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, as we age, the cartilage that performs the shock-absorbing function when the joint bends becomes thinner and the amount of fluid inside the joint decreases, leading to pain. However, not only age, but also a number of diseases contribute to the occurrence of pain of varying intensity from mild to unbearable. Hip joint pain can be dull, sharp, pressing or aching in nature. They often depend on load, time of day and other factors. The causes of pain are determined using X-ray, CT, MRI, ultrasound, arthroscopy and other studies. Painkillers and rest of the lower extremities are recommended until the diagnosis is made.
Causes of hip joint pain
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 eases 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 sensation of popping. Pain due to swelling often increases again, moving to the groin and thigh.
In case of ligament injuries, the motor functions suffer from a severe restriction of the movement of the lower limbs to the inability to stand on the legs and depend on the severity of the injuries such as: sprain, rupture, tear. The pain intensifies when the body leans in the opposite direction from the damaged joint.
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 stuck heel symptom 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 experience supratrochanteric 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 a fall, direct blow, sharp muscle contraction and are accompanied by sharp, severe pain, which is located outside the joint. In this regard, patients avoid active movements.
The appearance of hip dislocations with unbearable acute pain is preceded by falls from a height, industrial injuries and injuries on the road.
The leg may bend or extend as a result of the joint deformity. When you try to stand on your feet or make movements, an elastic gait appears, against a background of severe pain, which does not decrease until the joint is reduced. Acetabular fractures develop independently or may be caused by hip dislocations. They are characterized by sharp exploding pain deep in the hip joint, which makes any movement difficult. The leg may shorten and turn outward, so that support on it is impossible.
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 radiating to the hip or knee joint with slight stiffness in movement. Further increasing, pain is noted 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 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, transient pain is accompanied by tingling and limited mobility. When the nerve endings within a joint are compressed, severe, sharp pain occurs that limits movement. With arthropathy of the hip joint, trochanteritis is usually formed, which is 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 you lie on the painful side, the pain intensifies when you try 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, sharp and debilitating. There is swelling of the joint, limitation of movements and lameness. Subsequently, the pain syndrome is reduced 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, since in half the cases it is bilateral.
At first, the nagging pain occurs periodically, then it intensifies, so much so that the person loses the ability to fully stand on his leg due to destruction of the joint due to insufficient blood circulation. Gradually the pain syndrome decreases. Progressive limitations of movement over two years are a result of hip joint arthrosis 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 small children there is no swelling. Due to unexpressed symptoms, the reason for visiting a doctor is a pathological fracture or increasing limitation of movements.
Hip pain can 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 dependence and severe diabetes mellitus. Necrosis of the joint may be preceded by trauma, but in some cases the actual 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-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 noted.
Periodic pain in rheumatoid arthritis occurs due to changes in weather conditions due to the change of seasons, as a result of hormonal changes after childbirth or during menopause. Pain can be moderate and weak, nagging and aching, sharply increasing with palpation, which is accompanied by arthritis, edema, hyperemia, hyperthermia and limited mobility.
The syndrome of severe spasmodic 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 increased temperature. If left untreated, bacterial infectious arthritis can develop into panarthritis - severe purulent inflammation of the hip joint with sharp throbbing pain, throbbing fever, weakness, fainting, hyperemia and hyperthermia.
Other inflammatory disorders
In the context 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. Arthritis, tendinitis and bursitis develop with injuries and other diseases of the hip joint and less often become a manifestation of allergies. In acute arthritis, the joint hurts slightly, but the pain can be intensified due to increased swelling and fluid inside it. Chronic arthritis is accompanied by mild pain. With intermittent hydroarthrosis, the hip joint hurts slightly, accompanied by limited mobility, which disappears within 3-5 days and returns 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 pain in the muscles in the joint occurs when walking. The patient begins to spare the limb. As it progresses, pain radiates to the knee along with swelling, redness and arthritis. With acute brucellosis, drawing, twisting pains may occur along with fever, lymphadenopathy and skin rashes. In the chronic course of the disease, deformations 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 a moderate subluxation, the pain that occurs at the age of 5-6 years is related to 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, 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 pain symptoms of benign tumors are small and unstable, which do not develop for a long time. The growth of the tumor causes a gradual increase in pain in the hip area. Malignant tumors (osteogenic sarcomas, chondrosarcoma) are characterized by small, short-term pain, which sometimes worsens at night. Then the manifestations of pain become acute, continuous, cutting, circular, 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 excruciating and unbearable that it can only be eliminated with the help of 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 fades into the background compared to severe pain in the back of the buttock and thigh, weakness in the lower limb with sensory disturbances. Dull and aching pain occurs with osteochondrosis, disc herniation, spondylitis, deforming spondyloarthritis and curvature of the spine due to joint overload, development of coxarthrosis and mental illnesses.
Diagnostics
A general practitioner is involved for the initial diagnosis. Diagnostic measures for injuries are carried out by traumatologists at the clinic. For degenerative and inflammatory diseases - orthopedic and rheumatologists. For the treatment of purulent processes, the participation of surgeons is necessary. The examination consists of the collection of complaints, the study of the history, the physical examination and additional methods of material investigation. Taking into account the characteristics of the pathological process, the following methods are used:
- X-ray of the sacral lumbar spine, hip joint and femur is the main method for most diseases, such as for the detection of fractures, dislocations, changes in the contour of the acetabulum and femoral head, margins and intraosseousabnormalities, bony 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 and computed tomography (MRI and CT) are clarifying methods that can be performed with contrast to clarify the nature, extent and location of the pathological focus.
- Puncture of the joint is a therapeutic and diagnostic technique to remove the effusion, study the composition of the fluid inside the joint and determine the 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.
- Laboratory clinical blood tests to determine inflammation and indicators 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 deal with the diagnosis: doctors of physiotherapy and surgery, neurologists.
Complex treatment
Help before diagnosis
In case of severe various 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 sufficient to rest the leg by applying cold. If the pain is severe, an analgesic is given. It is strictly forbidden to eliminate a dislocation yourself by performing active actions with your leg. Minor manifestations of nontraumatic diseases should be treated with the use of painkillers and anti-inflammatory drugs, ensuring rest of the lower extremity. If you experience fever, weakness, severe pain, rapid increase in swelling and hyperemia, it is recommended to seek medical help immediately.
Conservative therapy
Severe dislocations should be reduced immediately. Skeletal traction is used for leg fractures, and patients are then operated on or put in a cast after calluses develop. In elderly patients with a femoral neck fracture, immobilization with a derotational boot is allowed to prevent rotational movements of the joint. For other patients, unloading the hip joint using orthoses or additional devices such as crutches or a cane is recommended. Physiotherapy methods are prescribed, such as 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 indications of the doctors, joint punctures, intra- and peri-articular blockades with hormonal drugs, intra-articular injections of chondroprotectants and synovial fluid substitutes are performed.
Surgery
Surgery on the hip joint is performed both with open access and with the help of arthroscopic equipment. Operations are performed taking into account the type of pathology:
- Traumatic injuries: acetabular reconstruction, neck fusion, trochanteric fractures.
- Degenerative processes: arthrotomy, arthroscopy, removal of loose intra-articular bodies.
- Tumors: removal, bone resection, hip dislocation.
- For ankylosis and peri-articular tissue scars, repair, arthroplasty and arthrodesis are performed. Endoprosthesis is an effective way to restore 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 sake of prevention, it is recommended to carry out special physical exercises and control body weight through nutrition, as well as normalizing weight, firstabove all, it helps relieve stress on the hip joint. An individual complex of physical therapy (physiotherapy) and a program of medical rehabilitation will help bring the joints to a normal state; they aim to increase the quality of life and improve the health of both men and women.