Pain in the hip joint

Pain in the hip jointThey are specificuncomfortable, difficult to bear sensations caused by pathology of the upper femur, acetabulum, nearby soft tissue structures. In intensity, they vary from weak to unbearable, in nature they can be dull, sharp, hasty, aching, erupting, drilling, and so on. Often they depend on workload, time of day and other factors. Causes of pain are determined using X-rays, CT, MRI, ultrasound, arthroscopy and other studies. Pain relievers and rest of the limbs are recommended until the diagnosis is made.

Causes of pain in the hip joint

Soft tissue injuries

The most common traumatic cause of pain is a contusion of the hip joint. Occurs when falling sideways or a direct impact, manifests itself in moderate acute pain, which quickly becomes dull, gradually decreases and disappears within a few days, in severe cases - weeks. Support is maintained, movements are slightly restricted. Edema is detected on the spot, bruising is possible.

Ligament injuries of the hip joint are rare, usually the result of road traffic accidents and sports injuries, accompanied by severe pain, sometimes - a cracking sensation (as from tissue rupture). The pain decreases somewhat, then often increases again due to edema. The ellipse from the joint extends to the groin area, the thigh.

The degree of trauma dysfunction in the ligament apparatus depends on the severity of the injury (stretching, tearing, rupture), ranging from a small restriction to the inability to support the foot. The pain increases with the deviation of the trunk, movements in the opposite direction to the damaged ligament.

Bone and joint injuries

Hip fractures usually occur in older people as a result of family or street trauma. A characteristic feature, especially in the presence of osteoporosis, is the absence of intense pain syndrome, mild edema. At rest, the pain is deep, dull, moderate or insignificant, with movements the painful sensations increase significantly. Help is sometimes held. A common symptom is the inability to lift a foot run from a prone position (symptom of a stuck heel).

Transcranial fractures are most often diagnosed in middle-aged and young people and develop as a result of high-energy trauma. Unlike cervical fractures, they are associated with excruciating sharp deep diffuse pain. Then the pain diminishes, but remains very strong, hard to bear. The union is swollen, bruising is possible. Movement is very limited. Support is impossible.

Isolated fractures of the largest trocar are rare; they are found in children and young people; they are formed by a fall, direct impact, or a sharp contraction of the muscles. The pain is acute, very intense, localized mainly on the outer surface of the wrist. Due to the increase in pain, the patient avoids active movements.

Hip dislocations occur during falls from a height, industrial and road traffic injuries, manifested in excruciating excruciating pain that hardly diminishes until reduced. The joint is deformed, the leg is shortened, bent at the knee joint, turned outwards, less often from the inside (depending on the type of displacement). Support and movement are impossible, when you try to move, spring resistance is determined.

Acetabular fractures develop in isolation or combine with hip dislocations. It is characterized by acute explosive pain in the depths of the hip joint. Afterwards, the pain subsides somewhat, but remains strong, impeding any movement. The leg is shortened, rotated outwards. Support is impossible.

Degenerative processes

With coxarthrosis in the initial stage, the pain is periodic, dull, with uncertain localization, appearing at the end of the day or after a considerable load, sometimes radiating to the hip, knee joint. Light stiffness, which passes quickly is possible at the beginning of the movements. Subsequently, the intensity of pain increases, painful sensations are observed not only during movements, but also at rest. After a heavy strain, the patient begins to limp. Movement is somewhat limited.

In severe coxarthrosis, the pain is deep, diffuse, constant, painful, torsional. Worry both day and night. Resistance to stress decreases; when walking, patients lean on a cane. Movement is significantly restricted, the affected leg shortens, which leads to an increase in load on the joints, increased pain when walking and standing.

Chondromatosis of the hip joint in its course resembles subacute arthritis. The pain is moderate, diffuse, transient, combined with limited mobility. When bodies within the article are injured, blockages occur, characterized by severe excruciating pain, inability, or significant restriction of movement. Upon completion of the articular mouse violation, the listed symptoms disappear.

Trochanteritis usually forms with osteoarthritis of the hip joint, accompanied by an inflammatory-degenerative lesion of the gluteal muscle tendons at the point of their connection to the greater trocaner, manifested by pain in the area of the lesion in the spine. position on the affected side. There is an increase in pain when you try to grab the hip with resistance.

Bone nutrition disorders

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

Aseptic necrosis of the downstream femoral head resembles Perthes disease, but is detected in adults, persists less favorably, in half of cases is bilateral. At first, the pain is periodic, attractive. Then the pain syndrome intensifies, appearing at night. At the peak of clinical manifestations, the pain is so strong that the person completely loses the ability to stand on his feet. Then the pain gradually decreases. 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 boys 10-15 years old, accompanied by non-intense pain with rupture in the hip joint. Edema is usually absent, prolonged course contractures often develop, especially in young children. Due to the mild symptoms, the cause of the treatment is a pathological fracture or an increased restriction of movements.

Arthritis

Aseptic arthritis manifests with wave-like pain in the joint, which increases in the hours before breakfast. The severity of the pain varies from insignificant to acute, strong, constant, significantly limiting physical activity. There is stiffness, swelling, redness and an increase in local temperature. Palpation is painful.

In rheumatoid arthritis, the hip joints are rarely involved, the lesion is symmetrical. Periodic pain first appears against the background of the change of seasons (autumn, spring), with a sharp change in weather conditions, during periods of hormonal changes after birth or during menopause. The pain is moderate or weak, diffuse, attractive or painful, significantly increased on touch. It is combined with recurrent synovitis, edema, hyperemia, hyperthermia, increased mobility restriction.

Infectious arthritis develops with hematogenous or lymphogenic spread of the infection, more rarely - with the penetration of the pathogen into the joints from nearby tissues. Typical acute onset with rapidly increasing pain. The pain is intense, trembling, tearing, erupting, restlessness at rest, aggravated by movement, due to which the limb assumes a forced position. Patients have fever, chills, sweating, severe weakness, edema, redness of the joint, and an increase in local temperature.

In the absence of timely treatment, infectious bacterial arthritis can turn into panarthritis - a purulent inflammation of all hip joint tissue. It is characterized by a severe course with very widespread pulsating pain, rapid fever, severe weakness, pre-syncope, significant hyperemia, and hyperthermia.

Other inflammatory diseases

Osteomyelitis of the upper thigh can be hematogenous, post-traumatic or postoperative. Hematogenous osteomyelitis is manifested by clearly localized, very acute outbursts, tremors, aching or aching pain, due to which the patient avoids the slightest movements of the limbs. Has pronounced hyperthermia, severe intoxication.

Post-traumatic and postoperative osteomyelitis occurs with similar but less pronounced symptoms. Typically, a more gradual onset against the background of an open fracture or postoperative wound, the appearance of purulent discharge. Pain in the hip joint increases within 1-2 weeks in parallel with the progression of signs of local inflammation.

Synovitis develops against the background of injuries, other diseases of the hip joints, rarely becomes a manifestation of allergies. In acute synovitis, the pain is usually small, dull, erupting, gradually increasing due to the increase in the amount of fluid within the joint. The joint is swollen, palpation is slightly painful, a fluctuation symptom is defined. Chronic synovitis is asymptomatic, accompanied by mild pain.

With intermittent hydroarthrosis, the pain is also insignificant, accompanied by discomfort, limited mobility, and disappears within 3-5 days after reverse spill resorption. They are renewed at regular, individual intervals for each patient, caused by repeated accumulations of fluid in the joint.

Specific infections

Tuberculosis of the hip joint is a common form of osteoarticular tuberculosis, which is manifested by general weakness, fatigue, subfebrile condition. Then there is weak pulling or aching pain in the muscles, painful transient sensations in the joints when you walk. The patient begins to spare the limb. As the pain progresses, they become moderate, diffuse, radiating to the knee, filled with swelling, redness, synovitis. A protective contract is developed.

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

Congenital anomalies

Manifestations of hip dysplasia are determined by the degree of mismatch of the femoral head and acetabulum. With complete congenital displacement, the pain appears as soon as the child begins to walk, accompanied by lameness. With moderate subluxation, painful sensations occur at the age of 5-6 years, directly related to the load on the foot.

With a slight subluxation, the pathology is asymptomatic for a long time, the pain syndrome is manifested with the development of dysplastic coxarthrosis at the age of 25-30 years. Characteristics of such osteoarthritis are rapid intensification of pain, early onset of pain at rest and at night, and progressive restriction of movement. All forms of dysplasia are accompanied by asymmetry of the skin folds, symptoms of "clicking" and limited mobility. In case of displacement, shortening of the limbs is observed.

Neoplasia

For benign neoplasms, a typical asymptomatic course. The pain is minor, intermittent, and often does not progress over the years. Tumor growth is associated with a slow increase in pain syndrome, recurrent synovitis. In the area of the hip joint, osteoma, osteoid osteoma, osteoblastoma, chondroma are most often detected.

Malignant neoplasms (osteosarcoma, chondrosarcoma) are characterized by rapid progression of pain syndrome and other manifestations of pathology. At first, the pain is small, short-lived, without a specific localization, sometimes more severe at night. Subsequently, they become sharp, intermittent, cutting, circular, spreading throughout the node. The affected area is swollen, deformed. Weight loss, weakness, subfebrile condition are observed. With advanced neoplasms, excruciating, excruciating pain is eliminated only with narcotic medication.

Other reasons

Pain in the hip joint sometimes appears with lumbosacral plexus and sciatic nerve neuropathy, however, they usually occupy an insignificant position in the clinical picture of the disease, fade in the background compared to severe pain in the back of the buttocks and thighs, weakness oflimbs and sensory disorders.

The pain syndrome of this localization is often detected in osteochondrosis and disc herniation. Pain can be detected with spondylitis, deforming spondyloarthritis and curvature of the spine. The pain is dull, periodic, painful, often intensifying during the period of deterioration of the underlying disease. The cause of their appearance may be a constant overload of the joint or the development of coxarthrosis.

Sometimes joint pain is caused by mental illness or depressive disorder. Diabetes mellitus is often associated with enthesopathy, capsule, and other periarticular soft tissue lesions. Possible medication arthropathy while taking certain medications.

Diagnosing

In case of injuries, diagnostic measures are performed by traumatologists. Degenerative and inflammatory diseases are managed by orthopedists and rheumatologists. In case of purulent processes, the participation of surgeons is necessary. Examination includes collection of complaints, study of medical history, physical examination, additional research. Considering the features of the pathological process, the following methods can be used:

• Radiography.It is the basic technique for most joint diseases. Detects fractures, displacements, changes in the contours of the acetabulum and femoral head, marginal and intraosseous defects, bone growth, narrowing of the joint space.
• Ultrasound.More informative when studying soft tissues. Detects signs of inflammatory and degenerative processes, areas of calcification. Used to diagnose the articulated mouse.
• MRI and CT.Clarification techniques are used in case of vague data from basic studies, to clarify the nature, prevalence and location of the pathological focus. Can be performed with contrast.
• Joint puncture.Has a diagnostic or therapeutic and diagnostic character. Allows you to remove the leak, study the composition of the intra-articular fluid, determine the causative agent of the infection using laboratory tests.
• Arthroscopy.During a visual examination of the wrist, the doctor assesses the condition of the bones and soft tissue structures, if necessary, takes a biopsy sample for subsequent histological examination, and performs therapeutic measures.
• Laboratory tests.They are prescribed to determine the signs of inflammation and markers of rheumatic diseases, to assess the general condition of the body, the activity of various organs in severe infectious or systemic pathologies.

treatment

Help before diagnosis

In severe injuries, it is necessary to fix the joint by applying a stick from the foot to the armpit. In case of minor traumatic injuries, it is sufficient to provide the foot with rest. Cooling is applied to the affected area. For intense pain, an analgesic is given. You can not make active movements with the limbs, load the leg. Strictly forbidden to try to eliminate bone dislocation or displacement.

Tactics for non-traumatic illness are determined by the symptoms. With minor manifestations, it is permissible to provide the rest of the limb, the use of local remedies with analgesic and anti-inflammatory effects. In case of fever, weakness, severe pain, rapidly increasing edema and hyperemia, it is recommended to seek specialized help immediately.

Conservative therapy

Dislocations are an indicator of immediate reduction. In case of fractures, skeletal traction is usually applied, then patients are operated on or the limb is fixed with a cast after the signs of callus appear. In elderly patients with hip fractures, immobilization with a deroting boot is allowed, which prevents rotational movements in the joints.

The rest of the patients are advised to lighten the hip joint. According to the indications, it is recommended to use orthoses or additional equipment (crutches, cane). Define massage, physiotherapy exercises, physiotherapy procedures:

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

It is possible to use NSAIDs, chondroprotectants, antibacterial drugs. Local agents are widely used. According to the indications, punctures of the joints, intra-articular and periarticular blockages with hormones, intra-articular injections of chondroprotectors, replacement of synovial fluids are performed.

Surgery

Operations on the hip joint are performed with open access and with the help of arthroscopic devices. Depending on the type of pathology, it can be performed as follows:

• Traumatic injuries:open reduction of hip displacement, acetabulum reconstruction, neck osteosynthesis, trochanteric fracture.
• Degenerative processes:arthrotomy, arthroscopy, removal of free bodies within the joints.
• Tumors:neoplasia removal, bone removal, hip joint disarticulation, io-abdominal amputation, io-abdominal resection.

In case of contractures, ankylosis, scarring of periarticular tissues, correction, arthroplasty and arthrodesis are performed. Endoprosthetics is an effective way to restore limb function in diseases of various origins, accompanied by limited movement or destruction of the joint.