Hip pain

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 hurt only 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 inside the joint decreases, leading to the appearance of pain. However, not only age, but also a number 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. Often depend on load, time of day and other factors. The causes of pain are determined using radiography, CT, MRI, ultrasound, arthroscopy, and other studies. Until the diagnosis is made, painkillers and rest of the lower extremities are recommended.

Causes of pain in the hip joint

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, 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 road 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 case of ligament injuries, motor functions suffer from severe limitation of movement of the lower extremities 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 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 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 lift a 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 a fall, direct blow, sharp muscle contraction and are accompanied by acute, intense pain, which is localized outside the joint. In this regard, patients avoid active movements.

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

The leg may be bent or extended as a result of joint deformity. When trying 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 dislocations. They are characterized by acute explosive pain deep in the hip joint, which makes any movement difficult. The leg may be shortened and turned outward, 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, the 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 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 nerve endings inside a joint are pinched, 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 attachment to the greater trochanter. The 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, which is characterized by necrosis of the femoral head. The pain intensifies after a few months, becoming constant, acute, and debilitating. There is swelling of the joint, limitation of movements, 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 favorable, since in half of the cases it is bilateral.

At first, the nagging pain occurs periodically, then 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 restrictions of 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 10-15 years, solitary bone cysts form, accompanied by periodic, mild pain in the hip joint. In young 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 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 (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 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 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, nagging and aching, sharply increasing with palpation, which is accompanied by synovitis, edema, hyperemia, hyperthermia, and limited mobility.

Intense, jerking, tearing pain syndrome, 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 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 develop with injuries and other diseases of the hip joint, and less often become a manifestation of allergies. In acute synovitis, the joint hurts slightly, but the pain may intensify due to increased swelling and fluid inside it. 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 again 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 a weak pulling or aching muscle pain appears in the joint when walking. The patient begins to spare the limb. As it progresses, pain radiates to the knee in combination with swelling, redness, and synovitis. Pulling, twisting pain along with fever, lymphadenopathy, and skin rashes can appear with acute brucellosis. In 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 acetabulum. With congenital dislocation, pain appears from the moment the child begins to walk, accompanied by lameness. With moderate subluxation, pain that occurs at the age of 5-6 years is associated with 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 years, 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 minor and unstable, which do not progress for a long time. The growth of the tumor causes pain in the hip area to slowly increase. Malignant tumors (osteogenic sarcomas, chondrosarcomas) are characterized by minor, short-term pain, which sometimes worsens at night. Subsequently, manifestations of pain become acute, constant, cutting, encircling, spreading to the entire joint, which swells and deforms. Patients experience weight loss, weakness and low-grade fever. In advanced cases, the pain becomes excruciating and unbearable so much 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, in the back due to neuropathy of the sciatic nerve, but it fades into the background compared to intense 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 spondyloarthrosis and curvature of the spine due to overload of the joints, the development of coxarthrosis, and mental illness.

Diagnostics

For initial diagnosis, a general practitioner is involved. Diagnostic measures for injuries are carried out by traumatologists of the clinic. 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 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 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 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 fluid inside the joint, and determining 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 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 diagnostics: 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 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 eliminate a dislocation on your own by performing active actions with your foot. Minor manifestations of non-traumatic diseases should be treated with the use of painkillers and anti-inflammatory drugs, ensuring rest of the 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 leg fractures, skeletal traction is used, then patients are operated on or put in a plaster cast after the appearance of 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, it is recommended to unload the hip joint using orthoses 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;
• 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 doctors' indications, joint punctures, intra- and periarticular blockades with hormonal drugs, intra-articular injections of chondroprotectors, and synovial fluid substitutes are performed.

Surgery

Surgical intervention on the hip joint is carried out both by open access and with the help of arthroscopic equipment. Operations are performed 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: removal, bone resection, disarticulation of the hip joint.
• For ankylosis and scarring of periarticular tissues, redressing, arthroplasty, and arthrodesis are performed. Endoprosthetics 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 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 the hip joint. joints. An individual complex of physical therapy (physical therapy) and a rehabilitation medicine program will help bring joints to a normal state; they are aimed at increasing the quality of life and improving the health of both men and women.