The hip joint, the largest joint in the human body, experiences daily stress as a result of physical activity, supporting body weight. Many people think that joints only hurt in old age. Of course, with age, the cartilage that performs the function of absorbing shocks when the joint bends 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. Pain in the hip joint can be dull, sharp, pressing or aching in nature. It often depends on the load, time of day and other factors. The causes of pain are determined using x-rays, CT, MRI, ultrasound, arthroscopy and other studies. Until the diagnosis is made, painkillers and the 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 on the side or from a direct blow, the movement is slightly 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 a sharp pain syndrome with a popping sensation. The pain due to the swelling often increases again, moving into the groin and thigh.
In case of ligament injuries, motor functions suffer from severe limitation of movement of the lower extremities to the inability to stand and depend on the severity of the injuries such as: sprains, ruptures, ruptures. 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 the elderly 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 significantly with movement. The symptom of a stuck heel is a typical sign in which it is impossible to raise a straight leg while lying down.
Due to high-energy injuries, young and old 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 are rarely found in children and young people due to falls, direct impact, sharp muscle contraction and are accompanied by acute, intense pain, which is 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 as a result of joint deformity. When you try to stand or make movements, an elastic 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 dislocations. They are characterized by acute exploding pain deep in the hip joint, which makes any movement difficult. The leg can be shortened and turned outwards, so leaning on it is impossible.
Degenerative processes
In the initial stage of coxarthrosis, after a significant effort 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 movement. Growing further, the pain is noticed not only during movements, but also at rest.
With severe coxarthrosis, patients rely on a cane. Movements are limited, the affected leg is shortened, this leads to increased load on the joint. The pain intensifies not only when walking, but also when standing. Chondromatosis of the hip joint occurs as subacute arthritis. Moderate, transient pain is accompanied by tingling and limited mobility. When the nerve endings within a joint are pinched, sharp, sharp pains occur, 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. The pain syndrome appears 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 and deep pain in the knee and groin develops against the background of Perthes disease, which is characterized by necrosis of the femoral head. The pain intensifies after a few months, becoming constant, acute and debilitating. There is swelling of the joint, limitation of movements and lameness. Then, the pain syndrome decreases and the motor functions are restored in different ways.
Aseptic necrosis of the femoral head in adults occurs due to blood circulation disorders and proceeds like Perthes disease, but less favorable, as it is bilateral in half of the cases.
At first, the annoying pain appears periodically, then it intensifies, so much so that the person loses the ability to stand completely due to the destruction of the joint due to insufficient blood circulation. Gradually, the pain syndrome decreases. Progressive limitations of movement over two years result from hip joint arthrosis and shortening of the lower extremities.
In the proximal metaphysis of the femur in boys aged 10-15 years, solitary 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 to visit a doctor is a pathological fracture or increasing limitation of movements.
Hip pain may result from avascular necrosis of the femoral head. The disease appears due to blood circulation disorders in the joints associated with the 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. 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 appears when you walk and when you try to stand on the affected leg.
Arthritis
Wave-like pain from mild to severe and constant, limited 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 pains in rheumatoid arthritis appear 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 painful, increasing significantly with palpation, which is accompanied by synovitis, edema, hyperemia, hyperthermia and limited mobility.
The syndrome of intense, throbbing, tearing pain, 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, joint redness and fever. If untreated, bacterial infectious arthritis can develop into panarthritis - severe purulent inflammation of the hip joint with acute throbbing pain, febrile fever, weakness, fainting, hyperemia and hyperthermia.
Other inflammatory disorders
Against the background of an open fracture, wound after surgery, 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 rarely become a manifestation of allergies. In acute synovitis, the joint hurts a little, but the pain can intensify due to increased swelling and fluid inside it. Chronic synovitis is accompanied by mild pain. With intermittent hydroarthrosis, the hip joint hurts a little, accompanied by limited movement, 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 a weak pull or muscle pain appears in 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. Pulling, twisting pain along with fever, lymphadenopathy, and rash may occur with acute brucellosis. In the chronic course of the disease, deformities are formed over time.
Congenital diseases
Hip dysplasia is determined by the degree of discrepancy 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, the pain that appears at the age of 5-6 years is associated with the 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 appears at rest, which intensifies with movement. All forms of dysplasia are associated with asymmetry of skin folds and limited mobility. In case of dislocation, shortening of the leg is observed.
Neoplasms
The first pain symptoms of benign tumors are small and unstable, which do not progress for a long time. The growth of the tumor causes the pain in the hip area to increase slowly. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by small, short-term pain, which sometimes worsens at night. Then, the manifestations of pain become acute, constant, cutting, surrounding, spreading throughout the joint, which swells and deforms. Patients experience weight loss, weakness and low fever. In advanced cases, the pain becomes so excruciating and unbearable that it can only be eliminated with the help of narcotic drugs.
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 withsensory disturbances. . Dull and aching pain occurs with osteochondrosis, disc herniation, spondylitis, deforming spondyloarthrosis and curvature of the spine due to joint overload, the development of coxarthrosis and mental illnesses.
Diagnosing
For the initial diagnosis, a general practitioner is involved. Diagnostic measures for injuries are performed 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 the anamnesis, physical examination and additional methods of hardware research. 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 most diseases, including 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 space ofcommon.
- Ultrasound diagnostics (ultrasound) is the most informative technique 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 technique for removing effusion, studying 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.
- Clinical laboratory 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 physiotherapy and surgery, neurologists.
Complex treatment
Help before diagnosis
In case of various severe traumatic injuries, it is necessary to fix the joint by applying a splint from the leg to the armpit. In case of minor injuries, it is enough to rest the leg by applying cold. If the pain is intense, an analgesic is given. It is strictly forbidden to eliminate a dislocation yourself by performing active actions with your leg. Small manifestations of non-traumatic diseases should be treated with the use of sedatives and anti-inflammatory drugs, ensuring rest of the lower limbs. If you have fever, weakness, severe pain, rapid swelling and hyperemia, it is recommended to immediately seek medical help.
Conservative therapy
Heavy displacements should be reduced immediately. For leg fractures, skeletal traction is used, then patients are operated on or put in a cast after the appearance of a callus. In elderly patients with a fracture of the femoral neck, immobilization with a derotational boot is allowed to prevent rotational movements of the joint. For other patients, offloading the hip joint 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;
- electrophoresis with drugs;
- UVT.
To reduce pain, drug treatment is possible using 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' 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 in the hip joint is performed both with open access and with the help of arthroscopic devices. Operations are performed taking into account the type of pathology:
- Traumatic injuries: acetabulum reconstruction, neck osteosynthesis, trochanteric fracture.
- Degenerative processes: arthrotomy, arthroscopy, removal of loose intra-articular bodies.
- Tumors: removal, bone resection, disarticulation of the hip joint.
- For ankylosis and scarring of periarticular tissues, correction, arthroplasty and arthrodesis are performed. Endoprosthetics is an effective way to restore the motor function of the lower limbs due to joint destruction.
Preventing
A sedentary lifestyle negatively affects the musculoskeletal system of each person and aggravates the development of discomfort in the hip joint, therefore, for preventive purposes, it is recommended to perform special physical exercises and control body weight through diet, after weight normalization, beforeabove all, it helps relieve stress on the hip 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 men and women.