash may occur in acute brucellosis. In the chronic course of the disease, deformations are formed over time.
Congenital diseases
Hip dysplasia is defined by the degree of misalignment between the femoral head and the acetabulum. With a congenital dislocation, the pain appears from the moment the child begins to walk, accompanied by lameness. In moderate subluxation, the pain that appears at the age of 5-6 years is related to 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 years, pain appears at rest, which intensifies when moving. All forms of dysplasia are accompanied by asymmetry of skin folds and limited mobility. In case of dislocation, shortening of the leg is noted.
New formations
The first symptoms of pain in benign tumors are insignificant and unstable, which do not progress for a long time. The growth of the tumor causes a slow increase in pain in the area of the hip joint. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by mild, short-lasting pain that sometimes worsens at night. Subsequently, the manifestations of pain become sharp, constant, cutting, surrounding, spreading throughout the joint, which swells and deforms. Patients experience weight loss, weakness, and low-grade fever. In advanced cases, the pain becomes so excruciating and unbearable that it can only be removed with the help of narcotics.
Other reasons
Pain in the hip joint sometimes appears in the lower back, in the back due to neuropathy of the sciatic nerve, but it fades into the background compared to severe pain in the back of the buttock and thigh, weakness in the lower limb with sensory disturbances. Dull and aching pain occurs in osteochondrosis, disc herniation, spondylitis, deforming spondyloarthrosis and curvature of the spine due to joint overload, coxarthrosis development and mental illness.
Diagnosis
A general practitioner is involved for initial diagnosis. Diagnostic measures for injuries are carried out by traumatologists of the clinic. 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, taking an anamnesis, physical examination and additional hardware methods of examination. 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 primary method for most diseases, including for the detection of fractures, dislocations, changes in the contours of the acetabulum and femoral head, marginal and intraosseous defects, bone growths and narrowing of the 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 localization of the pathological focus.
- Joint puncture is a therapeutic and diagnostic technique for removing an effusion, examining the composition of the fluid inside the joint and determining 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.
- 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 various traumatic injuries, it is necessary to fix the joint by applying a splint from the foot to the armpit. For minor injuries, it is sufficient to rest the foot by applying cold. If the pain is severe, an analgesic is administered. It is strictly forbidden to eliminate a sprain yourself by performing active actions with your leg. Minor manifestations of non-traumatic diseases should be treated with pain-relieving and anti-inflammatory drugs, ensuring rest of the lower limb. If you experience fever, weakness, severe pain, rapid 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, after which patients undergo surgery or apply a plaster cast after the appearance of a callus. In elderly patients with a femoral neck fracture, immobilization with a derotational boot is allowed to prevent rotational movements of the joint. For other patients, offloading of the hip using orthoses or additional devices such as crutches or a cane is recommended. Physiotherapy methods are prescribed, including massage, therapeutic exercises, manual therapy, as well as procedures such as:
- laser therapy;
- magnetic therapy;
- UHF;
- ultrasound;
- reflexology;
- drug electrophoresis;
- UVT.
To reduce pain, drug treatment is possible using drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), antibacterial substances. To strengthen the cartilaginous tissue of the pelvis, chondroprotectors are prescribed, and muscle relaxants are prescribed to eliminate muscle spasms. Local remedies are widely used - ointments, creams with an analgesic and anti-inflammatory effect.
According to doctors' indications, joint punctures, intra- and peri-articular blockades with hormonal drugs, intra-articular injections of chondroprotectors and synovial fluid substitutes are performed.
surgery
Surgical intervention of 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 disarticulation.
- In case of ankylosis and scars of the periarticular tissues, correction, arthroplasty and arthrodesis are performed. Arthroplasty 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 purposes of preventive measures, it is recommended to carry out special physical exercises and control body weight through diet, since the normalizationof weight, in the first place, helps to relieve the tension on the hip joint joints. An individual complex of physical therapy (physical therapy) and a program of rehabilitation medicine will help bring the joints to a normal state, they are aimed at increasing the quality of life and improving the health of both men and women.