Hip pain

Hip painThey are specificunpleasant, unbearable sensations caused by pathology of the upper femur, acetabulum, nearby soft tissue structures. In terms of intensity, they vary from weak to unbearable, and in nature can be dull, sharp, oppressive, pain, cracking, piercing and more. They often depend on the load, the time of day and other factors. The causes of pain are determined using X-rays, CT, MRI, ultrasound, arthroscopy and other tests. It is recommended to relieve pain and rest the limbs until the diagnosis is made.

Causes of hip pain

Soft tissue injuries

The most common traumatic cause of pain is a contusion of the hip joint. It occurs when falling from the side or in a direct blow, manifests itself in moderate sharp pain, which quickly dulls, gradually decreases and disappears within a few days, in severe cases - weeks. The support is preserved, the movements are slightly limited. The swelling 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 - a feeling of cracking (as from a torn tissue). The pain decreases to some extent, then often increases again due to edema. The swelling from the joint extends to the groin area, the thigh.

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

Bone and joint injuries

Hip fractures are usually seen in the elderly as a result of domestic or street trauma. A characteristic feature, especially in the presence of osteoporosis, is the lack of severe pain syndrome, mild edema. At rest the pain is deep, dull, moderate or insignificant, with movements the painful sensations increase sharply. Help is sometimes saved. A common symptom is the inability to lift an upright leg from a lying 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 acute diffuse deep pain. Then the pain decreases, but remains very strong, difficult to bear. The joint is swollen, bruising is possible. Movement is severely restricted. Maintenance is impossible.

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

Hip sprains from falls from a height, industrial and traffic injuries, manifested in unbearable sharp pain, which almost does not decrease to reduction. The joint is deformed, the leg is shortened, bent at the knee joint, turned outwards, less often inwards (depending on the type of dislocation). Assistance and movement are impossible, when trying to move the spring resistance is determined.

Acetabular fractures develop in isolation or in combination with hip dislocations. It is characterized by sharp explosive pain in the depths of the hip joint. Subsequently, the pain subsides somewhat, but remains intense, preventing any movement. The leg is shortened, turned outwards. Maintenance is impossible.

Degenerative processes

In coxarthrosis in the initial stage the pain is periodic, dull, with uncertain localization, appears at the end of the day or after a significant load, sometimes radiating to the hip, knee joint. Slight, rapidly passing stiffness is possible at the beginning of the movements. Subsequently, the intensity of pain increases, painful sensations are observed not only during movement but also at rest. After a heavy effort, the patient begins to limp. Movement is somewhat limited.

In severe coxarthrosis the pain is deep, diffuse, constant, pain, torsion. Disturb both during the day and at 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 joint load, 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 occur, characterized by intense sharp pain, impossibility or significant restriction of movements. After the cessation of the violation of the joint mouse, the listed symptoms disappear.

Trochanteritis is usually formed by arthrosis of the hip joint, accompanied by inflammatory-degenerative damage to the tendons of the gluteal muscles at the point of their attachment to the large trochanter, manifested by pain in the area of the lesion in the supine position on the affected side. The pain increases when trying to abduct the thigh 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 mild dull deep pain, sometimes radiating to the knee and hip joint. 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 recovery of joint function varies.

Aseptic necrosis of the femoral head downstream is similar to Perthes' disease, but is found in adults, is less favorable, and in half of the cases is bilateral. At first the pain is periodic, pulling. Then the pain syndrome intensifies, it appears at night. In the midst of clinical manifestations, the pain is so intense that a person completely loses the ability to lean on his feet. Then the pain gradually decreases. Restrictions on movement progress in about 2 years, resulting in osteoarthritis of the hip, contractures and shortening of the limb.

Lonely bone cysts form in the proximal metaphysis of the thigh in boys 10-15 years of age, accompanied by mild intermittent pain in the hip joint. The swelling is usually absent, with prolonged contractures often developing, 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 wavy pain in the joint, which increases in the morning. The severity of the pain varies from insignificant to acute, strong, constant, significantly limiting physical activity. Stiffness, swelling, redness and local fever are noted. Palpation is painful.

In rheumatoid arthritis, the hip joints are rarely affected, the lesion is symmetrical. Periodic pain appears for the first time against the background of the changing 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 mild, diffuse, pulling or painful, sharply intensified on palpation. It is combined with recurrent synovitis, edema, hyperemia, hyperthermia, increasing restriction of mobility.

Infectious arthritis develops with hematogenous or lymphogenic spread of the infection, less frequently - with the penetration of the pathogen into the joint from nearby tissues. Typical acute onset with rapidly increasing pain. The pain is intense, twitching, tearing, cracking, anxiety at rest, worsening with movement, due to which the limb occupies a forced position. Patients have fever, chills, sweating, severe weakness, swelling, redness of the joint and fever.

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

Other inflammatory diseases

Osteomyelitis of the upper thigh can be hematogenous, post-traumatic or postoperative. Hematogenous osteomyelitis presents with a clearly localized, very sharp crack, twitching, tearing or dull pain, which is why the patient avoids even the slightest movement of the limbs. There is pronounced hyperthermia, severe intoxication.

Post-traumatic and postoperative osteomyelitis have similar but less severe symptoms. Usually a more gradual onset against the background of an open fracture or postoperative wound, the appearance of purulent discharge. Hip pain increases within 1-2 weeks as signs of local inflammation progress.

Synovitis develops against the background of injuries, other diseases of the hip joint, rarely becomes a manifestation of allergies. In acute synovitis, the pain is usually insignificant, dull, bursting, gradually increasing due to an increase in the amount of intra-articular fluid. The joint is swollen, palpation is slightly painful, a symptom of fluctuation is determined. Chronic synovitis is asymptomatic, accompanied by mild excruciating pain.

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

Specific infections

Tuberculosis of the hip joint is a common form of osteoarticular tuberculosis, which manifests itself with general weakness, fatigue, subfebrile condition. Then there are weak pulling or muscle pain, transient painful sensations in the joint when walking. The patient begins to spare the limb. As the pain progresses, they become moderate, diffuse, radiate 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 pulling, twisting, combined with periodic fever, lymphadenopathy, skin rash. In the chronic course the pain syndrome is similar to that in aseptic arthritis, over time deformities form.

Congenital anomalies

The manifestations of hip dysplasia are determined by the degree of mismatch between the femoral head and the acetabulum. In complete congenital dislocation, the pain appears as soon as the child begins to walk, accompanied by lameness. In moderate subluxation, painful sensations appear at the age of 5-6 years, directly related to the load on the legs.

With mild subluxation, the pathology is asymptomatic for a long time, the pain syndrome manifests itself with the development of dysplastic coxarthrosis at the age of 25-30 years. The hallmarks of such osteoarthritis are the 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, symptom "click" and limited mobility. In case of sprain, shortening of the limbs is noted.

Neoplasms

For benign neoplasms, a typical asymptomatic course. The pain is minor, intermittent and often does not progress with age. Tumor growth is accompanied by a slow increase in pain syndrome, recurrent synovitis. Osteomas, osteoid osteomas, osteoblastomas, chondromas are more often found in the area of the hip joint.

Malignant neoplasms (osteosarcomas, chondrosarcomas) are characterized by the rapid progression of the pain syndrome and other manifestations of pathology. At first the pain is insignificant, short-term, without specific localization, sometimes stronger at night. Subsequently, they become sharp, permanent, cutting, surrounding, spreading throughout the joint. The affected area is swollen, deformed. Weight loss, weakness, subfebrile condition are noted. In advanced neoplasms, painful, unbearable pain is eliminated only with narcotic drugs.

Other reasons

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

The pain syndrome of this localization is often found in osteochondrosis and disc herniation. Pain can be found in spondylitis, deforming spondyloarthritis and curvature of the spine. The pain is dull, intermittent, painful, often intensifying in the period of exacerbation of the underlying disease. The reason for their appearance may be constant overload of the joint or the development of coxarthrosis.

Sometimes joint pain is caused by a mental illness or depressive disorder. Diabetes mellitus is often accompanied by enthesopathies, capsulitis and other lesions of the surrounding 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 case of purulent processes, the participation of surgeons is required. The examination includes the collection of complaints, a study of the medical history, a physical examination, additional examinations. 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 the head of the femur, marginal and intraosseous defects, bone growths, narrowing of the joint space.
• Ultrasound.Most informative in the study of soft tissues. Reveals signs of inflammatory and degenerative processes, areas of calcification. Used to diagnose effusion, joint mice.
• MRI and CT.Clarification techniques are used in case of unclear data from basic studies to clarify the nature, prevalence and location of the pathological focus. It can be done with contrast.
• Puncture of the joint.It has a diagnostic or therapeutic and diagnostic nature. It allows you to remove the effusion, to study the composition of the intra-articular fluid, to determine the cause of the infection with the help of laboratory tests.
• Arthroscopy.During a 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 researches.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 sufficient to provide rest to the legs. Coldly apply on the affected area. In case of intense pain, an analgesic is given. You can not make active movements with a limb, load the legs. It is strictly forbidden to try to remove the sprain or displacement of the bones.

The tactics for non-traumatic diseases are determined by the symptoms. In case of insignificant manifestations it is permissible to provide rest of the limb, the use of topical drugs with analgesic and anti-inflammatory effects. In case of fever, weakness, severe pain, rapid swelling and redness, it is recommended to seek specialized help immediately.

Conservative therapy

Dislocations are an indication of immediate reduction. In the case of fractures, skeletal traction is usually applied, after which patients are operated on or the limb is fixed with a plaster cast after signs of callus appear. In elderly patients with hip fractures, immobilization with a derotation boot is permitted, which prevents rotational movements in the joint.

Other 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;
• magnetic therapy;
• UHF;
• ultrasound;
• drug electrophoresis;
• UHT.

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

Surgery

Hip surgeries are performed with open access and with the help of arthroscopic equipment. Taking into account the type of pathology, the following can be done:

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

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