Pain in the hip joint

Pain in the hip jointAre specificunpleasant, difficult to tolerate sensations caused by the pathology of the upper femur, acetabulum, nearby soft tissue structures. In terms of intensity, they vary from weak to unbearable, in nature they can be dull, sharp, pressing, aching, bursting, drilling, etc. Often they depend on the load, time of day and other factors. The causes of pain are determined using X-ray, CT, MRI, ultrasound, arthroscopy, and other studies. Pain relievers and limb rest 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. It occurs when falling on the side 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. 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 caused by road traffic accidents and sports injuries, accompanied by severe pain, sometimes by a cracking sensation (like from torn tissue). The pain decreases somewhat, then often increases again due to edema. Swelling from the joint extends to the groin area, thigh.

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

Bone and joint injuries

Hip fractures usually occur in older people as a result of domestic 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 sharply. The support is sometimes retained. A common symptom is the inability to lift a straightened leg from a prone position (a symptom of a stuck heel).

Transtrochanteric fractures are more often diagnosed in middle-aged and young people and develop as a result of high-energy injuries. 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, bruising is possible. Movement is severely limited. Support is impossible.

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

Dislocations of the hip occur during falls from a height, industrial and road traffic injuries, manifested in unbearable sharp pains that almost do not diminish until reduction. The joint is deformed, the leg is shortened, bent at the knee joint, turned outward, less often inward (depending on the type of dislocation). Support and movement are impossible, when trying to move, spring resistance is determined.

Acetabular fractures develop in isolation or are combined with hip dislocations. Characterized by acute explosive pain in the depths of the hip joint. Subsequently, the pain subsides somewhat, but remains intense, impeding any movement. The leg is shortened, rotated outward. Support is impossible.

Degenerative processes

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

With severe coxarthrosis, the pain is deep, diffuse, constant, aching, twisting. Disturb both in the daytime 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 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, combined with crunching, limitation of mobility. When the intra-articular bodies are infringed, blockages occur, characterized by intense sharp pain, impossibility or significant limitation of movements. After the termination of the infringement of the articular mouse, the listed symptoms disappear.

Trochanteritis is usually formed with arthrosis 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 in the area of the lesion in the supine position on the affected side. There is an increase in pain when trying to abduct the hip with resistance.

Bone nutritional disorders

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, 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, proceeds less favorably, in half of the cases it is bilateral. At first, the pains are 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 pains gradually decrease. Restrictions of movement progress over about 2 years, the outcome 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 intermittent pain in the hip joint. Edema is usually absent, with prolonged course contractures often develop, especially in young children. Due to mild symptoms, the cause of treatment is a pathological fracture or an increasing restriction of movements.

Arthritis

Aseptic arthritis is manifested by wave-like pain in the joint, which increases in the pre-morning hours. The severity of 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, pulling or aching, sharply increased on palpation. It is combined with recurrent synovitis, edema, hyperemia, hyperthermia, increasing limitation of mobility.

Infectious arthritis develops with hematogenous or lymphogenous spread of the infection, less often - with the penetration of the pathogen into the joint from nearby tissues. Typically acute onset with rapidly increasing pain. The pain is intense, twitching, tearing, bursting, bothering at rest, aggravated by movement, due to which the limb takes 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, 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 widespread throbbing pains, hectic 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 bursting, twitching, tearing or boring pain, due to which the patient avoids the slightest limb movements. There is marked 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 joint, less often it becomes a manifestation of allergies. In acute synovitis, 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, pain is also insignificant, accompanied by discomfort, limited mobility, and disappear within 3-5 days after the reverse resorption of the effusion. They renew 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, which manifests itself with general weakness, fatigue, subfebrile condition. Then there are weak pulling or aching 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, radiate to the knee, supplemented by swelling, redness, synovitis. A protective contracture develops.

Joint pain, including the hip, may appear with brucellosis. In acute and subacute form, painful sensations pulling, twisting, combined with periodic fever, lymphadenopathy, skin rashes. In a chronic course, the pain syndrome resembles that in 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 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 arthrosis are the rapid intensification of pain, early onset of pain at rest and at night, and progressive 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, limb shortening is noted.

Neoplasms

For benign neoplasms, a symptom-less course is typical. 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 pain syndrome, recurrent synovitis. In the area of the hip joint, osteomas, osteoid osteomas, osteoblastomas, and chondromas are more often detected.

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

Other reasons

Pain in the hip joint sometimes appears with 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 on the back of the buttock and thigh, limb weakness and sensitivity disorders.

Pain syndrome of this localization is often detected in osteochondrosis and disc herniation. Pain can be detected with spondylitis, deforming spondyloarthrosis and curvature of the spine. The pains are dull, periodic, aching, often intensifying during the exacerbation of the underlying disease. The cause of their 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 often accompanied by enthesopathies, capsulitis, and other lesions of periarticular soft tissues. Possible drug arthropathy while taking certain medications.

Diagnostics

In case of injuries, diagnostic measures are carried out by traumatologists. Degenerative and inflammatory diseases are managed 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, physical examination, additional 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.Most informative when studying soft tissues. Reveals signs of inflammatory and degenerative processes, areas of calcification. Used to diagnose effusion, articular mice.
• MRI and CT.Clarifying techniques are used in case of ambiguous data from basic studies, to clarify the nature, prevalence and location of the pathological focus. Can be carried out with contrasting.
• Puncture of the joint.Has a diagnostic or therapeutic and diagnostic character. It allows you to remove effusion, study the composition of the intra-articular fluid, determine the causative agent of infection using 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 tests.They are prescribed to determine signs of inflammation and markers of rheumatological 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. With minor traumatic injuries, it is enough to provide the leg with rest. Cold is applied to the affected area. For intense pain, an analgesic is given. You can not make active movements with the limb, load the leg. It is strictly forbidden to try to eliminate the dislocation or displacement of the bones.

The tactics for non-traumatic diseases are determined by symptoms. With minor manifestations, it is permissible 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 increase in edema and hyperemia, it is recommended to immediately seek specialized help.

Conservative therapy

Dislocations are an indication for immediate reduction. In case of fractures, skeletal traction is usually applied, then 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 allowed, which prevents rotational movements in the joint.

The rest of the patients are advised to relieve the hip joint. According to 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 indications, joint punctures, intra- and periarticular blockages with hormones, intra-articular injections of chondroprotectors, synovial fluid substitutes are performed.

Surgery

Operations on the hip joint are carried out by 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 dislocation of the hip, 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.

With contractures, ankylosis, scarring of periarticular tissues, redressing, arthroplasty, and arthrodesis are performed. Endoprosthetics is an effective way to restore limb functions in diseases of various origins, accompanied by limitation of movement or destruction of the joint.