hip pain

The hip joint is the largest joint in the human body and is under pressure from physical activity every day to support body weight. Many people believe that joint pain only occurs in old age. Of course, as we age, the cartilage that absorbs shock when the joints bend becomes thinner, and the amount of fluid in the joints decreases, leading to pain. However, not only age but also many diseases can cause the occurrence of pain of varying intensity, from mild to unbearable. Hip pain can be dull, sharp, pressing, or aching in nature. Typically depends on load, time of day, and other factors. Radiography, CT, MRI, ultrasound, arthroscopy, and other studies are performed to determine the cause of the pain. Pain medication and lower extremity rest are recommended until a diagnosis is made.

Causes of Hip Pain

soft tissue injuryThe most common cause of acute pain is a bruised hip, caused by a fall on the side or a direct blow that results in slight limitation of movement. Swelling may occur.The pain symptoms gradually decreased and disappeared after a week. Hip ligament injuries are often caused by traffic accidents and sports injuries and are accompanied by a severe pain syndrome with a rupturing sensation. Pain from swelling often worsens again and moves to the groin and thighs.If the ligament is injured, the movement function will be severely limited in the movement of the lower limbs, and even the inability to stand depends on the severity of the injury, such as: sprain, tear, rupture. The pain worsens when the body leans in the opposite direction to the damaged ligament.Bone and joint injuriesFemoral neck fractures usually occur in older adults due to trauma. A typical feature of osteoporosis is mild swelling without severe pain at rest. The pain increases dramatically with movement. Symptoms of a stuck heel are classic symptoms of being unable to lift a straight leg while lying down.Intertrochanteric fractures of the femur are common in young adults due to high-energy trauma, and are associated with sharp and deep pain. Due to severe swelling of the affected joints, the movement of the lower limbs was limited and unable to stand.Isolated greater trochanteric fractures rarely occur in children and adolescents and result from falls, direct blows, severe muscle contractions, and are associated with acute, severe pain outside the joint. In response, patients avoid active movement.Falls from heights, industrial injuries, and road injuries can all cause hip dislocation with excruciating, acute pain.The leg may bend or extend due to joint deformation. When trying to stand or play sports, a bouncy gait occurs, accompanied by severe pain that does not relieve until the joint is reset. Acetabular fractures occur independently or can be caused by hip dislocation. They are characterized by acute, explosive pain deep in the hip joint that makes any movement difficult. The legs may shorten and turn outward, making it impossible to support them.degradation processIn the initial stages of hip arthropathy, after strenuous exertion or at the end of the day, patients may begin to limp with periodic dull pain that radiates to the hip or knee joints, along with slight stiffness of motion. Further exacerbating it, the pain occurs not only during exercise but also at rest.For severe hip joint disease, patients can only rely on crutches. Movement is restricted and the affected leg is shortened, which leads to increased load on the joints. The pain is not only worse when walking, but also when standing. The onset of chondromatosis of the hip is similar to that of subacute arthritis. Moderate, brief pain with chewing sensation and limited movement. Severe, sharp pain occurs when nerve endings within the joint become pinched, limiting movement. With arthropathy of the hip joint, trochanteritis often develops, accompanied by inflammatory and degenerative damage to the gluteal tendon in the area of attachment of the greater trochanter. The pain syndrome occurs when lying on the painful side and becomes worse when trying to move the hip to one side.

Bone nutrition issues

In children and adolescents, dull, deep pain in the knees and hips occurs on the background of Perthes disease, which is characterized by necrosis of the femoral head. After a few months the pain worsened and became constant, severe and debilitating. Joint swelling, limited movement, and lameness occur. Subsequently, pain symptoms subside and motor function is restored in different ways.Aseptic necrosis of the femoral head in adults is due to circulatory impairment and its progression is similar to that of Perthes' disease, but less favorable because in half of the cases it is bilateral.At first, persistent pain occurs in cycles and then intensifies to the point that the patient loses the ability to stand fully due to the destruction of the joints due to insufficient blood circulation. The pain syndrome gradually decreased. Due to arthritis in the hip joint and shortening of the lower limbs, movement has been gradually restricted for more than two years.Boys aged 10 to 15 years may develop a solitary bone cyst in the proximal femoral metaphysis and experience periodic mild pain in the hip joint. Younger children have no swelling. With symptoms not manifesting, reasons for seeing a doctor are pathological fractures or increasing limitations in mobility.Hip pain may be caused by avascular necrosis of the femoral head. This disease occurs due to long-term use of glucocorticoids (used to treat bronchial asthma, rheumatoid arthritis, and many other diseases), alcohol dependence, and joint circulatory disorders associated with severe diabetes. Arthronecrosis may precede trauma, but in some cases, the true cause cannot be determined. In this condition, the pain is severe and occurs while walking and trying to stand on the affected leg.

arthritis

Wave-like pain that ranges from mild to severe and persistent, limiting movement of the hip joint in the morning, is a classic symptom of aseptic arthritis. Symptoms include stiffness, swelling, redness, increased body temperature, and pain with pressure.Periodic pain in rheumatoid arthritis occurs due to changing weather conditions due to seasonal changes, hormonal changes after childbirth, or menopause. The pain can be moderate, weak, and persistent, which worsens sharply with palpation, and is accompanied by synovitis, edema, congestion, high fever, and limited activity.In the context of infectious arthritis, a syndrome of severe, throbbing, tearing pain occurs at rest and during exercise due to the spread of infection. Therefore, the limb assumes a forced posture. The disease is accompanied by fever, chills, sweating, severe weakness, swelling, red joints and an increase in body temperature. If left untreated, bacterial arthritis may progress to panarthritis—severe suppurative inflammation of the hip joint, accompanied by acute throbbing, hot flashes, weakness, fainting, congestion, and hyperthermia.

Other inflammatory diseases

In the context of open fractures, postoperative wounds, hip joint pain with osteomyelitis increases for 1-2 weeks due to the appearance of pus, accompanied by signs of inflammation. Synovitis, tendonitis, and bursitis occur with hip injuries and other conditions and are rarely manifestations of allergies. In acute synovitis, the joints are mildly painful, but the pain may worsen due to swelling and fluid buildup within the joints. Chronic synovitis is associated with mild soreness. Intermittent hydroarthrosis. Due to the accumulation of fluid in the joint, there is slight pain in the hip joint, accompanied by limited movement. It disappears within 3-5 days and returns after a period of time.

specific infection

Hip TB begins with weakness and fatigue, followed by a weak pull on the joint or aching muscle pain when walking. The patient began to retain limbs. As the condition progresses, pain radiates to the knee, along with swelling, redness, and synovitis. Acute brucellosis may present with straining and twisting pain as well as fever, swollen lymph nodes, and rash. In the chronic course of the disease, deformities develop over time.

congenital disease

Hip dysplasia is determined by the degree of misalignment between the femoral head and acetabulum. A congenital dislocation that causes pain and is associated with lameness from the moment the child begins to walk. With moderate subluxation, the pain that occurs at 5-6 years of age is related to loading on the leg. In subluxation, the pathology occurs for a long time without symptoms; with the development of dysplastic hip joints in 25-30 years, there is pain at rest, which worsens with movement. All forms of dysplasia are associated with asymmetric skin folds and limited mobility. If dislocated, shortening of the leg will be noticed.

tumor

The initial pain symptoms of benign tumors are mild and unstable, and will not progress in the long term. The growth of the tumor causes pain in the buttock area that slowly increases. Malignant tumors (osteosarcoma, chondrosarcoma) are characterized by mild, short-term pain, sometimes worsening at night. Subsequently, the pain becomes severe, persistent, cutting, surrounding, and spreading throughout the joint, causing swelling and deformation. Patients experience weight loss, weakness, and low-grade fever. In advanced cases, the pain becomes so unbearable that it can only be relieved with the help of narcotic drugs.

other reasons

Due to neuropathy of the sciatic nerve, hip pain sometimes occurs in the lower back, back, but gradually disappears compared to severe pain in the buttocks and back of the thigh, weakness in the lower limbs with sensory disturbances. . Dull pain and soreness occur in cases of osteochondrosis, disc herniation, spondylitis, spinal arthrodeformities and curvature of the spine due to overloading of the joints, hip joint disease and psychiatric disorders.

diagnosis

For initial diagnosis, the involvement of a general practitioner is required. Diagnostic measures of injuries were performed by the clinic's traumatologist. For degenerative and inflammatory diseases - orthopedic surgeons and rheumatologists. In order to treat the suppurative process, the involvement of the surgeon is necessary. The examination includes collecting complaints, studying medical history, physical examination and other hardware research methods. Taking into account the characteristics of the pathological process, the following methods are used:

• X-rays of the sacrolumbar spine, hip, and femur are the mainstay of investigation for most conditions and include detection of fractures, dislocations, changes in acetabular and femoral head contours, marginal and intraosseous defects, bony growth, and femoral head narrowing. Joint space.
• Diagnostic ultrasonography (ultrasound) is the most informative technique for identifying areas of calcification, inflammation, and degenerative processes in soft tissues.
• Magnetic resonance and computed tomography (MRI and CT) are clarifying methods that allow the use of contrast agents to define the nature, extent, and location of pathological lesions.
• Arthrocentesis is a therapeutic and diagnostic technique used to remove fluid buildup, study the composition of the fluid within a joint, and identify infection through laboratory testing.
• Arthroscopy is a method of assessing the condition of bone structure and soft tissue through visual inspection and, if necessary, taking biopsy samples for histological examination.
• Laboratory clinical blood tests determine inflammatory and rheumatological markers to assess the general condition of the body, the activity of infectious or systemic diseased organs.

In the future, more specialized specialists may be involved in diagnosis: physical therapists and surgeons, neurologists.

Comprehensive Treatment

Pre-diagnosis helpIn case of various severe trauma, splints are needed to immobilize the joints from the foot to the armpit. If the injury is minor, just apply a cold compress to the leg. If the pain is severe, give analgesics. It is strictly prohibited to use your feet to remove the dislocation by taking active movements. Mild manifestations of non-traumatic diseases should be treated with analgesics and anti-inflammatory drugs, and the lower limbs should be rested. If symptoms such as fever, weakness, severe pain, rapidly increasing swelling, and congestion occur, immediate medical attention is recommended.Conservative treatmentSevere dislocation should be reduced immediately. For leg fractures, skeletal traction is used, and then the patient is operated on or placed in a cast after callus appears. For older patients with femoral neck fractures, a derotation boot may be used for immobilization to prevent rotational motion of the joint. For other patients, orthotics or other devices such as crutches or canes are recommended to reduce the load on the hip joint. Physical therapy methods are prescribed, including massage, therapeutic exercises, manual therapy, and the following procedures:

• Laser Treatment;
• magnet therapy;
• UHF;
• ultrasound;
• Reflexology;
• drug electrophoresis;
• UV exposure.

To relieve pain, non-steroidal anti-inflammatory drugs (NSAIDs), antibacterial substances and other medications can be used. To strengthen the cartilage tissue of the pelvis, chondroprotectants are used, and muscle relaxants are used to eliminate muscle spasms. Topical preparations - ointments, creams with analgesic and anti-inflammatory effects are widely used.Arthrocentesis, intra-articular and peri-articular blockade with hormonal drugs, intra-articular injections of chondroprotectants and synovial fluid substitutes are performed according to the doctor's instructions.SurgerySurgical intervention in the hip joint is performed through open channels and with the help of arthroscopic equipment. The surgery is performed taking into account the type of pathology:

• Trauma: Acetabular reconstruction, cervical osteosynthesis, trochanteric fractures.
• Degenerative processes: Arthrotomy, arthroscopy, removal of loose intraarticular bodies.
• Tumors: excision, bone resection, hip disarticulation.
• Ankylosis and scarring of periarticular tissues may require correction, arthroplasty, and arthrodesis. Endoprosthesis is an effective method to restore lower limb movement function caused by joint destruction.

prevention

A sedentary lifestyle has a negative impact on the musculoskeletal system of everyone and aggravates the development of hip joint discomfort, therefore as a preventive measure it is recommended to perform special physical exercises and control weight through diet, since weight normalization, first of all, Helps relieve pressure on hip joints. An individual comprehensive physical therapy (physiotherapy) and rehabilitative medicine program will help return joints to their normal state; the goal is to improve quality of life and improve the health of men and women.