The hip joint, the largest joint in the human body, experiences daily stress as a result of physical activity and supporting body weight. Many people think that joints only hurt in old age. Of course, with advancing age, the cartilage that performs the shock-absorbing function during joint bending becomes thinner and the amount of fluid inside the joint decreases, which leads to the appearance of 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. It often depends on the load, time of day and other factors. The causes of pain are determined with the help of radiography, CT, MRI, ultrasound, arthroscopy and other tests. Painkillers and rest of the lower limbs are recommended until the diagnosis is made.
Causes of hip pain
Soft tissue injuries
The most common cause of acute pain is a contusion of the hip joint resulting from a fall to the side or a direct blow, the movement is slightly limited. Possible swelling.
The pain syndrome gradually dulls 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 and a feeling of cracking. The pain caused by the swelling often increases again and spreads to the groin and thigh.
In ligament injuries, motor function ranges from severe limitation of lower limb movement to inability to stand, and depends on the severity of the injury, such as: sprain, tear, laceration. The pain intensifies when the body is tilted in the opposite direction to the damaged ligament.
Bone and joint injuries
Fractures of the femoral neck usually occur in older people as a result of 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. The stuck heel symptom is a typical sign when it is impossible to raise a straight leg while lying down.
Due to high-energy injuries, young and middle-aged people often develop pertrochanteric fractures, which are associated with sharp and deep pain. Movement is limited, it is impossible to stand on the lower limbs due to severe swelling of the affected joint.
An isolated fracture of the greater trochanter rarely occurs in children and young people as a result of a fall, direct blow, sharp muscle contraction, and is accompanied by sharp, intense pain that is 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, industrial and road injuries.
As a result of joint deformity, the leg may bend or extend. When you try to stand up or make 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 can be caused by hip dislocation. They are characterized by sharp, explosive pain deep in the hip joint, which makes any movement difficult. The leg can be shortened and turned outwards, so it is impossible to lean 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 radiating to the hip or knee joint with slight movement stiffness. It continues to increase, the pain can be observed not only during movement, but also at rest.
In case of 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 intensifies not only when walking, but also when standing. Chondromatosis of the hip joint is like subacute arthritis. Moderate, temporary pain is accompanied by crunching and limited movement. When the nerve endings inside the joint are pinched, intense sharp pain occurs, limiting movement. With arthrosis of the hip joint, trochanteritis usually develops, which is 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 hip develops against the background of Perthes disease, which is characterized by necrosis of the femoral head. After a few months, the pain intensifies, becoming constant, acute and debilitating. Joint swelling, limited movement and lameness occur. After that, the pain syndrome decreases and motor functions are restored in different ways.
In adults, aseptic necrosis of the femoral head occurs due to circulatory disorders and develops similarly to Perthes disease, but is less favorable, as it is bilateral in half of the cases.
The nagging pain appears periodically at first and then intensifies, to such an extent that the person loses the ability to stand completely on his feet due to joint damage due to insufficient blood circulation. The pain syndrome gradually decreases. The progressive limitation of movement lasting two years is the result of arthrosis of the hip joint and shortening of the lower limbs.
In 10-15-year-old boys, solitary bone cysts form in the proximal metaphysis of the femur, which are accompanied by intermittent, mild hip joint pain. There is no swelling in small children. Due to non-expressive symptoms, the reason for consulting a doctor is a pathological fracture or increasing mobility limitation.
Hip pain can be caused by avascular necrosis of the femoral head. The disease develops due to glucocorticoid hormones (prescribed for bronchial asthma, rheumatic arthritis and many other diseases), joint circulation disorders, alcohol addiction and severe diabetes. Joint necrosis can 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 standing on the affected leg.
Arthritis
Wave-like pain from mild to severe and constant, limiting motor activity in the morning in the hip joint is a characteristic sign of aseptic arthritis. Symptoms include stiffness, swelling, redness, increased body temperature, and pain when pressed.
Intermittent pain in rheumatoid arthritis occurs due to changes in weather conditions due to the change of seasons, hormonal changes after childbirth or during menopause. The pain can be moderate and weak, nagging and aching, sharply increased by touch, which is accompanied by synovitis, edema, hyperemia, hyperthermia, and limited movement.
An intense, jerking, 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 assumes a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, joint redness and increased temperature. If left untreated, bacterial infectious arthritis can develop into panarthritis - severe purulent inflammation of the hip joint with acute throbbing pain, hectic fever, weakness, fainting, hyperemia and hyperthermia.
Other inflammatory disorders
Due to the appearance of pus in the background of an open fracture and postoperative wound, the pain of the hip joint in osteomyelitis increases for 1-2 weeks with signs of inflammation. Synovitis, tendinitis and bursitis develop together with injuries and other diseases of the hip joint, and are less often a manifestation of allergies. In acute arthritis, the joint hurts slightly, but the pain may increase due to increased swelling and fluid in it. Chronic arthritis is accompanied by mild aching pain. In the case of periodic hydroarthrosis, the hip joint hurts slightly, accompanied by limited movement, which disappears within 3-5 days, and then reappears after a certain time, due to the accumulated fluid in the joint.
Specific infections
In the case of tuberculosis of the hip joint, weakness and fatigue first appear, then weak pulling or aching muscle pain occurs in the joint while walking. The patient begins to spare his limb. As it progresses, the pain radiates to the knee, combined with swelling, redness and arthritis. In acute brucellosis, pulling, twisting pain, fever, lymphadenopathy and skin rashes may occur. In the chronic course of the disease, deformities develop over time.
Congenital diseases
Hip dysplasia is defined by the degree of incongruence between the femoral head and the acetabulum. In the case of congenital dislocation, the pain appears from the moment the child begins to walk, accompanied by lameness. In the case of moderate subluxation, the pain that occurs at the age of 5-6 is associated with loading the leg. In the case of subluxation, the pathology appears without symptoms for a long time, with the development of dysplastic coxarthrosis at the age of 25-30, pain occurs at rest, which increases with movement. All forms of dysplasia are accompanied by asymmetry of skin folds and limited mobility. In case of dislocation, shortening of the leg can be observed.
Neoplasms
The first pain symptoms of benign tumors are mild and unstable, which do not progress for a long time. The growth of the tumor causes a slow increase in hip pain. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by minor, short-lasting pain, which sometimes worsens at night. After that, the manifestations of pain become acute, permanent, cutting, enveloping, spreading to the entire joint, which swells and deforms. Patients experience weight loss, weakness, and low-grade fever. In advanced cases, the pain becomes so unbearable, unbearable that it can only be stopped with the help of drugs.
Other reasons
Hip joint pain sometimes occurs in the lower back, due to neuropathy of the sciatic nerve, but it takes a backseat to severe pain in the buttocks and the back of the thigh, with sensory disturbances compared to the weakness of the lower limb. . Dull and aching pain occurs in the case of osteochondrosis, disc herniation, spondylitis, deforming spondyloarthrosis and spinal curvature due to joint overload, the development of coxarthrosis and mental illnesses.
Diagnostics
A general practitioner should be involved for the initial diagnosis. Traumatologists at the clinic carry out diagnostic measures for injuries. In the case of degenerative and inflammatory diseases - orthopedists and rheumatologists. The treatment of purulent processes requires the participation of surgeons. The examination consists of complaint collection, anamnesis study, physical examination and additional hardware research methods. Taking into account the characteristics of the pathological process, the following methods are used:
- X-rays of the sacral spine, hip joint and femur are the main method for detecting most diseases, including fractures, dislocations, changes in the contours of the acetabulum and femoral head, marginal and intraosseous defects, bony growths and bony stenosis. joint space.
- Ultrasound diagnostics (ultrasound) is the most informative technique for identifying calcification, inflammatory and degenerative processes of soft tissues.
- Magnetic resonance imaging and computed tomography (MRI and CT) are clarifying methods that can be performed with contrast material to clarify the nature, extent, and location of the pathological focus.
- Joint puncture is a therapeutic and diagnostic technique for removing effusion, studying the composition of the fluid inside the joint, and determining the infection with laboratory tests.
- Arthroscopy is a visual examination method for assessing the state of bone structures and soft tissues, and if necessary, taking a biopsy sample for histological examination.
- Laboratory clinical blood tests to determine markers of inflammation and rheumatological diseases, to assess the general condition of the body, the activity of organs in infectious or systemic pathologies.
In the future, several specialists may be involved in diagnostics: physiotherapists and surgeons, neurologists.
Complex treatment
Help before diagnosis
In case of severe traumatic injuries, it is necessary to immobilize the joint by applying a splint from the leg to the armpit. In case of minor injuries, it is sufficient to rest the foot by applying cold. If the pain is severe, painkillers are given. It is strictly forbidden to eliminate the dislocation independently by performing active operations with the 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 increase in swelling and hyperemia, seek medical help immediately.
Conservative therapy
Severe dislocations should be reduced immediately. For leg fractures, skeletal traction is used, and after the appearance of calluses, patients are operated on or placed in a cast. In elderly patients with femoral neck fractures, immobilization with a derotational boot is allowed to prevent rotational movements in the joint. For other patients, relief of the hip joint using orthoses or additional devices such as crutches or canes is recommended. Physiotherapy methods are prescribed, including massage, therapeutic exercises, manual therapy, and procedures such as:
- laser therapy;
- magnet therapy;
- UHF;
- ultrasound;
- reflexology;
- electrophoresis with drugs;
- UVT.
In order to reduce pain, drug treatment is possible with drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), antibacterial substances. To strengthen the cartilage 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, joint injections, intra- and peri-articular blockades with hormonal drugs, intra-articular injections of chondroprotectors and synovial fluid substitutes are performed.
Surgery
Surgery of the hip joint is performed with open access and with the help of arthroscopic equipment. Operations are performed taking into account the type of pathology:
- Traumatic injuries: acetabulum reconstruction, cervical osteosynthesis, trochanteric fractures.
- Degenerative processes: arthrotomy, arthroscopy, removal of loose intra-articular bodies.
- Tumors: removal, bone resection, hip joint disarticulation.
- In case of ankylosis and scarring of the periarticular tissues, redressing, arthroplasty and arthrodesis are performed. Endoprosthesis is an effective way to restore the motor functions of the lower limb due to joint damage.
Prevention
A sedentary lifestyle negatively affects the locomotor system of each person and aggravates the development of hip joint discomfort, therefore, for preventive measures, it is recommended to perform special physical exercises and control body weight with a diet, since normalizing body weight, above all, helps relieve the stress on the hip joint. joints. Individual physical therapy (physiotherapy) complex and rehabilitation medical program help bring the joints back to normal, and are aimed at improving the quality of life and health of both men and women.