Hip joint pain

Hip joint painare specific<1_img_leftxx>unpleasant sensations and difficult to bear caused by the pathology of the upper femur, acetabulum, nearby soft tissue structures. In terms of intensity, they range from weak to unbearable, in nature they can be opaque, sharp, pressing, painful, popping, piercing, etc. They often depend on load, time of day and other factors. The causes of pain are determined through X-rays, CT scans, MRIs, ultrasound, arthroscopy and other studies. Analgesics and limb rest are recommended until diagnosis is made.

Causes of hip joint pain

Soft tissue injuries

The most common traumatic cause of pain is a contusion to the hip joint. It occurs when falling on the side or by direct impact, it manifests as moderate acute pain, which quickly becomes opaque, gradually diminishes and disappears in a few days, in severe cases - weeks. Support is preserved, movement is slightly limited. Edema is detected locally, bruises are possible.

Injuries to the ligaments of the hip joint are rare, usually the result of traffic accidents and sports injuries, accompanied by sometimes intense pain - a popping sensation (like tearing tissue). The pain subsides a little, but it often increases again due to the swelling. The joint swelling extends to the groin area, thigh.

The degree of dysfunction in ligamentous apparatus trauma depends on the severity of the injury (stretch, tear, tear), ranging from slight limitation to inability to support the leg. Pain increases with trunk deviation, movements in the opposite direction to the injured ligament.

Bone and Joint Injuries

Hip fractures often occur in elderly people as a result of home or street trauma. A feature, especially in the presence of osteoporosis, is the absence of severe pain syndrome, mild edema. At rest, the pain is deep, dull, moderate or insignificant, with movements the painful sensations increase markedly. Support is sometimes maintained. A common symptom is the inability to lift a straight leg from a lying position (a symptom of stuck heel).

Transtrochanteric fractures are most commonly diagnosed in middle-aged and young people and develop as a result of high-energy trauma. Unlike cervical fractures, they are accompanied by deep, diffuse, sharp, unbearable pain. Then the pain subsides, but it remains very strong, difficult to bear. The joint is swollen, there may be bruises. Movement is severely limited. Support is impossible.

Isolated fractures of the greater trochanter are rare, occur in children and young people, and are formed by a fall, direct impact or strong muscle contraction. The pain is sharp, very intense, located mainly on the outer surface of the joint. Due to increased pain, the patient avoids active movements.

Hip dislocations occur during falls from heights, industrial and traffic injuries, manifested in excruciating sharp pains that barely subside until reduction. The joint is deformed, the leg is shortened, bent at the knee joint, facing outwards, less often inwards (depending on the type of dislocation). Support and movement are impossible, when trying to move, spring resistance is determined.

Acetabular fractures develop alone or in combination with hip dislocations. Characterized by sharp, explosive pain deep in the hip joint. Afterwards, the pain subsides a little, but remains intense, preventing any movement. The leg is shortened, turned outwards. Support is impossible.

Degenerative processes

With coxarthrosis in an early stage, the pain is periodic, monotonous, of uncertain location, appears at the end of the day or after a significant load, sometimes radiating to the hip, knee joint. A slight and transient stiffness is possible at the beginning of the movements. Afterwards, the intensity of the pain increases, the painful sensations are noticed not only during the movements, but also at rest. After great effort, the patient begins to limp. Movement is somewhat limited.

In severe coxarthrosis, the pain is deep, diffuse, constant, painful, tortuous. Disturb day and night. Resistance to stress is reduced; when walking, patients lean on a cane. Movement is significantly limited, the affected leg is shortened, which leads to increased load on the joint, increased pain when walking and standing.

Chondromatosis of the hip joint in its course resembles subacute arthritis. Pains are moderate, diffuse, transient, combined with crushing, limited mobility. When intra-articular bodies are violated, blockages occur, characterized by severe acute pain, impossibility or significant limitation of movement. After the end of the mouse articular infringement, the listed symptoms disappear.

Trochanteritis usually forms with arthrosis of the hip joint, accompanied by an inflammatory-degenerative lesion of the gluteal muscle tendons at the point of attachment to the greater trochanter, manifested by pain in the region of the lesion in the supine position on the affected side. There is increased pain when trying to abduct the hip with resistance.

Bone nutritional disorders

Perthes disease, which develops in children and adolescents, is characterized by partial necrosis of the femoral head, which is initially accompanied by deep, non-intense pain, sometimes radiating to the knee and hip. After a few months the pain intensifies sharply, becomes constant, sharp, exhausting. The joint swells, movement is limited, and lameness occurs. Then the pain decreases, the degree of restoration of joint function varies.

Aseptic necrosis of the femoral head downstream is similar to Perthes' disease, but it is detected in adults, proceeds less favorably, in half of the cases it is bilateral. In the beginning, the pain is periodic, pulling. Then the pain syndrome intensifies, appears at night. At the height of clinical manifestations, the pain is so intense that the person completely loses the ability to lean on the leg. Then the pain gradually subsides. Movement restrictions progress for about 2 years, the result is arthrosis of the hip joint, contractures and shortening of the limb.

Solitary bone cysts form in the proximal metaphysis of the thigh in 10- to 15-year-old boys, accompanied by non-severe intermittent pain in the hip joint. Edema is usually absent, with the development of contractures with a prolonged course, especially in young children. Due to mild symptoms, the cause of treatment is a pathological fracture or increasing limitation of movement.

Arthritis

Aseptic arthritis manifests as a wave-like pain in the joint, which increases in the early morning hours. Pain intensity ranges from negligible to acute, severe, constant and significantly limiting physical activity. Stiffness, swelling, redness and increased local temperature are noted. Palpation is painful.

In rheumatoid arthritis, the hip joints are rarely involved, the lesion is symmetrical. Periodic pain first appears in the context of seasonal changes (autumn, spring), with a sudden change in climatic conditions, during periods of hormonal changes after childbirth or during menopause. Pain is moderate or mild, diffuse, pulling or painful, markedly increased on palpation. It is combined with recurrent synovitis, edema, hyperemia, hyperthermia, increasing mobility limitation.

Infectious arthritis develops with hematogenous or lymphogenic spread of the infection, less frequently - with penetration of the pathogen into the joint in nearby tissues. Typically acute onset with rapid increase in pain. The pain is intense, spasmodic, lacerating, bursting, bothering at rest, aggravated by movement, due to which the limb assumes a forced position. Patients present with fever, chills, sweating, severe weakness, swelling, redness of the joint, and increased local temperature.

In the absence of timely treatment, bacterial infectious arthritis can develop into panarthritis - a purulent inflammation of all tissues in the hip joint. It is characterized by a severe course with very sharp generalized throbbing pains, restless fever, severe weakness, presyncope, significant hyperemia, and hyperthermia.

Other Inflammatory Diseases

Thigh osteomyelitis can be hematogenous, post-traumatic or postoperative. Hematogenous osteomyelitis is manifested by sharp bursting pain, spasms, tearing, or clearly localized and very sharp perforating pain, due to which the patient avoids the slightest movement of the limbs. There is marked hyperthermia, severe intoxication.

Posttraumatic and postoperative osteomyelitis occur with similar but less pronounced symptoms. Usually, a more gradual onset against the background of an open fracture or postoperative wound, the appearance of purulent discharge. Hip joint pain increases within 1-2 weeks in parallel with the progression of signs of local inflammation.

Synovitis develops in the context of injuries, other diseases of the hip joint, less often becomes a manifestation of allergies. In acute synovitis, the pain is usually mild, dull, explosive, gradually increasing due to the increase in the amount of intra-articular fluid. The joint is swollen, palpation is a little painful, a symptom of fluctuation is determined. Chronic synovitis is asymptomatic, accompanied by sharp, dull pain.

In intermittent hydroarthrosis, pain is also negligible, accompanied by discomfort, difficulty in walking, and disappears within 3 to 5 days after reverse reabsorption of the effusion. They are renewed at regular intervals, individual for each patient, and are caused by repeated accumulations of fluid in the joint.

Specific infections

Hip joint tuberculosis is a common form of osteoarticular tuberculosis, which presents with general weakness, fatigue, and subfebrile condition. Then there are weak pulling or sore muscles, transient painful sensations in the joints when walking. The patient starts to spare the limb. As the pain progresses they become moderate, diffuse, radiate to the knee, complemented by swelling, redness, synovitis. A protective contracture develops.

Joint pain, including the hip, can appear with brucellosis. In the acute and subacute form, painful sensations pulling, twisting, combined with periodic fever, lymphadenopathy, skin rash. In a chronic course, the pain syndrome resembles that of aseptic arthritis, over time, deformities form.

congenital anomalies

The manifestations of hip dysplasia are determined by the degree of incongruence of the femoral head and the acetabulum. With complete congenital dislocation, pain appears immediately after the child begins to walk, accompanied by lameness. With moderate subluxation, painful sensations occur at the age of 5 to 6 years, directly related to the load on the leg.

With a mild subluxation, the pathology is asymptomatic for a long time, the painful syndrome manifests with the development of dysplastic coxarthrosis at the age of 25-30 years. The hallmarks of this arthrosis are the rapid intensification of pain, the early onset of pain at rest and at night, and the progressive limitation of movement. All forms of dysplasia are accompanied by skinfold asymmetry, the "click" symptom, and limited mobility. In case of displacement, shortening of the limb is observed.

Neoplasms

For benign neoplasms, a typical asymptomatic course. The pain is mild, intermittent and usually does not progress over the years. Tumor growth is accompanied by a slow increase in pain syndrome, recurrent synovitis. In the area of the hip joint, osteomas, osteoid osteomas, osteoblastomas, chondromas are more frequently detected.

Malignant neoplasms (osteosarcomas, chondrosarcomas) are characterized by the rapid progression of the pain syndrome and other manifestations of the pathology. Initially, the pain is mild, of short duration, without a specific location, sometimes worsening at night. Later, they become sharp, permanent, cutting, surrounding, spreading throughout the joint. The affected area is swollen, deformed. Weight loss, weakness, subfebrile condition are observed. With advanced neoplasms, painful and unbearable pain is eliminated only with narcotic drugs.

other reasons

Hip joint pain sometimes appears with lumbosacral plexitis and sciatic nerve neuropathy, however, they generally occupy an insignificant position in the clinical picture of the disease, disappearing in the background compared to severe pain in the back of the buttocks and thigh. , limb weakness and sensitivity disorders.

Pain syndrome of this location is frequently detected in osteochondrosis and herniated disc. Pain can be detected with spondylitis, deforming spondyloarthrosis, and spinal curvature. The pains are dull, periodic, intense, often intensifying during the period of exacerbation of the underlying disease. The cause of its appearance can be a constant overload of the joint or the development of coxarthrosis.

Sometimes joint pain is triggered by mental illness or depressive disorder. Diabetes mellitus is usually accompanied by enthesopathies, capsulitis, and other periarticular soft tissue lesions. Possible drug arthropathy when taking certain medications.

Diagnosis

In case of injuries, diagnostic measures are performed by traumatologists. Degenerative and inflammatory diseases are treated by orthopedists and rheumatologists. In the case of purulent processes, the participation of surgeons is necessary. The examination includes collecting complaints, studying the medical history, physical examination, and further research. Taking into account the peculiarities of the pathological process, the following methods can be used:

• Radiography.It is the basic technique for most joint diseases. Detects fractures, dislocations, changes in the contours of the acetabulum and femoral head, marginal and intraosseous defects, bone growths, narrowing of the joint space.
• Ultrasound.More informative when studying soft tissue. Reveals signs of inflammatory and degenerative processes, areas of calcification. Used to diagnose effusion in mice joints.
• Magnetic resonance imaging and computed tomography.Clarification techniques are used in case of ambiguous data from basic studies, to clarify the nature, prevalence and location of the pathological focus. It can be performed with contrast agents.
• Puncture of the joint.It has a diagnostic or therapeutic and diagnostic character. It allows removing the effusion, studying the composition of the intra-articular fluid, determining the causative agent of the infection through laboratory tests.
• Arthroscopy.During the visual examination of the joint, the physician assesses the condition of the bone structures and soft tissue, if necessary, collects a biopsy sample for further histological examination and performs therapeutic measures.
• Laboratory tests.They are prescribed to determine signs of inflammation and markers of rheumatologic diseases, to assess the general state of the body, the activity of various organs in serious systemic or infectious pathologies.

Treatment

Help before diagnosis

In severe injuries, it is necessary to secure the joint by applying a foot splint to the armpit. In case of minor traumatic injuries, just rest the leg. Cold is applied to the affected area. For severe pain, an analgesic is administered. You cannot make active movements with the limb, carry the leg. It is strictly forbidden to try to eliminate displacement or displacement of bones.

Tactics for non-traumatic illnesses are determined by symptoms. With minor manifestations, it is allowed to guarantee rest of the limb, use of local remedies with analgesic and anti-inflammatory effects. In case of fever, weakness, severe pain, rapid increase in edema and hyperemia, it is recommended to seek specialized help immediately.

conservative therapy

Dislocations are an indication for immediate reduction. In the case of fractures, skeletal traction is usually applied, operating the patient or fixing the limb with a plaster after the appearance of calluses. In elderly patients with hip fractures, immobilization with a spinning boot is allowed, which prevents rotational movements of the joint.

The rest of the patients are advised to relieve the hip joint. According to the indications, the use of orthotics or additional devices (crutches, canes) is recommended. Prescribe massage, physiotherapy exercises, physiotherapy procedures:

• laser therapy;
• magnetotherapy;
• UHF;
• ultrasound;
• drug electrophoresis;
• UHT.

It is possible to use NSAIDs, chondroprotectives, antibacterial drugs. Local agents are widely used. According to indications, joint punctures, intra and periarticular blocks with hormones, intra-articular injections of chondroprotectors, synovial fluid substitutes are performed.

Surgery

Hip joint operations are performed through open access and with the aid of arthroscopic equipment. Taking into account the type of pathology, the following can be done:

• Traumatic Injuries:open reduction of hip dislocation, acetabulum reconstruction, neck osteosynthesis, trochanteric fractures.
• Degenerative processes:arthrotomy, arthroscopy, removal of free intra-articular bodies.
• Tumors:neoplasm removal, bone resection, hip joint disarticulation, Io-abdominal amputation, Io-abdominal resection.

In case of contractures, ankylosis, periarticular tissue healing, correction, arthroplasty and arthrodesis are performed. Endoprosthesis is an effective way to restore limb function in diseases of various origins, accompanied by movement limitation or joint destruction.