The hip joint, the largest joint in the human body, experiences daily stress from physical activity, supporting body weight. Many people think that joints only hurt in old age. Of course, as we age, the cartilage that performs the cushioning function when the joint flexes becomes thinner and the amount of fluid inside the joint decreases, leading to the development 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 may be dull, sharp, pressing or aching. This often depends on the load, time of day and other factors. The causes of pain are determined by x-ray, CT scan, MRI, ultrasound, arthroscopy and other studies. Until the diagnosis is made, pain medications and lower extremity rest are recommended.
Causes of pain in the hip joint
Soft tissue injuries
The most common cause of acute pain is a bruise in the hip joint, resulting from a fall to the side or a direct blow, with movements 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 road accidents and sports injuries, accompanied by acute pain syndrome with a crunching sensation. Pain from swelling often increases again, moving to the groin and thigh.
In case of ligament injuries, motor functions suffer from severe limitation of movements of the lower limbs up to the inability to stand and depend on the severity of the injuries such as: sprain, tear, rupture. The pain intensifies when the body is tilted in the direction away from 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 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 middle-aged people often develop pertrochanteric fractures, accompanied by sharp and deep pain. Movements are limited, it is impossible to stand on the lower extremities due to significant swelling of the affected joint.
Isolated fractures of the greater trochanter are rarely observed in children and young people due to a fall, direct blow, strong muscle contraction and are accompanied by sharp and intense pain, localized in theexterior of the joint. In this regard, patients avoid active movements.
The occurrence of hip dislocations accompanied by acute unbearable pain is preceded by falls from height, industrial and road accidents.
The leg may be bent or extended due to joint deformity. When you try to stand or perform movements, an elastic gait appears, against the background of severe pain, which only decreases when 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 movement difficult. The leg can be shortened and turned outwards, so that support on it is impossible.
Degenerative processes
At 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 movement. Further increasing, pain is noted not only during movements, but also at rest.
In cases of severe hip osteoarthritis, patients rely on a cane. Movements are limited, the affected leg is shortened, which leads to increased load on the joint. The pain intensifies not only when walking, but also when standing. Chondromatosis of the hip joint occurs like subacute arthritis. Moderate, transient pain is accompanied by crunching and limited mobility. When the nerve endings inside a joint are pinched, intense, sharp pain occurs, limiting movement. With osteoarthritis of the hip joint, trochanteritis is usually formed, accompanied by inflammatory and degenerative lesions of the tendons of the gluteal muscles in the area of attachment to the greater trochanter. 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, characterized by necrosis of the femoral head. 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 different 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, the shooting pain occurs periodically, then intensifies, so much so that the person loses the ability to completely stand on his leg due to the destruction of the joint from insufficient blood circulation. Gradually, the pain syndrome decreases. Progressive restrictions of movement over two years are the result of osteoarthritis of the hip joint and shortening of the lower limbs.
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 young children there is no swelling. Due to unexpressed symptoms, the reason for consulting the 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 circulatory disorders of the joint associated with long-term use of glucocorticoid hormones (they are prescribed for bronchial asthma, rheumatoid arthritis and a number of other diseases), addictionto alcohol and severe diabetes mellitus. Joint necrosis may be preceded by trauma, but in some cases the true cause cannot be determined. In this case, the pain is intense and occurs when walking and trying to stand on the affected leg.
Arthritis
Wavelike pain ranging from mild to severe and constant, limiting motor activity of 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 appears due to changes in weather conditions due to changing seasons, as a result of hormonal changes after childbirth or during menopause. The pain can be moderate and weak, throbbing and aching, sharply increasing with palpation, which is accompanied by synovitis, edema, hyperemia, hyperthermia and limited mobility.
A syndrome of intense, jerking, tearing pain, both at rest and during movement, develops as a result of the spread of infection against the background of infectious arthritis. The member therefore takes a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, redness of the joints and an increase in temperature. If left untreated, bacterial infectious arthritis can develop into panarthritis - severe purulent inflammation of the hip joint accompanied by sharp shooting pain, hectic fever, weakness, fainting, hyperemia andhyperthermia.
Other inflammatory disorders
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, tendonitis 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 is slightly painful, but the pain may intensify due to increased swelling and fluid inside. Chronic synovitis is accompanied by mild aching pain. With intermittent hydroarthrosis, the hip joint hurts slightly, accompanied by limited mobility, which disappears within 3-5 days and resumes after a while, due to the accumulation of fluid in the joint.
Specific infections
With tuberculosis of the hip joint, weakness and fatigue first appear, then weak pulling or aching muscle pain appears in the joint when walking. The patient begins to spare the limb. As it progresses, the pain radiates towards the knee, associated with swelling, redness and synovitis. Pulling and twisting pain accompanied by fever, lymphadenopathy and skin rashes may appear in cases of acute brucellosis. During the chronic course of the disease, deformities form over time.
Congenital diseases
Hip dysplasia is determined by the degree of incongruence between the femoral head and the acetabulum. In case of congenital dislocation, pain appears as soon as the child begins to walk, accompanied by lameness. In case of moderate subluxation, the pain that occurs between 5 and 6 years of age is associated with the load on the leg. With subluxation, the pathology occurs for a long time without symptoms; with the development of dysplastic coxarthrosis at the age of 25-30, pain occurs at rest, which intensifies with movement. All forms of dysplasia are accompanied by asymmetry of skin folds and limited mobility. In the event of a dislocation, there is a shortening of the leg.
Tumors
The first painful symptoms of benign tumors are minor and unstable, which do not progress for a long time. The growth of the tumor causes a slow increase in pain in the hip area. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by minor, short-term pain, which sometimes worsens at night. Subsequently, painful manifestations become acute, constant, cutting, encircling, extending to the entire joint, which swells and deforms. Patients experience weight loss, weakness, and mild fever. In advanced cases, the pain becomes so excruciating and unbearable 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 it takes a back seat to severe pain in the back of thebuttock and thigh, weakness of the lower limb with sensory disturbances. . Dull, aching pain occurs with osteochondrosis, herniated disc, spondyloarthritis, deforming spondyloarthrosis and curvature of the spine due to overload of the joints, the development of coxarthrosis and mental illness.
Diagnostic
For the initial diagnosis, a general practitioner intervenes. Diagnostic measurements of injuries are carried out by the clinic's traumatologists. 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 researching the material. 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 detecting fractures, dislocations, changes in the contours of the acetabulum and headfemoral, marginal and intraosseous defects, bony outgrowths and narrowing of the common space.
- 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 clarification 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 the effusion, studying the composition of the fluid inside the joint and determining the infection using laboratory tests.
- Arthroscopy is a visual examination method for assessing the condition of bone structures and soft tissues, if necessary by taking a biopsy sample for histological examination.
- Clinical laboratory blood tests to determine inflammation and markers of rheumatological diseases in order 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 diagnosis: doctors of physiotherapy and surgery, neurologists.
Complex treatment
Help before diagnosis
In case of various serious traumatic injuries, it is necessary to fix the joint by applying a splint from the foot to the armpit. In case of minor injuries, simply rest the leg by applying cold. If the pain is severe, pain medication is given. It is strictly forbidden to eliminate a dislocation yourself by performing active actions with your foot. Minor manifestations of non-traumatic diseases should be treated with analgesics and anti-inflammatory drugs, thereby ensuring rest of the lower limb. 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 are operated on or put in a cast after the calluses appear. In elderly patients with a femoral neck fracture, immobilization with a derotation boot is permitted to prevent rotational movements of the joint. For other patients, it is recommended to unload the hip joint using orthotics 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;
- magnetic therapy;
- Ultra-high frequency;
- ultrasound;
- reflexology;
- electrophoresis with drugs;
- UVT.
To reduce pain, drug treatment is possible using drugs such as nonsteroidal 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 indications of doctors, joint punctures, intra- and periarticular blockades with hormonal drugs, intra-articular injections of chondroprotectors and synovial fluid substitutes are carried out.
Surgery
Surgical intervention on the hip joint is carried out both open access and using arthroscopic equipment. Operations are carried out taking into account the type of pathology:
- Traumatic injuries: reconstruction of the acetabulum, osteosynthesis of the neck, trochanteric fractures.
- Degenerative processes: arthrotomy, arthroscopy, removal of loose intra-articular bodies.
- Tumors: ablation, bone resection, hip disarticulation.
- For ankylosis and healing of periarticular tissues, straightening, arthroplasty and arthrodesis are performed. Endoprostheses are an effective means of restoring motor function to the lower limb following 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 purpose of preventive measures, it is recommended to perform special physical exercises and control body weight through diet, since normalizing weight, first of all, helps relieve stress on thehip joint. An individual complex of physiotherapy (physiotherapy) and a program of rehabilitation medicine will help return the joints to a normal state and are aimed at increasing the quality of life and improving the health of men and women.