Pain in the hip joint is a specific unpleasant, hard tolerable sensation caused by the pathology of the upper parts of the femur, acetabulum, and nearby soft tissue structures. They vary in intensity 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 radiography, CT, MRI, ultrasound, arthroscopy, and other studies. Prior to establishing a diagnosis, painkillers and rest of the limb are recommended.
The most common traumatic cause of pain syndrome is a contusion of the hip joint. It occurs when you fall on your side or a direct blow, manifests itself as moderate acute pain, which quickly becomes dull in nature, gradually decreases and disappears within a few days, in severe cases - weeks. The support is preserved, movements are limited slightly. Local swelling is detected, bruising is possible.
Injuries to the ligaments of the hip joint are rare, usually the result of road accidents and sports injuries, accompanied by sharp pain, sometimes a crackling sensation (as if from torn tissue). The pain decreases somewhat, then often increases again due to swelling. Swelling from the joint extends to the groin area, thigh.
The degree of dysfunction in injuries of the ligamentous apparatus depends on the severity of the damage (stretching, tear, rupture), varies from a slight limitation to the impossibility of supporting the leg. The pain intensifies with the deviation of the body, movements in the direction opposite to the damaged ligament.
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, mild swelling. At rest, the pains are deep, dull, moderate or slight, with movements, the pain sensations sharply increase. Support is sometimes preserved. A typical symptom is the inability to raise the straightened leg from a prone position (stuck heel symptom).
Pertrochanteric fractures are more often diagnosed in people of middle and young age, they develop as a result of high-energy injuries. Unlike fractures of the neck, they are accompanied by unbearable sharp diffuse deep pain. Then the pains decrease, but remain very strong, hard to bear. The joint is swollen, bruising is possible. Movement is severely limited. Support is impossible.
Isolated fractures of the greater trochanter are rare, found in children, young people, are formed during a fall, direct impact, 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 injuries, are manifested by unbearable acute pain, which almost does not decrease until reduction. The joint is deformed, the leg is shortened, bent at the knee joint, turned outward, rarely inward (depending on the type of dislocation). Support and movements 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, making any movement difficult. The leg is shortened, rotated outwards. Support is impossible.
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 radiates to the thigh, knee joint. There may be slight, quickly passing stiffness 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 loads, the patient begins to limp. Movement is somewhat limited.
In severe coxarthrosis, the pain is deep, diffuse, constant, aching, twisting. They are disturbing both during the day and at night. Resistance to stress is reduced; when walking, patients rely on a cane. Movements are significantly limited, the diseased 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, limited mobility. When the intraarticular bodies are infringed, blockades occur, characterized by intense sharp pain, impossibility or significant limitation of movements. After the cessation of 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 affected area in the supine position on the sore side. There is an increase in pain when trying to abduct the hip with resistance.
Perthes disease develops in children and adolescents and is characterized by partial necrosis of the femoral head, which is initially accompanied by mild, dull, deep pain, sometimes radiating to the knee and thigh. After a few months, the pains sharply increase, become constant, sharp, exhausting. The joint swells, movements are limited, lameness occurs. Then the pain decreases, the degree of restoration of joint functions varies.
Aseptic necrosis of the femoral head along the course resembles Perthes' disease, but 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 pain gradually decreases. Restrictions of movements progress within about 2 years, the outcome is arthrosis of the hip joint, contractures, shortening of the limb.
Solitary bone cysts are formed 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 a long course, contractures often develop, especially in young children. Due to mild symptoms, the cause of treatment is a pathological fracture or an increasing limitation of movement.
Aseptic arthritis is manifested by wavy pains in the joint, aggravated in the early hours. The severity of pain varies from minor to acute, strong, constant, significantly limiting motor activity. There are stiffness, swelling, redness, increased local temperature. Palpation is painful.
In rheumatoid arthritis, the hip joints are rarely involved, the lesion is symmetrical. Periodic pains first appear against the background of the change of 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 aggravated by 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 penetration of the pathogen into the joint from nearby tissues. Typically acute onset with rapidly increasing pain. The pains are intense, jerking, tearing, bursting, disturbing at rest, aggravated by movements, due to which the limb takes a forced position. In patients, fever, chills, sweating, severe weakness, swelling, redness of the joint, and an increase in local temperature are detected.
In the absence of timely treatment, bacterial infectious arthritis can turn into panarthritis - 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.
Osteomyelitis of the upper thigh can be hematogenous, post-traumatic or postoperative. Hematogenous osteomyelitis is manifested by clearly localized, very sharp arching, jerking, tearing or boring pain, due to which the patient avoids the slightest movement of the limb. There is marked hyperthermia, severe intoxication.
Post-traumatic and postoperative osteomyelitis occur with similar, but less pronounced symptoms. Typically, a more gradual onset against the background of an open fracture or postoperative wound, the appearance of a 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 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 edematous, palpation is slightly painful, a symptom of fluctuation is determined. Chronic synovitis is asymptomatic, accompanied by mild aching pain.
With intermittent hydroarthrosis, the pain is also minor, accompanied by discomfort, limited mobility, and disappear within 3-5 days after the reverse resorption of the effusion. Renewed at certain intervals, individual for each patient, are caused by repeated accumulations of fluid in the joint.
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 pain in the joint when walking. The patient begins to spare the limb. With progression, the pain becomes moderate, spilled, given to the knee, supplemented by swelling, redness, synovitis. Protective contracture develops.
Pain in the joints, including the hip, can appear with brucellosis. In acute and subacute form, painful sensations are pulling, twisting, combined with periodic fever, lymphadenopathy, skin rashes. In a chronic course, the pain syndrome resembles that of aseptic arthritis, and deformities form over time.
The 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 starts walking, accompanied by lameness. With moderate subluxation, pain occurs at the age of 5-6 years, directly related to the load on the leg.
With a mildly pronounced subluxation, the pathology is asymptomatic for a long time, the pain syndrome manifests itself with the development of dysplastic coxarthrosis at the age of 25-3 years. Distinctive signs of such arthrosis are the rapid increase in pain, the early onset of pain at rest and at night, the progressive restriction of movement. All forms of dysplasia are accompanied by asymmetry of skin folds, a "click" symptom, and limitation of mobility. In case of dislocation, shortening of the limb is noted.
For benign neoplasia, an asymptomatic course is typical. Pain is minor, intermittent, often does not progress over the years. Tumor growth is accompanied by a slow increase in pain, recurrent synovitis. In the area of the hip joint, osteomas, osteoid osteomas, osteoblastomas, and chondromas are more often detected.
Malignant neoplasias (osteogenic sarcomas, chondrosarcomas) are characterized by rapid progression of pain syndrome and other manifestations of pathology. Initially, the pain is minor, short-term, without a specific localization, sometimes worse at night. Subsequently, they become sharp, permanent, cutting, girdle, spread to the entire joint. The affected area swells, deforms. Weight loss, weakness, subfebrile condition are noted. With advanced neoplasia, the pain is excruciating, unbearable, eliminated only by narcotic drugs.
Pain in the hip joint sometimes appears with lumbosacral plexitis and sciatic nerve neuropathy, but they usually occupy an insignificant position in the clinical picture of the disease, fade into the background compared to intense pain along the back of the buttock and thigh, limb weakness and sensory disturbances.
The pain syndrome of this localization is often detected in osteochondrosis and herniated discs. Pain can be detected with spondylitis, deforming spondyloarthrosis and curvature of the spine. Pain is dull, periodic, aching, often aggravated during an exacerbation of the underlying disease. The reason for their appearance may be a constant overload of the joint or the development of coxarthrosis.
Sometimes joint pain is provoked by mental illness or a depressive disorder. Diabetes mellitus is often accompanied by enthesopathy, capsulitis, and other lesions of the periarticular soft tissues. Drug arthropathies are possible while taking certain medications.
In case of injuries, diagnostic measures are carried out by traumatologists. Degenerative and inflammatory diseases are managed by orthopedists and rheumatologists. With purulent processes, the participation of surgeons is necessary. The examination includes the collection of complaints, the study of the anamnesis of the disease, physical examination, additional studies. Taking into account the characteristics of the pathological process, the following methods can be used:
X-ray of TBS. Osteosynthesis of a fracture with internal fixation devices
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 provide rest to the leg. Cold is applied to the affected area. With intense pain, give an analgesic. You can not make active movements with a limb, load the leg. It is strictly forbidden to try to eliminate the dislocation or displacement of the bones.
Tactics for non-traumatic diseases is determined by the symptoms. With minor manifestations, it is permissible to ensure the rest of the limb, the use of local agents with analgesic and anti-inflammatory effects. With fever, weakness, severe pain, a rapid increase in edema and hyperemia, it is recommended to immediately seek specialized help.
Dislocations are an indication for immediate reduction. For fractures, skeletal traction is usually applied, subsequently patients are operated on or the limb is fixed with a plaster cast after the appearance of signs of callus. In senile patients with fractures of the femoral neck, immobilization with a derotation boot is allowed, which prevents rotational movements in the joint.
The rest of the patients are advised to unload the hip joint. According to indications, it is recommended to use orthoses or additional devices (crutches, cane). Assign massage, physiotherapy exercises, physiotherapy procedures:
Perhaps the use of NSAIDs, chondroprotectors, antibacterial drugs. Widely used means of local action. According to indications, joint punctures, intra- and periarticular blockades with hormones, intra-articular injections of chondroprotectors, synovial fluid substitutes are performed.
Operations on the hip joint are carried out by open access and with the help of arthroscopic equipment. Depending on the type of pathology, the following can be performed:
With contractures, ankylosis, scarring of periarticular tissues, redressing, arthroplasty, arthrodesis are performed. An effective way to restore limb functions in diseases of various origins, accompanied by limitation of movement or destruction of the joint, is arthroplasty.