Pain in the hip joint

Pain in the hip jointThey are specificunpleasant, unbearable sensations caused by pathology of the upper femur, acetabulum, nearby soft tissue structures. As for the intensity, they vary from weak to unbearable, in nature they can be annoying, sharp, pressing, painful, shooting, drilling, etc. They often depend on load, time of day and other factors. The causes of pain are determined by X-ray, CT, MRI, ultrasound, arthroscopy and other studies. Pain relievers and limb rest are recommended until the diagnosis is made.

Causes of hip pain

Soft tissue injuries

The most common traumatic cause of pain is contusion of the hip joint. It occurs when falling from the side or a direct blow, manifested by moderate acute pain, which quickly numbs, gradually decreases and disappears within a few days, in severe cases - weeks. The support is preserved, the movements are a bit limited. Edema is detected locally, bruising is possible.

Injuries to the ligaments of the hip joint are rare, usually the result of traffic accidents and sports injuries, accompanied by severe pain, sometimes - cracking (such as tearing tissue). The pain decreases somewhat, and then often increases again due to edema. Swelling from the joint extends to the groin area, thighs.

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

Bone and joint injuries

Hip fractures usually occur in the elderly as a result of domestic or street trauma. A characteristic feature, especially in the presence of osteoporosis, is the absence of an intense pain syndrome, mild edema. At rest the pain is deep, dull, moderate, or insignificant, with movements the painful feelings increase abruptly. Support is sometimes withheld. A common symptom is the inability to lift a straight leg from a prone position (symptom of a stuck heel).

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

Isolated fractures of the greater trochanter are rare; found in children and young people; they are caused by a fall, a direct blow, or a sharp contraction of a muscle. The pain is acute, very intense, localized mainly on the outer surface of the joint. Due to the increased pain, the patient avoids active movements.

Hip sprains occur with falls from a height, injuries in industrial and road traffic, which is manifested in unbearable sharp pain that hardly subsides until it subsides. The joint is deformed, the leg is shortened, bent at the knee joint, turned outwards, less often inwards (depending on the type of sprain). Support and movement are impossible, when trying to move, the resistance of the spring is determined.

Acetabular fractures develop in isolation or combine with hip dislocation. It is characterized by acute explosive pain in the depth of the hip joint. After that, the pain subsides somewhat, but remains intense, interfering with every movement. The leg is shortened, rotated outwards. Support is impossible.

Degenerative processes

In coxarthrosis in the initial stage, the pain is periodic, dull, uncertain localization, appears at the end of the day or after a significant load, sometimes radiating to the hip joint, knee. At the beginning of the movement, a slight, transient stiffness is possible. After that, the intensity of pain increases, painful sensations are recorded not only during movement, but also at rest. After heavy exertion the patient begins to limp. Movement is somewhat limited.

In severe coxarthrosis, the pain is deep, diffuse, constant, painful, twisted. Disturb both day and night. Resistance to stress is reduced; while walking, patients rely on a cane. Movements are significantly limited, the affected leg is shortened, which leads to an increase in the load on the joint, 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 crunch, limited mobility. When the intra-articular bodies are disturbed, blockages appear which are characterized by intense sharp pain, impossibility or significant restriction of movement. After the cessation of the articular mouse, the above symptoms disappear.

Trochanteritis is usually formed with arthrosis of the hip joint, followed by an inflammatory-degenerative lesion of the gluteal muscle tendons at the site of their attachment to the larger trochanter, which is manifested by pain in the area of the lesion in the back. position on the affected side. The pain increases when trying to abduct the hip with resistance.

Eating disorders of the bones

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

Aseptic necrosis of the femoral head downstream resembles Perthes' disease, but is detected in adults, is less favorable, and in half of the cases is bilateral. In the beginning, the pains are occasional, pulling. Then the pain syndrome intensifies, it appears at night. At the peak of clinical manifestations, the pain is so intense that the person completely loses the ability to lean on his leg. 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 extremities.

Lonely bone cysts form in the proximal metaphysis of the thigh in boys aged 10-15 years, followed by non-intense occasional pain in the hip joint. Edema is usually absent, with long courses often developing contractures, especially in young children. Due to mild symptoms, the cause of treatment is a pathological fracture or increasing restriction of movement.

Arthritis

Aseptic arthritis is manifested by pain resembling waves in the joint, which intensify in the early hours of the morning. The severity of the pain varies from insignificant to acute, strong, constant, significantly limiting physical activity. Stiffness, swelling, redness and an increase in local temperature are observed. Palpation is painful.

In rheumatoid arthritis, the hip joints are rarely affected, the lesion is symmetrical. Periodic pain first appears in the background of the change of seasons (autumn, spring), with a sharp change in weather conditions, during the period of hormonal changes after childbirth or during menopause. The pain is moderate or mild, diffuse, pulling or aching, intensified by palpation. It is combined with recurrent synovitis, edema, hyperemia, hyperthermia, increasing mobility limitation.

Infectious arthritis develops by hematogenous or lymphogenic spread of the infection, less often - by the penetration of pathogens into the joint from nearby tissues. Typically an acute onset with rapidly growing pain. The pain is intense, twitching, tearing, shooting, disturbing at rest, intensified by movement, due to which the limb takes a forced position. Patients have fever, chills, sweating, severe weakness, edema, redness of the joints and fever.

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

Other inflammatory diseases

Osteomyelitis of the thigh can be hematogenous, posttraumatic, or postoperative. Hematogenous osteomyelitis is manifested by clearly localized, very acute cracking, twitching, tearing, or dull pain, which is why the patient avoids even the slightest movement of the limbs. Hyperthermia, severe intoxication is expressed.

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

Synovitis develops in the background of injuries, other diseases of the hip joint, rarely becomes a manifestation of allergies. In acute synovitis, the pain is usually slight, dull, cracking, and gradually increases due to an increase in the amount of intra-articular fluid. The joint is swollen, palpation is a little painful, and the symptom of fluctuation is determined. Chronic synovitis is asymptomatic, accompanied by mild aching pain.

With occasional hydroarthritis, the pain is also insignificant, accompanied by discomfort, limited mobility, and disappears within 3-5 days after reverse resorption of the effusion. They are renewed at regular intervals, individually 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, and subfebrile condition. Then there are weak pulling or painful pains in the muscles, transient painful sensations in the joint when walking. The patient begins to spare the limb. As the pain progresses, they become moderate, diffuse, radiating to the knee, supplemented by swelling, redness, synovitis. Protective contracture develops.

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

Congenital anomalies

Manifestations of hip dysplasia are determined by the degree of incompatibility of the femoral head and acetabulum. With complete congenital dislocation, the pain appears immediately after 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 leg.

With mild subluxation, the pathology is asymptomatic for a long time, the pain syndrome is manifested by the development of dysplastic coxarthrosis at the age of 25-30. Characteristics of such arthrosis 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 skin folds, the symptom of "clicking" and limited mobility. In case of dislocation, shortening of the limbs is noticed.

Neoplasms

For benign neoplasms, a typical asymptomatic course. The pain is insignificant, occasional and often does not progress for years. Tumor growth is accompanied by a slight increase in pain syndrome, recurrent synovitis. Osteomas, osteoid osteomas, osteoblastomas, chondromas are more often detected in the area of the hip joint.

Malignant neoplasms (osteosarcomas, chondrosarcomas) are characterized by rapid progression of pain syndrome and other manifestations of pathology. In the beginning, the pains are smaller, short-lived, without a specific localization, and sometimes worse at night. After that, they become sharp, permanent, cutting, surrounding themselves, spreading to the entire wrist. The affected area is swollen, deformed. Weight loss, weakness, subfebrile condition are noticed. With advanced neoplasms, painful, unbearable pains are removed only with narcotics.

Other reasons

Hip pain sometimes occurs in lumbosacral plexitis and sciatic nerve neuropathy, however, they usually occupy an insignificant position in the clinical picture of the disease, fade into the background compared to intense pain in the back of the buttocks and thighs, limb weakness and sensitivity disorders.

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

Sometimes joint pain is caused by mental illness or a depressive disorder. Diabetes mellitus is often accompanied by enthesopathies, capsulitis and other lesions of the periarticular soft tissues. Possible drug arthropathy while taking certain medications.

Diagnosis

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

• Radiography.This 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.The most informative in the study of soft tissues. Detects signs of inflammatory and degenerative processes, areas of calcification. It is used to diagnose effusions, joint mice.
• MRI and CT.Explanatory techniques are used in the case of ambiguous data from basic studies, to clarify the nature, prevalence, and location of the pathological focus. It can be performed with contrast.
• Joint puncture.It has a diagnostic or therapeutic and diagnostic character. It allows you to remove effusions, study the composition of intra-articular fluid, determine the cause of infection using laboratory tests.
• Arthroscopy.During the visual examination of the joint, the doctor assesses the condition of the bone 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 splint from the foot to the armpit. In case of minor traumatic injuries, it is enough to ensure the leg rests. Apply cold to the affected area. An analgesic is given for intense pain. You can not do active movements with the limb, load the leg. It is strictly forbidden to try to eliminate dislocation or displacement of the bones.

The tactics of non-traumatic diseases are determined by the symptoms. With minor manifestations, it is allowed to provide limb rest, the use of topical drugs with analgesic and anti-inflammatory effects. In case of fever, weakness, severe pain, rapid growth of edema and hyperemia, it is recommended to seek specialized help immediately.

Conservative therapy

Dislocations are an indicator of an immediate decline. In the case of fractures, skeletal traction is usually applied, then patients are operated on or the limb is fixed with plaster after the appearance of signs of callus. In elderly patients with hip fractures, immobilization with a derotation boot is allowed, which prevents rotational movements in the joint.

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

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

It is possible to use NSAIDs, chondroprotectors, antibacterial drugs. Local agents are widely used. According to the indications, joint punctures, intra- and peri-articular blockade with hormones, intra-articular injections of chondroprotectors, synovial fluid replacement are performed.

Surgery

Operations on the hip joint are performed with open access and with the help of arthroscopic equipment. Taking into account the type of pathology, the following can be performed:

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

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