The hip joint, the largest joint in the human body, experiences daily stress from physical activity, supporting body weight. Many people think that joints hurt only in old age. Of course, with age, the cartilage that performs the function of absorbing shock when the joint flexes becomes thinner, and the amount of fluid in the joint decreases, which leads to the appearance of pain. However, not only age, but also some diseases contribute to the occurrence of pain that varies in 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 cause of pain is determined using radiography, CT, MRI, ultrasound, arthroscopy, and other studies. Until the diagnosis is made, painkillers and the entire lower limb are recommended.
Causes of hip joint pain
Soft tissue injuries
The most common cause of acute pain is a bruise on the hip joint, as a result of falling on the side or from a direct blow, movement is slightly limited. Possible swelling.
The pain syndrome gradually dulls 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 cracking sensation. Pain due to swelling often increases again, moving to the groin and thigh.
In the case of ligament injury, motor function suffers from severe limitation of movement in the lower part of the leg to the inability to stand on one's leg and depends on the severity of the injury such as: sprain, tear, rupture. The pain worsens when the body is tilted 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 slight swelling without severe pain at rest. Painful sensations increase sharply with movement. The stuck heel symptom is a typical sign where it is impossible to raise the leg straight while lying down.
Due to high-energy injuries, young and middle-aged people often suffer from pertrochanteric fractures, which are accompanied by sharp and deep pain. Movement is limited, it is impossible to stand on the lower leg 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, sharp muscle contractions and are accompanied by acute, intense pain, located outside the joint. In this case, the patient avoids active movement.
Incidents of hip dislocation with unbearable acute pain are preceded by falls from a height, industrial and road injuries.
Legs may be bent or extended due to joint deformities. When trying to stand on your feet or make a movement, a springy gait appears, against the background of severe pain, which does not subside until the joint subsides. 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 legs can be shortened and turned outwards, so that support on them is impossible.
Degenerative process
In the early stages of coxarthrosis, after significant exercise or at the end of the day, the patient begins to limp due to the appearance of periodic, dull pain that radiates to the hip or knee joint with slight stiffness of movement. Increasingly, pain is observed not only during movement, but also during rest.
With severe coxarthrosis, the patient depends on crutches. Movement is limited, the affected leg is shortened, this leads to increased load on the joints. The pain increases not only when walking, but also when standing. Chondromatosis of the hip joint occurs like subacute arthritis. Mild and temporary pain accompanied by stiffness and limited movement. When the nerve endings in the joint are pinched, strong sharp pain occurs, limiting movement. With arthrosis of the hip joint, trochanteritis is usually formed, accompanied by inflammatory and degenerative damage to the gluteal muscle tendon in the area of attachment to the greater trochanter. The pain syndrome appears when lying on the painful side, the pain increases when trying to move the hip to the side.
Bone nutritional problems
In children and adolescents, dull, deep pain in the knees and hips develops against the background of Perthes disease, which is characterized by necrosis of the femoral head. The pain increases after several months, becoming constant, acute, and debilitating. There is swelling in the joints, limitation of movement, and lameness. After that, the pain syndrome decreases and motor function is restored in different ways.
Aseptic necrosis of the femoral head in adults occurs due to circulatory disorders and is persistent like Perthes disease, but less favorable, because in half of the cases it is bilateral.
At first, the annoying pain occurs periodically, then it gets stronger, until the person loses the ability to stand completely on his feet due to the destruction of the joints due to insufficient blood circulation. Gradually the pain syndrome decreases. Progressive restriction of movement over two years resulted from arthrosis of the hip joint and shortening of the lower leg.
In the proximal metaphysis of the femur in boys aged 10-15 years, a solitary bone cyst forms, accompanied by periodic, mild pain in the hip joint. In small children there is no swelling. Due to the unspecified symptoms, the reason to visit the doctor is a pathological fracture or increased movement limitations.
Hip pain may be caused by avascular necrosis of the femoral head. This disease occurs as a result of circulatory disorders in the joints associated with long-term use of glucocorticoid hormones (they are prescribed for bronchial asthma, rheumatoid arthritis and some other diseases), alcohol dependence, and severe diabetes mellitus. Joint necrosis may be preceded by trauma, but in some cases the exact cause cannot be determined. The pain in this case is intense and occurs when walking and when trying to stand on the affected leg.
Joint pain
Wave-like pain from mild to severe and persistent, 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 seasonal changes, due to hormonal changes after childbirth or during menopause. The pain can be moderate and weak, nagging and aching, increasing sharply 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 limbs take a forced position. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, redness of the joints, 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
Against the background of open fractures, postoperative wounds, 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 are less often allergic manifestations. In acute synovitis, the joint hurts a little, but the pain may worsen due to increased swelling and fluid in it. Chronic synovitis is accompanied by mild pain. With intermittent hydroarthrosis, the hip joint hurts a little, accompanied by limited mobility, 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 occur, then pulling muscle pain or weak pain appears in the joint when walking. The patient began to save limbs. As it progresses, pain radiates to the knee in combination with swelling, redness, and synovitis. Pulling, twisting pain along with fever, lymphadenopathy, and skin rash can appear with acute brucellosis. In the chronic course of this disease, deformations are formed over time.
Congenital disease
Hip dysplasia is determined by the degree of misalignment 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 occurs at the age of 5-6 years is associated with the load on the leg. With subluxation, pathology occurs without symptoms for a long time; with the development of dysplastic coxarthrosis at the age of 25-30 years, 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 is observed.
Neoplasms
The first painful symptoms of benign tumors are small and unstable, which do not develop for a long time. Tumor growth causes pain in the hip area to slowly increase. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by small, short-term pain, which sometimes worsens at night. After that, the manifestation of pain becomes acute, continuous, cutting, surrounding, spreading throughout the joint, which swells and changes shape. 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.
Another reason
Pain in the hip joint sometimes appears in the lower back, in the back caused by neuropathy of the sciatic nerve, but it fades into the background compared to severe pain in the back of the buttocks and thighs, weakness in the lower limbs with sensory disturbances. . Dull and painful pain occurs with osteochondrosis, disc herniation, spondylitis, spondyloarthrosis deformation and curvature of the spine due to joint loading, the development of coxarthrosis, and mental illness.
Diagnostics
For initial diagnosis, a general practitioner is involved. Diagnostic measures for injuries are carried out by clinical traumatologists. For degenerative and inflammatory diseases - orthopedic specialists and rheumatologists. To treat the purulent process, the participation of a surgeon is necessary. The examination consists of collecting complaints, reviewing anamnesis, physical examination, and additional hardware research methods. 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 detecting fractures, dislocations, changes in the contour of the acetabulum and femoral head, marginal and intraosseous defects, bone growth, and narrowing of the joint space.
- Diagnostic ultrasound (ultrasound) is the most informative technique to identify areas of calcification, inflammatory and degenerative processes in soft tissue.
- Magnetic resonance and computed tomography (MRI and CT) are explanatory methods that can be performed with contrast agents to clarify the nature, extent and location of pathological focus.
- Joint puncture is a therapeutic and diagnostic technique to remove effusion, study the composition of fluid in the joint, and determine infection using laboratory tests.
- Arthroscopy is a visual examination method to assess the state of bone structure and soft tissue, if necessary, take biopsy samples for histological examination.
- Laboratory clinical blood tests to determine inflammation and markers of rheumatological diseases to assess the general condition of the body, organ activity 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 the case of various severe traumatic injuries, it is necessary to fix the joint by using a splint from the leg to the armpit. In the event of a minor injury, it is enough to rest the foot using cold. If the pain is severe, analgesics are given. It is absolutely forbidden to remove the dislocation yourself by doing active actions with your legs. Small manifestations of non-traumatic diseases should be treated with the use of painkillers and anti-inflammatory drugs, ensuring the entire lower limb. If you experience fever, weakness, severe pain, rapid increase in swelling and hyperemia, it is recommended to immediately seek medical help.
Conservative therapy
Severe dislocations should be reduced immediately. For broken legs, skeletal traction is used, then the patient is operated on or put in a plaster cast after the callus appears. In elderly patients with femoral neck fractures, immobilization with a derotational boot is allowed to prevent rotational movement of the joint. For other patients, it is recommended to unload the hip joint using orthoses or additional devices such as crutches or crutches. 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 can be done using drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), antibacterial substances. To strengthen the pelvic cartilage tissue, 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 doctor's instructions, joint puncture, intra- and periarticular blockade with hormonal drugs, intra-articular injection of chondroprotectors, and synovial fluid replacement are performed.
Surgery
Surgical intervention on the hip joint is performed with open access and with the help of arthroscopic equipment. The operation is 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.
- Tumor: removal, bone resection, hip joint disarticulation.
- For ankylosis and periarticular tissue scarring, rehabilitation, arthroplasty, and arthrodesis are performed. Endoprosthetics is an effective way to restore the motor function of the lower limbs due to joint destruction.
Prevention
An inactive lifestyle has a negative effect on the musculoskeletal system of everyone and worsens the development of discomfort in the hip joint, therefore, for the purpose of preventive measures, it is recommended to do special physical exercises and control body weight through diet, since normalizing body weight, first of all, helps relieve pressure on the hip joint. jointsAn individual complex of physical therapy (physical therapy) and rehabilitation medical programs will help bring the joint to a normal state; it aims to improve the quality of life and improve the health of men and women.