Hip pain

The hip joint, the largest joint in the human body, undergoes daily stress as a result of 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 shock-absorbing function when the joint flexes becomes thinner and the amount of fluid within the joint decreases, leading to the appearance of pain. However, not only age, but also a series 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 in nature. They often depend on the load, time of day and other factors. The causes of pain are determined using radiography, computed tomography, magnetic resonance imaging, ultrasound, arthroscopy and other studies. Until the diagnosis is made, analgesics 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 to 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 often occurs as a result of road accidents and sports injuries, accompanied by a sharp pain syndrome with a popping sensation. Pain due to swelling usually increases again, moving to the groin and thigh.

In the 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: sprain, rupture, rupture. The pain intensifies when the body is tilted in the opposite direction to the damaged ligament.

Bone and joint injuries

Femoral neck fractures often occur in elderly people due to trauma. A characteristic of osteoporosis is the presence of mild swelling in the absence of severe pain at rest. Painful sensations increase markedly with movement. The stuck heel symptom is a typical sign in which it is impossible to lift the straight leg while lying down.

Due to high-energy injuries, young and middle-aged 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 blows, severe muscle contraction and are accompanied by sharp and intense pain, located outside the joint. In this regard, patients avoid active movements.

The occurrence of hip dislocations with acute unbearable pain is preceded by falls from heights, industrial and road injuries.

The leg may be bent or extended as a result of joint deformity. When trying to stand or perform movements, an elastic gait appears, in a context 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 sharp, explosive pain deep in the hip joint, which makes any movement difficult. The leg can be shortened and turned outward so that it is impossible to support 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 that radiates to the hip or knee joint with slight stiffness of movement. Increasing further, the pain is noted not only during movement but also at rest.

In 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 occurs like subacute arthritis. Moderate and transient pain is accompanied by crushing and limited mobility. When nerve endings within a joint are compressed, intense, sharp pain occurs, limiting movement. With arthrosis of the hip joint, trochanteritis usually forms, accompanied by inflammatory and degenerative damage to the tendons of the gluteal muscles in the area of insertion of 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, a dull, deep pain appears in the knee and hip in the context 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 subsides and motor functions are restored in different ways.

Aseptic necrosis of the femoral head in adults occurs due to circulatory disorders and progresses like Perthes' disease, but less favorably, as in half of the cases it is bilateral.

At first, the dull 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 subsides. Progressive restrictions in movement over two years become the result of arthrosis of the hip joint and shortening of the lower extremities.

In the proximal metaphysis of the femur in boys aged 10 to 15 years, solitary bone cysts form, accompanied by mild, periodic pain in the hip joint. In young children there is no swelling. Due to unexpressed symptoms, the reason for consulting a 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 in the joint associated with prolonged 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 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 trying to stand on the affected leg.

Arthritis

Wave-like 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, increased body temperature and pain when pressed are observed.

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, dull and aching, increasing markedly on palpation, which is accompanied by synovitis, edema, hyperemia, hyperthermia and difficulty in locomotion.

The syndrome of intense, spasmodic, 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 member takes a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, redness in the joints and an increase in 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 diseases

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, 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 hurts a little, but the pain may intensify due to the increase in swelling and fluid inside. Chronic synovitis is accompanied by mild pain. In intermittent hydroarthrosis, the hip joint hurts slightly, accompanied by limited mobility, which disappears in 3 to 5 days and starts again after a certain period of time, due to the accumulation of fluid in the joint.

Specific infections

In tuberculosis of the hip joint, weakness and fatigue first occur, and then a weak pulling 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 and twisting pain along with fever, lymphadenopathy and rashes may appear in acute brucellosis. In the chronic course of the disease, deformities form over time.

Congenital diseases

Hip dysplasia is determined by the degree of incongruity between the femoral head and the acetabulum. In congenital dislocation, the pain appears from the moment the child begins to walk, accompanied by limping. In moderate subluxation, pain that occurs at 5-6 years of age is associated with load on the leg. With subluxation, the pathology proceeds without symptoms for a long time, 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 case of dislocation, 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 the 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 sharp, constant, cutting, enveloping, spreading throughout the joint, which swells and deforms. Patients experience weight loss, weakness, and low-grade 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, back due to sciatic nerve neuropathy, but fades into the background compared to severe pain in the back of the buttocks and thighs, weakness in the lower limb with sensory disturbances . Dull, aching pain occurs with osteochondrosis, herniated disc, spondylitis, deforming spondyloarthrosis and curvature of the spine due to overload of the joints, development of coxarthrosis and mental illness.

Diagnosis

For the initial diagnosis, a general practitioner is involved. Injury diagnostic measures 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 hardware research methods. Taking into account the features 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 for detecting 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 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 liquid inside the joint and determining infection through 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 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 the diagnosis: doctors of physiotherapy and surgery, neurologists.

Complex treatment

Help before diagnosis

In the case of various and severe 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, an analgesic is given. It is strictly forbidden to eliminate a dislocation on your own by performing active actions with your foot. Minor manifestations of non-traumatic diseases must be treated with the use of analgesics and anti-inflammatories, ensuring rest of the lower limb. If you experience fever, weakness, severe pain, rapidly increasing swelling and hyperemia, it is recommended to seek medical help immediately.

Conservative therapy

Severe dislocations must be reduced immediately. For leg fractures, skeletal traction is used, and then patients are operated on or put in a cast after the callus appears. In elderly patients with femoral neck fractures, immobilization with a derational boot is permitted to prevent rotational movements in the joint. For other patients, it is recommended to unload the hip joint with orthoses or additional devices such as crutches or a cane. Physiotherapeutic methods are prescribed, including massages, therapeutic exercises, manual therapy, as well as procedures such as:

• laser therapy;
• magnetic therapy;
• UHF;
• ultrasound;
• reflexology;
• drug electrophoresis;
• UVT.

To reduce pain, drug treatment is possible with medications such as non-steroidal anti-inflammatory drugs (NSAIDs), antibacterial substances. To strengthen the cartilaginous tissue of the pelvis, chondroprotectors and muscle relaxants are prescribed to eliminate muscle spasms. Local agents are widely used - ointments, creams with analgesic and anti-inflammatory effects.

Under medical indication, joint punctures, intra- and peri-articular blocks with hormonal medications, intra-articular injections of chondroprotectors and synovial fluid substitutes are performed.

Surgery

Surgical intervention in the hip joint is carried out both by open access and with the help of arthroscopic equipment. Operations are carried out 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, disarticulation of the hip joint.
• For ankylosis and scarring of periarticular tissues, dressings, arthroplasty and arthrodesis are performed. Endoprosthesis is an effective way to restore the motor function of the lower limb due to 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 carry out special physical exercises and control body weight through a diet, since normalizing weight, first of all, helps relieve stress on the hip joint. An individual physiotherapy complex (physiotherapy) and a rehabilitation medicine program will help normalize joints and are aimed at increasing the quality of life and improving the health of men and women.