The hip joint, the largest joint in the human body, experiences daily stress as a result of physical activity, supporting the body's weight. Many people think that joints only hurt in old age. Of course, as we age, the cartilage that performs the function of cushioning when bending the joint 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 appearance of pain of varying intensity from mild to unbearable. Hip 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 by radiography, CT, MRI, ultrasound, arthroscopy and other studies. Until the diagnosis is made, painkillers and rest of the lower extremities are recommended.
Causes of hip joint pain
Soft tissue injuries
The most common cause of acute pain is a bruise in the hip joint, resulting from a fall on the side or a direct blow, the movement is slightly limited. Possible swelling.
The pain syndrome gradually dulls and disappears after a week. Ligament damage in the hip joint usually occurs as a result of traffic accidents and sports injuries, accompanied by a sharp pain syndrome with a shooting sensation. The pain due to the swelling often increases again, moving to the groin and thighs.
In the case of ligament injuries, motor functions suffer from a severe limitation of lower limb movement to the inability to stand on one's feet and depend on the severity of injuries such as: sprain, tear, rupture. The pain intensifies when the body leans 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 mild swelling in the absence of severe pain at rest. Painful sensations increase sharply with movement. Stuck heel symptom is a typical sign in which it is impossible to raise a straight leg while lying down.
Pertrochanteric fractures often occur in young and middle-aged people due to high-energy injuries, 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 a fall, direct blow, sharp muscle contraction and are accompanied by acute, intense pain, which is localized outside the joint. In this sense, patients avoid active movements.
Hip dislocations with unbearable acute pain are preceded by falls from a height, industrial and traffic injuries.
The leg may be bent or extended as a result of joint deformity. When you try to stand on your feet 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 can be caused by hip dislocation. They are characterized by acute explosive pain deep in the hip joint, which makes any movement difficult. The leg may be shortened and turned outwards, so that support on it is impossible.
Degenerative processes
In the initial stage of coxarthrosis, after significant effort or at the end of the day, patients begin to limp due to the appearance of periodic, dull pain that spreads to the hip or knee joint with slight stiffness of movement. With further increase, the pain is noticed not only during movement, but also at rest.
With severe coxarthrosis, patients rely on a stick. 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. Chondromatosis of the hip joint occurs as subacute arthritis. Moderate, transient pain is accompanied by grinding and limited mobility. When the nerve endings inside the joint are pinched, intense 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 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. The pain intensifies after a few months, becoming constant, acute and debilitating. Swelling of the joint, limitation of movement and lameness occur. After that, 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, excruciating pain occurs occasionally, and then it intensifies, so much so that the person loses the ability to stand completely on the leg due to the destruction of the joint due to insufficient blood circulation. Gradually the pain syndrome decreases. Progressive movement limitations over the course of two years become the result of hip joint arthrosis and shortening of the lower extremities.
Solitary bone cysts are formed in the proximal metaphysis of the femur in boys aged 10-15, accompanied by periodic, mild pain in the hip joint. There is no swelling in small children. Due to unexpressed symptoms, the reason for visiting the doctor is a pathological fracture or a growing restriction 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 (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 occurs when walking and when trying to stand on the affected leg.
Arthritis
Wave 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, elevated body temperature and pain on pressure are observed.
Periodic pain in rheumatoid arthritis occurs due to changes in weather conditions due to changes in seasons, as a result of hormonal changes after childbirth or during menopause. The pain can be moderate and weak, nagging and painful, suddenly increases with palpation, which is accompanied by synovitis, edema, hyperemia, hyperthermia and limited mobility.
The 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. Therefore, the limb takes a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, redness of the joint and high 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
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 occur with injuries and other diseases of the hip joint, and rarely become a manifestation of allergies. With acute synovitis, the joint hurts slightly, but the pain can 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 time, due to the accumulation of fluid in the joint.
Specific infections
With tuberculosis of the hip joint, weakness and fatigue first appear, and then a weak pull or pain in the muscles occurs 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. In the case of acute brucellosis, drawing, twisting pain may occur along with fever, lymphadenopathy and skin rash. In the chronic course of the disease, deformities are formed 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 from the moment the child begins to walk, followed by lameness. In moderate subluxation, pain that occurs at the age of 5-6 years is associated with weight bearing on the leg. In case of subluxation, the pathology occurs without symptoms for a long time, with the development of dysplastic coxarthrosis at the age of 25-30 years, the 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, shortening of the leg is observed.
Neoplasms
The first symptoms of pain in benign tumors are minor and unstable, which do not progress for a long time. The growth of the tumor causes the pain in the hip area to slowly increase. 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, constant, gnawing, surround, spread to the entire joint, which swells and deforms. Patients experience weight loss, weakness and low-grade fever. In advanced cases, the pain becomes so indescribable and unbearable that it can only be removed with the help of narcotic drugs.
Other reasons
Pain in the hip joint sometimes occurs in the lower back, in the back due to neuropathy of the sciatic nerve, but disappears in the background in relation to intense pain in the back of the buttocks and thighs, weakness in the lower extremity 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 illnesses.
Diagnostics
A general practitioner is involved for the initial diagnosis. Diagnostic measures for injuries are carried out by the clinic's traumatologists. For degenerative and inflammatory diseases - orthopedists and rheumatologists. For the treatment of purulent processes, the participation of a surgeon 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:
- X-ray of the sacrolumbar spine, hip joint and femur is the main 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 technique for identifying areas of calcification, inflammatory and degenerative processes in soft tissues.
- Magnetic resonance imaging and computed tomography (MRI and CT) are elucidation methods that can be performed with a contrast agent to clarify the nature, extent, and location of the pathological focus.
- Puncture of the joint is a therapeutic and diagnostic technique for removing the effusion, studying the composition of the liquid inside the joint and determining the infection with laboratory tests.
- Arthroscopy is a method of visual examination to assess the state of bone structures and soft tissues, if necessary, taking a biopsy sample for histological examination.
- Laboratory clinical blood tests for the determination of inflammation and markers of rheumatological diseases in order to assess the general state of the body, organ activity in infectious or systemic pathologies.
In the future, more specialized specialists could be involved in diagnostics: doctors of physiotherapy and surgery, neurologists.
Complex treatment
Help before diagnosis
In the case of severe various traumatic injuries, it is necessary to fix the joint by applying a splint from the foot 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 independently eliminate the dislocation by performing active actions with the leg. Minor manifestations of non-traumatic diseases should be treated with the use of painkillers and anti-inflammatory drugs, ensuring peace of the lower extremity. If you experience fever, weakness, severe pain, rapid swelling and hyperemia, it is recommended to seek medical help immediately.
Conservative therapy
Severe dislocations should be reduced immediately. In the case of leg fractures, skeletal traction is used, then patients are operated on or put in plaster 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 in the joint. For other patients, relief of 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. Chondroprotectors are prescribed to strengthen the cartilaginous tissue of the pelvis, and muscle relaxants are prescribed to remove muscle spasms. Local agents are widely used - ointments, creams with analgesic and anti-inflammatory effects.
According to the indications of the doctor, joint punctures, intra- and peri-articular blockades with hormonal drugs, intra-articular injections of chondroprotectors, replacement of synovial fluid are performed.
Operation
Surgical intervention on the hip joint is performed with an open approach 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.
- Redressing, arthroplasty and arthrodesis are performed for ankylosis and periarticular tissue scars. Endoprosthetics is an effective way to restore the motor function of the lower limb due to joint destruction.
Prevention
A sedentary lifestyle has a negative effect on the musculoskeletal system of each person and worsens the development of problems in the hip joint, therefore, for the purpose of preventive measures, it is recommended to perform special physical exercises and control body weight through nutrition, since normalizing weight, first of all, helpsin relieving stress on the hip joint. An individual complex of physical therapy (physical therapy) and a program of rehabilitation medicine will help the joints to return to their normal state, and are aimed at increasing the quality of life and improving the health of men and women.