The hip joint, the largest in the human body, is subjected to daily stress due to physical activity, supporting body weight. Many people think that joints only hurt in old age. Naturally, as we age, the cartilage that performs the function of shock absorption when the joint flexes becomes thinner and the amount of fluid inside the joint decreases, leading to the appearance of pain. However, not only age, but also a number of diseases contribute to the appearance of pain of varying intensity, from mild to unbearable. Hip joint pain can be dull, sharp, pressing, or aching. 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, painkillers 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 of the hip joint, resulting from a fall from the side or a direct blow, movement is slightly limited. Possible swelling.
The pain syndrome gradually subsides and disappears after a week. Damage to the ligaments of the hip joint usually occurs as a result of traffic accidents and sports injuries, accompanied by a sharp pain syndrome with a crunching sensation. Pain from swelling often increases again, moving to the groin and thigh.
In case of ligament injuries, the motor functions suffer from a serious limitation of the movement of the lower limbs up to the inability to stand and depend on the severity of the injuries such as: sprain, tear, break. The pain intensifies when the body is tilted in the direction opposite 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 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 leg straight while lying down.
Due to high-energy injuries, young and middle-aged people often develop pertrochanteric fractures, 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 adolescents due to a fall, a direct blow, a strong muscle contraction and are accompanied by sharp and intense pain, localized outside the joint. In this regard, patients avoid active movements.
The occurrence of hip dislocations with acute unbearable pain is preceded by falls from a height, industrial and road injuries.
The leg may be bent or extended due to the joint deformity. When trying to stand or perform movements, a springy gait appears, against the background of severe 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 a sharp explosive pain in the depth of the hip joint, which makes any movement difficult. The leg can 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 pains radiating to the hip or knee joint with slight stiffness of movements. Increasing further, the pain is noted not only during movements, but also at rest.
With severe coxarthrosis, patients rely on a stick. Movements are limited, the affected leg shortens, this leads to an increased load on the joint. The pain intensifies not only when walking, but also when standing. Chondromatosis of the hip joint presents as subacute arthritis. Moderate, transient pain is accompanied by crunching and limited mobility. When nerve endings within a joint are pinched, intense, sharp pain occurs, limiting movement. With 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. Pain syndrome appears when lying on the sore side, the pain intensifies when trying to move the hip to the side.
Bone nutrition problems
In children and adolescents, against the background of Perthes' disease, characterized by necrosis of the femoral head, a dull, deep pain in the knee and hip develops. 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 several ways.
Aseptic necrosis of the femoral head in adults occurs due to circulatory disorders and proceeds like Perthes' disease, but less favorably, since in half of the cases it is bilateral.
At first, annoying pain occurs periodically, then it intensifies, so much so that the person loses the ability to fully stand due to the destruction of the joint due to insufficient blood circulation. Gradually the pain syndrome decreases. Progressive restrictions of movement over two years become the result of arthrosis of the hip joint and shortening of the lower extremities.
Solitary bone cysts form in the proximal metaphysis of the femur in boys aged 10 to 15 years, accompanied by periodic, mild pain in the hip joint. In young children there is no swelling. Due to unexpressed symptoms, the reason for visiting a doctor is a pathological fracture or increasing limitation of movement.
Hip pain may result from avascular necrosis of the femoral head. The disease occurs due to circulatory disorders 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 can be preceded by trauma, but in some cases it is not possible to determine the true cause. 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 the motor activity of the hip joint in the morning is a characteristic sign of aseptic arthritis. You notice symptoms such as stiffness, swelling, redness, increased body temperature and pain when pressed.
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 aching, increasing sharply on palpation, accompanied by synovitis, edema, hyperemia, hyperthermia and limited mobility.
Severe, jerky, tearing pain syndrome, both at rest and during movement, develops due to 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 increased temperature. If left untreated, bacterial infectious arthritis can develop into panarthritis: severe purulent inflammation of the hip joint with sharp, throbbing pain, hectic fever, weakness, fainting, 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 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 in it. Chronic synovitis is accompanied by mild aching pain. With intermittent hydroarthrosis, the hip joint is slightly painful, 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 weak traction or muscle pain appears in the joint when walking. The patient begins to spare the limb. As it progresses, pain radiates to the knee in combination with swelling, redness, and synovitis. In acute brucellosis, pulling and twisting pains may appear, accompanied by fever, lymphadenopathy and skin rashes. In the chronic course of the disease, deformities are formed over time.
Congenital diseases
Hip dysplasia is determined by the degree of incongruity between the femoral head and the acetabulum. With congenital dislocation, pain appears from the moment the child begins to walk, accompanied by lameness. With moderate subluxation, pain that occurs at the age of 5-6 years is associated with load on the leg. With subluxation, the pathology occurs without symptoms for a long time, with the development of dysplastic coxarthrosis at the age of 25-30 years, pain occurs at rest, which intensifies with movement. All forms of dysplasia are accompanied by asymmetry of skin folds and limited mobility. In case of dislocation, a shortening of the leg is noted.
Neoplasms
The first painful symptoms of benign tumors are mild and unstable, which do not progress for a long time. The growth of the tumor causes pain in the hip area to slowly increase. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by mild, short-lasting pain, which sometimes worsens at night. Subsequently, the manifestations of pain become acute, constant, cutting, enveloping, spread to the entire joint, which swells and deforms. Patients experience weight loss, weakness, and mild fever. In advanced cases, the pain becomes excruciating and unbearable so much so that it can only be eliminated 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 takes a back seat to severe pain in the back of the buttocks and thigh, weakness of the lower limb with sensory disorders. 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.
Diagnostics
A general practitioner is involved in 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 participation of surgeons is necessary. The examination consists of collecting complaints, studying anamnesis, physical examination and additional methods of hardware research. Taking into account the characteristics 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 for detecting fractures, dislocations, changes in the contours of the acetabulum and femoral head, marginal and intrabony defects, bony growths and bone shrinkage. 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 the infection by laboratory testing.
- Arthroscopy is a visual examination method to evaluate the condition of bone structures and soft tissues, taking, if necessary, a biopsy sample for histological examination.
- Clinical laboratory blood tests to determine inflammation and markers of rheumatological diseases in order 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 case of serious traumatic injuries of various nature, it is necessary to fix the joint by applying a splint from the foot to the armpit. In case of minor injuries it is sufficient to support the leg by applying cold. If the pain is severe, an analgesic is given. It is strictly forbidden to eliminate the dislocation yourself by performing active actions with the foot. Minor manifestations of non-traumatic diseases should be treated with the use of painkillers and anti-inflammatory drugs, ensuring rest of the lower limb. If you experience fever, weakness, intense pain, rapid increase in swelling and hyperemia, it is recommended to contact your doctor immediately.
Conservative therapy
Severe dislocations should be reduced immediately. For leg fractures, skeletal traction is used, so patients are operated on or put in a cast after the callus appears. In elderly patients with femoral neck fracture, immobilization with a derotational cuff is allowed to prevent rotational movements of 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;
- magnetotherapy;
- UHF;
- ultrasound;
- reflexology;
- electrophoresis with drugs;
- UVT.
To reduce pain, pharmacological 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 agents are widely used: ointments, creams with analgesic and anti-inflammatory effects.
According to the doctors' indications, joint punctures, intra- and periarticular blocks with hormonal drugs, intra-articular injections of chondroprotectors and synovial fluid substitutes are performed.
Surgery
Surgical intervention on the hip joint is carried out both through open access and with the help of arthroscopic equipment. Operations are performed taking into account the type of pathology:
- Traumatic injuries: reconstruction of the acetabulum, neck osteosynthesis, trochanteric fractures.
- Degenerative processes: arthrotomy, arthroscopy, removal of intra-articular loose bodies.
- Tumors: excision, bone resection, disarticulation of the hip joint.
- For ankylosis and healing of periarticular tissues, repair, arthroplasty and arthrodesis are performed. Endoprosthesis is an effective way to restore motor function of the lower extremity due to joint destruction.
Prevention
A sedentary lifestyle negatively affects the musculoskeletal system of each person and aggravates the development of hip joint disorders, therefore, for preventive purposes, it is recommended to perform special physical exercises and control body weight through diet , since the normalization of weight, first of all helps to relieve stress on the hip joint. An individual complex of physical therapy (exercise therapy) and a program of rehabilitation medicine will help return the joints to a normal state; aim to increase the quality of life and improve the health of men and women.