Hip Pain – Causes, Symptoms, Diagnosis and Treatment

Table of contents:

Hip Pain – Causes, Symptoms, Diagnosis and Treatment
Hip Pain – Causes, Symptoms, Diagnosis and Treatment
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What to do if there is pain in the hip joint?

pain in the hip joint
pain in the hip joint

The hip joint is located at the junction of the femur with the pelvis. It is designed in such a way that it provides freedom of movement of the leg in all planes. The hip joint is the largest joint in the body and plays a critical role in upright posture. It bears the pressure of the entire upper half of the body.

All these features lead to the fact that it is very often subjected to various damages. Any trouble in the hip joint manifests itself in the form of pain. Painful changes can be exposed to all its constituent parts: bones; muscles surrounding the junction of the thigh and pelvis; articular cartilage; tendons; vessels and nerves entwining the joint.

The most common causes of hip pain are:

  • Infectious inflammation or arthritis;
  • Degenerative changes, or osteoarthritis (coxarthrosis);
  • Dislocations;
  • Fractures;
  • Pseptic necrosis of the femoral head;
  • Inflammation of the periarticular bursa (bursitis);
  • Non-infectious inflammation in autoimmune connective tissue diseases;
  • Tuberculosis;
  • Other reasons;

Infectious inflammation, or purulent arthritis

One of the most common diseases of the hip joint in the practice of a doctor.

Reasons

Purulent inflammation in the joint can be:

  • primary;
  • secondary.

Primary purulent inflammation develops with direct penetration of microbes into the joint cavity, for example, when injured in the hip joint (stab, fall on a sharp object).

Secondary infectious arthritis is the result of the introduction of microorganisms into the joint cavity with blood during sepsis or from surrounding tissues if there is a focus of purulent inflammation nearby (phlegmon of the thigh, furuncle, abscess).

Symptoms

Like any other purulent inflammation, septic arthritis is characterized by 5 classic signs:

  • temperature increase;
  • redness over the joint area;
  • pain;
  • edema;
  • violation of function.

Purulent arthritis begins with a sharp rise in temperature to 38-40 C and chills. Symptoms of general intoxication develop: weakness, headache, nausea. The joint area swells, the skin over it acquires a crimson hue. The anatomical boundaries of the joint are smoothed out, it increases in size. Pain in infectious arthritis is sharp, disturbing the patient both during movement and at rest. It is caused by the accumulation of purulent contents in the joint cavity. Because of the pain syndrome, movements in the hip joint become impossible: the patient lies down, he cannot sit or stand.

Diagnosis

A doctor may suspect purulent arthritis when listening to complaints and examining the hip area. The presence of a general infectious disease in the patient or foci of purulent inflammation of tissues nearby helps to clarify the diagnosis.

An x-ray of the hip joint in frontal and lateral projections will help confirm the suspicion.

Treatment

The basis for the treatment of purulent arthritis of the hip joint is powerful antibiotic therapy. A combination of 2-3 antibiotics of different groups is used. As a rule, they are administered in the form of intravenous systems. If the infection has entered the joint from the focus of inflammation in the soft tissues surrounding it, then the abscesses are excised and drains are installed.

An important point of treatment is to ensure complete rest for the sore leg. This is achieved by applying a splint or plaster cast.

If a lot of purulent contents have accumulated in the joint cavity, then it is punctured and washed with antibiotics.

After the end of the acute phase of inflammation, physiotherapy is prescribed: ultrasound, UHF. During the recovery period, a set of physical therapy exercises is prescribed to prevent the development of intra-articular adhesions and limit movements in the hip joint.

Surgical treatment may be necessary if drug therapy has not been successful or serious complications have developed. During the operation, the joint cavity is opened and cleaned of purulent masses. The most serious complication of septic arthritis is purulent fusion of the femoral head. In this case, after the inflammation subsides, the hip joint is replaced with an endoprosthesis.

Osteoarthritis, or coxarthrosis

Image
Image

Osteoarthritis, or coxarthrosis title="">Osteoarthritis, or coxarthrosis>

Is the most common cause of disability among all diseases of the hip joint.

Reasons

Coxarthrosis is based on degenerative (destruction) and dystrophic (malnutrition) processes in the hip joint. As a result, the joint ceases to perform its functions - leg movements are disturbed.

Osteoarthritis of the hip can affect people at any age, but it is more common in the 40+ age group. Although all the mechanisms for the development of painful changes in coxarthrosis have not been fully studied, it is possible to distinguish the main stages in the development of the disease.

The hip joint is subjected to enormous daily stress. With age, the articular cartilage covering the head of the femur begins to lose its elasticity and elasticity, its water content decreases, and the processes of replacing old cells with new ones slow down. All this leads to the fact that the cartilage gradually wears out under the influence of loads, becomes thinner and can no longer provide smooth movement of the femoral head in the acetabulum. The painful process is aggravated by the fact that, simultaneously with the thinning of the cartilage, the production of intra-articular fluid, which plays the role of a lubricant, decreases. Friction of bone against bone leads to the development of aseptic (non-infectious) inflammation in the joint cavity. In response to this, bone outgrowths begin to appear along the edges of the articular surfaces, which are a protective reaction of the body and reduce the amount of movement in the diseased joint. Joint deformity occurs.

In addition, postural disorders, flat feet, sports injuries, congenital hip subluxation, diabetes mellitus, the use of hormonal drugs, and past purulent arthritis contribute to the development of osteoarthritis of the hip joint.

Symptoms

Arthrosis, unlike arthritis, never develops suddenly. Its symptoms appear for a long time. Depending on the severity of the changes that have occurred in the joint, there are 3 stages of coxarthrosis.

Stage 1 is characterized by pain in the hip joint that occurs during excessive loads: walking up the stairs with a load in your hands, walking for a distance of more than 2-3 kilometers, running. Pain subsides after a short rest. At rest, the patient is not disturbed. On examination, the shape of the joint is unchanged, movements in it are unlimited.

At the 2nd stage of coxarthrosis, the pain begins to radiate to the groin, the inner and front side of the thigh, often going down to the knee. They occur after the usual daily load, but do not bother at rest. After a long walk, patients begin to limp. At this stage, rotational movements of the leg in the hip joint inward and abduction to its side are disturbed. Such a forced position leads to disruption of the muscles of the thigh, buttocks - a decrease in tone and strength.

At stage 3, pain in the hip joint disturbs patients even at rest, at night. A pronounced lameness is noticeable, which forces the use of a cane. The leg on the diseased side is shortened, the muscles of the buttocks and thighs decrease in size - they atrophy.

Diagnosis

In most cases, the diagnosis of coxarthrosis is not difficult. It is performed on the basis of the patient's complaints, an objective examination of the diseased leg and is confirmed on x-rays.

Treatment

The choice of methods for the treatment of arthrosis of the hip joint depends on the severity of the changes that have occurred in the joint. 1 and 2 degree of the disease can be treated, as a rule, conservatively. Anti-inflammatory drugs, chondroprotectors, drugs that improve blood circulation in the joint, physiotherapy, and therapeutic exercises are prescribed.

2 degree of coxarthrosis can be treated with surgical methods. The aim of the surgery is to improve the stability of the hip joint and remove the bone growths.

3 stage is treated only with the help of operations. Those patients who, for he alth reasons, can transfer a joint replacement to an artificial one, undergo hip arthroplasty. Palliative (auxiliary) operations are performed for patients with severe concomitant diseases (heart, kidney failure, advanced forms of diabetes mellitus) or very old age, for whom the installation of a prosthesis is contraindicated.

Dislocation

Dislocation
Dislocation

Hip dislocation is most common in children.

Reasons

Dislocation of the hip joint by origin is divided into congenital and acquired. Congenital dislocation of the hip occurs in utero due to improper formation of the pelvic bones.

Acquired is the result of an injury. It can occur when falling onto the thigh from a height, hitting the lower half of the body with the legs bent at the knee and hip joints, for example, during a car accident. Spontaneous dislocations of the hip joint are also observed in patients with paralysis of the lower extremities after a stroke, spinal injury or polio.

Symptoms

Congenital dislocation of the hip

It is detected in newborns, as a rule, at the first examination in the maternity hospital. It is characterized by asymmetry of skin folds under the buttocks, shortening of the legs on the affected side. When you try to spread the legs bent at the knees, there is a sharp pain in the hip joints, which makes the newborn cry.

Traumatic hip dislocation

The main sign of hip dislocation is a sharp pain in the hip joint, which does not allow movement, the patient does not sit or stand up. Immediately after the injury, swelling of the tissues over the joint develops, the appearance of hemorrhages. If the femoral head slips out of the acetabulum anteriorly, then the diseased leg is turned outward and longer than the he althy one. With a posterior dislocation, the leg turns inward and shortens.

Diagnosis

Congenital dislocation of the hip

Determined by a pediatrician or orthopedist during examination. It is specified with the help of ultrasound diagnostics of the hip joint and x-rays.

Traumatic hip dislocation

It is indicated by the features of the injury and the information obtained during the inspection of the joint area. Dislocation of the hip is confirmed by X-ray examination of the joint in 2 projections.

Treatment

Congenital dislocation of the hip

Can be treated both by applying orthopedic structures to keep the legs in the correct position, and by surgery. The choice of method depends on the severity of the disease.

The most common orthopedic devices for correcting congenital hip dislocation are:

  • spacer bars;
  • Pavlik's stirrups;
  • Frajka pillow.

They all fix the child's legs in a bent and spread position.

In the absence of success from conservative treatment, surgical techniques can be applied. They are aimed at the surgical reduction of the femoral head and the correction of defects in the shape of the hip joint.

Traumatic hip dislocation

It is reduced using local anesthesia and drugs that relieve muscle tone, or under general anesthesia if there is a strong displacement of the femur relative to the pelvis.

Fractures

fractures
fractures

The most common fracture that results in hip pain is a hip fracture.

Reasons

Fracture of the femoral neck occurs as a complication of reduced bone strength in osteoporosis. It most often develops in women over 60 years of age. In 90% of cases, a fracture occurs when an unsuccessful fall from a height of one's height, for example, during ice.

Symptoms

Sharp pain in the hip joint when moving and pressing on it, radiates to the groin, the inner surface of the thigh. Edema develops rapidly, a bruise may form over the area of the hip joint. The leg is turned out. The patient cannot raise the straightened leg from the supine position, arbitrarily turn it inward. There is a shortening of the leg on the side of the fracture.

Diagnosis

Suspect a fracture of the femoral neck allow the age of the patient, the fact of injury (fall), the data obtained during the examination of the sore leg. The diagnosis is confirmed on the basis of x-rays.

Treatment

An orthopedic traumatologist has at his disposal both conservative methods of treating a femoral neck fracture and surgical techniques. Non-operative methods of treatment have a very low efficiency and are used only in patients who, for he alth reasons, cannot undergo surgery. These methods include the imposition of a plaster cast on the sore leg from the lower back to the heel. Due to the fact that recovery after 60 years are slow, the fusion of the femur occurs in very rare cases. In addition, such a bandage makes older patients spend most of their time lying down, which contributes to the development of respiratory and heart failure, bedsores.

Therefore, preference is given to operational methods. The most common methods are:

  • osteosynthesis, when the head is fastened to the body of the bone with surgical screws or a pin;
  • total joint replacement with a prosthesis.

Aseptic necrosis of the femoral head

Aseptic necrosis
Aseptic necrosis

If a fracture of the femoral neck is typical for older women, then aseptic necrosis of the femoral head affects, as a rule, young men. Most of the cases occur between the ages of 20-45.

Reasons

The basis of aseptic necrosis is a violation of the blood supply to the femoral head, as a result of which the bone cells, deprived of nutrition, begin to die. Over time, the process spreads to the entire head, disrupting the function of the hip joint.

This might be happening:

  • spontaneously, for no apparent reason (1/3 cases);
  • after large doses of alcohol;
  • while taking corticosteroid hormonal drugs;
  • after radiotherapy;
  • old injuries.

Symptoms

The main sign of aseptic necrosis is the sharp appearance of pain in the hip joint against the background of full he alth. The pain radiates to the groin, the front surface of the thigh, and the lumbar region can also spread. It is so strong that the patient cannot lean on a sore leg, sit. This condition lasts for several days, then the pain gradually subsides.

As the disease progresses, pain attacks are repeated more and more often, visible changes in the thigh muscles begin to occur: they decrease, lose strength. Lameness appears.

If left untreated, atrophy descends to the calf muscles. Pain does not leave the patient even at rest, during sleep. Gait is sharply disturbed.

Diagnosis

Aseptic necrosis of the femoral head is one of the most difficult to diagnose diseases of the joints. Most often it is confused with coxarthrosis. Thorough questioning of the patient helps to make the correct diagnosis: a characteristic feature of bone necrosis is the sudden onset of pain without any precursors. Auxiliary methods are: radiography, MRI (magnetic resonance imaging), measurement of limb circumference.

Treatment

Carried out, as a rule, with the help of medications. Treatment goals are:

  • restoration of normal blood flow in the femoral head;
  • speedy resorption of dead areas;
  • prevent muscle wasting;
  • Maintain full range of motion in the hip joint.

For these purposes, anti-inflammatory drugs, vitamins, absorbable agents, drugs that improve the fluid properties of blood (antithrombotic), vasodilators, physiotherapy, therapeutic gymnastics complexes, massage, orthopedic shoes and leaning on a cane while walking are used.

Good therapeutic effect was shown by minimally invasive surgical techniques. These include decompressive surgery: several narrow holes are drilled in the head of the femur. This stimulates the growth of new blood vessels into the bone and improves blood circulation. In addition, this method reduces intraosseous pressure, which completely relieves pain in 70% of patients.

In cases where necrosis has spread to a significant part of the femoral head and it is impossible to restore the normal structure of the joints with medication, a complete replacement of the joint with an endoprosthesis is used.

Inflammation of the periarticular bursa, or bursitis

bursitis
bursitis

The most "harmless" cause of pain in the hip joint.

Reasons

Inflammation of the membrane that covers the joint can occur due to the following reasons:

  • direct entry of microorganisms into the tissues of the bag during a penetrating wound;
  • move the inflammatory process from the surrounding tissues or from the blood stream;
  • after hip replacement surgery;
  • violations of posture, gait;
  • professional cycling;
  • osteoarthritis of the hip joint with the formation of bone growths and the deposition of s alts in the tendons of the muscles, to the femur in the area of the periarticular bag.

Symptoms

The main symptom of bursitis is pain that radiates down to the knee on the outside of the leg. The palpation of the thigh in the projection of the greater trochanter is also painful. In the initial period of the disease, the pain is acute, sharply intensifying during attempts to move the leg in the hip joint. Bursitis is characterized by a rapid increase in symptoms: from the first signs to acute pain, it can take no more than 1 day.

Pain is associated with the accumulation of inflammatory fluid in the bag and the resulting friction of the tendons on the surface of the femur.

There may be an increase in the circumference of the thigh due to edema, an increase in body temperature.

Diagnosis

Bursitis is diagnosed only after other causes of hip pain have been ruled out.

The spread of pain along the outer surface of the leg and soreness at the location of the diseased trochanter on the femur help to establish the diagnosis. It is confirmed by x-ray.

Treatment

The goal of treatment is to relieve pain and eliminate inflammation. For this purpose, medical methods are used: non-steroidal anti-inflammatory drugs in the form of injections in a course. In the acute period of the disease, it is necessary to limit mobility in the hip joint in the form of bed rest.

Severe pain is an indication for the introduction of corticosteroid drugs into the periarticular bag. In this way, a rapid anti-inflammatory effect is achieved.

With purulent inflammation, a surgical opening of the bag is performed and its cavity is cleaned with the establishment of drainage. This helps prevent inflammation from moving directly to the joint.

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