Pain in the hip joint

Pain in the hip jointAre specificunpleasant and difficult to endure sensations caused by the pathology of the upper femur, acetabulum, nearby soft tissue structures. In terms of intensity, they vary from weak to unbearable, by nature they can be dull, sharp, pressing, painful, glowing, piercing, etc. They often depend on the load, time of day and other factors. The causes of pain are determined using an x-ray, CT scan, MRI, ultrasound, arthroscopy, and other studies. Pain relievers and limb rest are recommended until a diagnosis is made.

Causes of pain in the hip joint

Soft tissue injuries

The most common traumatic cause of pain is contusion of the hip joint. It occurs during a fall to the side or direct impact, manifests itself in moderate sharp pain, which quickly becomes dull, gradually decreases and disappears within a few days, in severe cases - weeks. The support is preserved, the movements are slightly 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 - a crunching sensation (like a tear in tissue). The pain decreases somewhat, then often increases again due to edema. The swelling of the joint spreads to the groin area, to the thigh.

The degree of dysfunction during trauma to the ligament apparatus depends on the severity of the injury (stretching, tearing, breaking), ranging from a slight limitation to the inability to lean on the leg. Pain increases with 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 home or street trauma. A characteristic 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 movement the pain sensations increase sharply. The support is sometimes retained. A common symptom is the inability to lift an outstretched leg from a lying position (a 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 a deep diffuse and acute pain that is unbearable. Then the pain decreases, but remains very strong, difficult to bear. The joint is swollen, bruising is possible. Travel is severely restricted. Support is not possible.

Isolated fractures of the greater trochanter are rare; they are found in children and adolescents; they are formed by a fall, a direct shock, or a sudden muscular contraction. 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.

Dislocations of the hip occur during falls from heights, accidents at work and on the road, manifesting as acute unbearable pain that hardly subsides to reduction. The joint is deformed, the leg is shortened, bent at the level of the knee joint, turned outwards, less often inwards (depending on the type of dislocation). Support and movement is impossible, when you try to move, the resistance of the spring is determined.

Acetabular fractures develop in isolation or are associated with dislocations of the hip. Characterized by sharp explosive pain in the depths of the hip joint. Afterwards, the pain subsides somewhat, but remains intense, preventing any movement. The leg is shortened, turned outward. Support is not possible.

Degenerative processes

With coxarthrosis at the initial stage, the pain is periodic, dull, of uncertain localization, appears at the end of the day or after a heavy load, sometimes radiating to the hip, the knee joint. A light stiffness and quickly transient is possible at the beginning of the movements. Subsequently, the intensity of pain increases, painful sensations are noted not only during movements, but also at rest. After intense exertion, the patient begins to limp. Travel is somewhat limited.

In severe coxarthrosis, the pain is deep, diffuse, constant, painful, twisted. Disturb both day and night. Resistance to stress is reduced; when walking, patients lean 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 pains are moderate, diffuse, transient, associated with cracking, limited mobility. When the intra-articular bodies are violated, blockages occur, which are characterized by severe sharp pain, the impossibility or significant limitation of movement. After the end of the mouse joint damage, the symptoms listed disappear.

Trochanteritis usually forms with osteoarthritis of the hip joint, accompanied by an inflammatory-degenerative lesion of the tendons of the gluteal muscles at the point of their attachment to the greater trochanter, manifested by pain at the level of the lesion in supine positiondorsal. position of the affected side. There is an increase in pain when you try to remove the hip with resistance.

Nutritional bone 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, not 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 functions varies.

Aseptic necrosis of the femoral head downstream resembles Perthes' disease, but it is detected in adults, progresses less favorably, in half of cases it is bilateral. At first, the pain is periodic, pulling. Then the pain syndrome intensifies, appears at night. At the height of clinical manifestations, the pain is so severe that the person completely loses the ability to lean on the leg. Then the pains gradually decrease. The movement restrictions progress over about 2 years, the result is osteoarthritis of the hip joint, contractures and limb shortening.

Solitary bone cysts form in the proximal thigh metaphysis in boys 10 to 15 years old, accompanied by intermittent, non-severe pain in the hip joint. Edema is usually absent, contractures of prolonged course often develop, 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 hours leading up to 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 noted. Palpation is painful.

In rheumatoid arthritis, the hip joints are rarely involved, the lesion is symmetrical. Periodic pain first appears against the background of changing seasons (autumn, spring), with a sharp change in weather conditions, during periods of hormonal changes after childbirth or during menopause. The pain is moderate or weak, diffuse, drawing or painful, greatly increased on palpation. It is associated with recurrent synovitis, edema, hyperemia, hyperthermia, increasing limitation of mobility.

Infectious arthritis develops with hematogenous or lymphogenous spread of infection, less often - with the penetration of the pathogen into the joint from nearby tissues. Usually acute onset with rapid increase in pain. The pain is intense, convulsive, tearing, bursting, bothersome at rest, aggravated by movement, due to which the limb takes a forced position. Patients have fever, chills, sweating, severe weakness, swelling, redness of the joint, and an increase in local temperature.

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 acute generalized stabbing pains, hectic fever, severe weakness, pre-syncope, severe hyperemia and hyperthermia.

Other inflammatory diseases

Osteomyelitis of the upper thigh can be hematogenous, post-traumatic or postoperative. Hematogenous osteomyelitis is manifested by well-localized and very acute bursting, tics, tearing or drilling pains, thanks to which the patient avoids the slightest movement of the limbs. There is marked hyperthermia, severe intoxication.

Post-traumatic and postoperative osteomyelitis occurs with similar, but less pronounced symptoms. As a rule, 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 to 2 weeks as signs of local inflammation progress.

Synovitis develops against the background of injuries, other diseases of the hip joint, less often it becomes a manifestation of allergies. In acute synovitis, the pain is usually minor, 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 weak aching pain.

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

Specific infections

Tuberculosis of the hip joint is a common form of osteoarticular tuberculosis, manifested by general weakness, fatigue, subfebrile condition. Then there are weak pulling pains or pain 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, radiate to the knee, supplemented by swelling, redness, synovitis. A protective contracture develops.

Joint pain, including the hip, can appear with brucellosis. In acute and subacute form, painful sensations of tightness, twisting, associated with periodic fever, lymphadenopathy, rashes. In a chronic course, the pain syndrome resembles that of aseptic arthritis, over time deformities are formed.

Congenital anomalies

Manifestations of hip dysplasia are determined by the degree of incongruence of the femoral head and 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 5-6 years, directly related to the load on the leg.

With a slight 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 years. Characteristics of such arthritis are rapid intensification of pain, early onset of pain at rest and at night, and gradual limitation of movement. All forms of dysplasia are accompanied by asymmetry of the skin folds, the "click" symptom and limited mobility. In case of dislocation, a shortening of the limb is noted.

Tumors

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

Malignant neoplasms (osteosarcomas, chondrosarcomas) are characterized by the rapid progression of the pain syndrome and other manifestations of the pathology. At first, the pain is minor, of short duration, without precise localization, sometimes worse at night. Subsequently, they become sharp, permanent, sharp, encircling, extending to the entire joint. The affected area is swollen, deformed. Weight loss, weakness, subfebrile condition are noted. With advanced neoplasms, painful and unbearable pains are eliminated only with narcotics.

Other reasons

Pain in the hip joint sometimes appears with lumbosacral plexitis and neuropathy of the sciatic nerve, however, they usually occupy an insignificant position in the clinical picture of the disease, fade in the background compared tosevere pain in the back of the buttock and thigh, weakness of the limbs and disturbance of feeling.

The pain syndrome of this localization is often detected in osteochondrosis and herniated disc. Pain can be detected with spondylitis, spondyloarthrosis deformans and curvature of the spine. The pains are dull, periodic, painful, often intensify during the period of exacerbation 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 triggered by a mental illness or depressive disorder. Diabetes mellitus is often accompanied by enthesopathies, capsulitis, and other periarticular soft tissue damage. Possible drug-induced arthropathy when taking certain medications.

Diagnostic

In the event of injuries, diagnostic measurements are carried out by traumatologists. Degenerative and inflammatory diseases are treated by orthopedists and rheumatologists. In case of purulent processes, the participation of surgeons is necessary. The examination includes the collection of complaints, the study of the medical history, the physical examination, additional research. Taking into account the peculiarities of the pathological process, the following methods can be used:

• X-ray.This is the basic technique for most joint diseases. Detects fractures, dislocations, changes in the contours of the acetabulum and the femoral head, marginal and intraosseous defects, bone growths, narrowing of the joint space.
• Ultrasound.The most informative when studying soft tissue. Reveals signs of inflammatory and degenerative processes, areas of calcification. Used to diagnose effusion, articular mice.
• MRI and CT.Clarification techniques are used in case of ambiguous data from basic studies, to clarify the nature, prevalence and location of the pathological focus. Can be achieved with contrasts.
• Puncture of the joint.Has a diagnostic or therapeutic and diagnostic character. Allows you to remove the effusion, study the composition of intra-articular fluid, determine the causative agent of infection with the help of laboratory tests.
• Arthroscopy.During a visual examination of the joint, the doctor assesses the condition of bone structures and soft tissues, if necessary, takes a biopsy sample for further histological examination and performs therapeutic measures.
• Laboratory tests.They are prescribed to determine signs of inflammation and markers of rheumatological diseases, to assess the general condition of the organism, 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 foot splint to the armpit. With minor traumatic injuries, it is enough to give the leg rest. Cold is applied to the affected area. For severe pain, an analgesic is administered. You can not make active movements with the limb, load the leg. It is strictly forbidden to try to eliminate dislocation or displacement of bones.

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

Conservative therapy

Dislocations are an indication for immediate reduction. In the event of a fracture, skeletal traction is usually applied, then patients are operated on or the limb is fixed with a cast after the appearance of signs of calluses. In elderly patients with a hip fracture, immobilization with a derotation boot is allowed, which prevents rotational movements of the joint.

Other patients are advised to relieve the hip joint. Depending on the indications, it is recommended to use orthoses or additional devices (crutches, cane). Prescribe massage, physiotherapy exercises, physiotherapy procedures:

• laser therapy;
• magnetotherapy;
• UHF;
• ultrasound;
• electrophoresis with drugs;
• UHT.

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

Surgery

Operations on the hip joint are performed freely and using arthroscopic equipment. Taking into account the type of pathology, the following operations can be performed:

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

In case of contractures, ankylosis, scarring of periarticular tissues, straightening, arthroplasty and arthrodesis are performed. The endoprosthesis is an effective means of restoring the functions of the limbs in diseases of various origins, accompanied by limitation of movement or destruction of the joint.