The hip joint is the largest joint in the human body. Every day you make thousands of movements while walking, running, climbing stairs and doing physical exercises. Constant loads, inflammatory processes, injuries and diseases can cause coxalgia, pain in the hip joint. It is necessary to establish the cause of its appearance as soon as possible to avoid limitation of mobility and disability.
Classification of pain sensations.
During a visit to the doctor, it is necessary to describe in detail the nature of the pain: the degree of severity, intensity, frequency; The accuracy of the diagnosis depends on this. Depending on the nature of the pain, it may be:
- Spicy.In this case the pain is intense, even unbearable. It can appear suddenly and also disappear suddenly. As a rule, a patient with acute pain can quite accurately indicate the area of its localization. Acute pain can radiate and extend to the areas closest to the origin of the pathology.
- Pain.The pain is not that intense, sometimes it can feel like a discomfort and it does not have an exact location. The pain may intensify during movement or after exercise and disappear for a while.
- Chronic.This category generally includes pain that occurs with varying regularity for more than six months. Chronic pain is generally the most difficult to treat.
Possible sources of pain.
The main causes of pain in the hip joint are:
- injuries,
- infectious diseases,
- inflammatory processes,
- degenerative tissue changes,
- pathologies of the development of the musculoskeletal system.
Injuries
In case of traumatic damage to the hip joint and femur, pain appears immediately, accompanied by redness and swelling of the tissue, limited mobility of the limb and the formation of extensive hematomas. Depending on the severity of the injury, the pain may be more or less intense.
If hit or fallen on its side, soft tissue bruising may occur. It is characterized by the formation of hematomas, pain at the site of injury intensifies on palpation. Unlike a dislocation and fracture, with a hematoma there is no restriction in the mobility of the injured leg, there are no visually discernible deformities, and the limb fully retains its functions.
Dislocation of the hip joint in a healthy person can only occur under very strong physical impact, for example, when falling from a great height or in a car accident.
The limb adopts a position of forced rotation, more often inward and less often outward. The pain is intense, accompanied by swelling, numbness (if the nerves are affected), the victim cannot move the injured limb.
Femoral neck fracture
The cause of pain in the hip joint may be a violation of the integrity of the femoral neck, an injury that mainly affects older women who have crossed the threshold of 60 years. Hormonal and age-related changes in the body after menopause accelerate the calcium leaching process, causing bones to become brittle and brittle even with minor exposure. A fall, bruise, or even a careless movement can cause a fracture of the femur in its thinnest part, where the shaft connects to the head embedded in the hip joint.
The symptoms of a hip fracture are:
- pain in the pelvic area, which radiates to the groin and lower back, and is aggravated by hitting the heel;
- shortening of the injured leg;
- limited mobility, inability to lean on the injured leg;
- outward rotation position of the limb;
- "Stuck heel" syndrome - the inability to lift the straight leg off the surface from a lying position.
A fracture of the femoral neck may occur; In this case, the bone fragments fit together. In this case, the functions of the limb can be partially or even completely preserved, but when the fragments are crushed, signs of injury will appear as a whole. An injury of this type requires immediate intervention, so if you suspect a fracture, you should seek medical help as soon as possible.
Inflammatory processes
One of the main causes of hip pain is inflammatory processes in the tissues of the joint or its surroundings.
Arthritis is inflammation of the cartilage tissue of the joint. The causes may be infections, chronic injuries, metabolic disorders, excessive stress and systemic connective tissue diseases. The symptoms of the disease, in addition to pain, which intensifies after exercise or at night, are redness and swelling of the tissues in the affected joint area, a local increase in temperature and limited mobility of the leg.
Rheumatoid arthritis is a systemic connective tissue disease of an autoimmune nature. Women are more susceptible to the disease. It affects both small and large joints, most often the even ones. Characteristic symptoms of rheumatoid arthritis:
- joint pain, which worsens at night and disappears after movement;
- formation of subcutaneous compactions in the affected joint area, the so-called rheumatic nodules;
- redness, swelling and local increase in temperature in the affected joints.
Bursitis is an inflammatory process that develops in the synovial bursa of a joint, accompanied by a pathological accumulation of exudative fluid in the tissues of the joint. The main causes of the development of the disease are considered to be injuries, excessive physical activity, infections and complications of arthritis of various etiologies. Bursitis pain occurs deep inside and spreads to the outer surface.
Ankylosing spondylitis is an idiopathic disease, that is, in most cases the exact causes of its appearance cannot be established. It is assumed that pathology is genetically determined and hereditary predisposition plays an important role in its development.
Most often, the manifestation of the disease occurs at the age of 20-30 years, its first symptoms are pain in the lower back, hips and buttocks, which worsens at night, stiffness, ankylosis that develops rapidly: joint immobility. In the later stages, if left untreated, the disease causes serious deformations of the joint tissue, causing profound disability.
Degenerative tissue changes.
Coxarthrosis or osteoarthritis of the hip joints, a degenerative change in cartilage tissue, is a common cause of hip pain in people over 40 to 45 years of age. The disease is chronic and progressive. The causes of its development are considered to be chronic injuries, hereditary predisposition, age-related changes and concomitant inflammatory diseases of the joints. In young people, the development of coxarthrosis may be due to congenital dysplasia of the hip joint.
Symptoms of pathology:
- pain in the groin, lower back, buttocks, thighs, which increases with movement and decreases at rest;
- muscular weakness;
- intermittent claudication, "duck" gait with bilateral joint damage;
- limb dysfunction, difficulties with abduction, adduction, rotation.
Infectious diseases
Infectious arthritis, which is also a common cause of coxalgia, can develop as a result of the entry of pathogenic microorganisms into the joint tissue from a distant focus of a viral or bacterial infection through the bloodstream. It can be caused by streptococci, staphylococci, Pseudomonas aeruginosa and tuberculosis bacilli, pallidum spirochetes, influenza viruses and other agents.
In infectious arthritis, joint pain is accompanied by redness and swelling of the surrounding tissues, as well as general symptoms: fever, malaise and weakness.
Other reasons
In addition to injuries, inflammation, and infections, hip joint pain can be caused by:
- Innervation disorders.Inflammation and pinching of nerve roots, particularly the sciatic nerve, can cause pain in the hip, inguinal triangle, and buttocks.
- Formation of neoplasms., including malignant ones, in the tissues of the joint and its surroundings.
- Aseptic necrosis of the femoral head.Chronic poor circulation in tissues causes degenerative changes in cartilage and bone tissue, and can lead to complete destruction of bone structures.
- Juvenile epiphysiolysis.Chronic pain in the hip joint in children and adolescents may be due to the development of epiphysiolysis - a pathological displacement of the femoral head caused by hormonal disorders in the body. Boys are more susceptible to the disease, but in rare cases it is also diagnosed in girls. As a rule, pathology is accompanied by delays in sexual development and endocrine disorders.
Pain in the hip joints is a common occurrence in women in the third trimester of pregnancy. Causes of coxalgia in pregnant women:
- increased body weight and shift of the center of gravity, redistribution of the load on the musculoskeletal system;
- natural hormonal changes: shortly before giving birth, a woman's body begins to produce a hormone that relaxes the ligaments;
- pressure of the enlarged uterus on large vessels and nerves, impaired innervation and blood circulation in the pelvic organs and lower extremities;
- calcium deficiency in the body of the future mother.
If the pain during pregnancy was caused by the above factors, a few weeks after birth they should disappear without a trace. If, a month after the birth of the child, the pain is still present, a doctor should be consulted.
Alarming symptoms
Pain in the hip joint is an alarming symptom, which is a mandatory reason for visiting the doctor. The sooner the cause of coxalgia is identified, the greater the chance of a complete cure. However, there are cases in which seeking medical help should be immediate:
- pain in the joint area occurs after a fall, blow, bruise or any other injury, while the mobility of the limb is affected;
- the tissues around the joint are red and swollen, and the general body temperature rises to feverish levels (38 and above);
- there are problems with defecation and urination.
Diagnosis
The first step in determining the cause of hip pain is to see a doctor. The surgeon or orthopedist will collect a history, find out the nature of the pain, the frequency and degree of its manifestation, and also examine the patient to assess the mobility of the joint and the condition of the surrounding tissues. To make an accurate diagnosis, laboratory and instrumental diagnostic methods can be prescribed:
- general, biochemical, serological, immunological blood tests;
- x-ray of the bones of the pelvis, thighs and hip joints;
- ultrasound examination of the tissues of the joint and the tissues surrounding it;
- MRI and CT scan to obtain an accurate three-dimensional image of the affected area;
- endoscopy of the joint using a probe inserted into its cavity;
- puncture to study the effusion: pathological fluid that accumulates in the joint capsules;
- tissue biopsy.
Treatment methods
Treatments for conditions that cause hip pain depend on the underlying cause. In cases where the pain is caused by an injury, the main method of conservative treatment will be immobilization of the joint; In some cases surgery may be necessary. If the pain is inflammatory in nature, hormonal or non-steroidal anti-inflammatory drugs may be prescribed; For general infectious diseases, antibiotic therapy or antiviral drugs will be required.
Pain syndrome, regardless of the cause of its occurrence, is relieved by taking pain relievers or blocking injections.
Immobilization
Immobilization is most often prescribed for joint injuries. Tight bandages, plaster splints or plastic orthoses can be used for fixation.
drug therapy
Depending on the cause of the coxalgia, the following may be prescribed:
- non-steroidal anti-inflammatory drugs or glucocorticoids to relieve inflammatory processes;
- chondroprotectors to stop degenerative changes in joint tissues;
- antibiotics and antiviral drugs in case of arthritis of an infectious nature;
- Muscle relaxants to reduce muscle spasms.
Physiotherapeutic procedures.
At the rehabilitation stage after injury, as well as during the period of remission of diseases, the following physiotherapy methods are used to restore joint mobility, improve blood circulation and restore limb function:
- physiotherapy,
- massage,
- magnetotherapy,
- balneotherapy,
- laser therapy,
- UHF heating,
- hirudotherapy.
endoprostheses
In some cases, conservative treatment of hip joint pain may be ineffective. Aseptic necrosis, coxarthrosis in a late stage and fracture of the femoral neck in elderly people are direct indications for endoprosthetic surgery - replacement of the head and acetabulum of the hip joint with a prosthesis made of chemically and biologically inert materials .
The operation allows you to shorten the rehabilitation process and return the patient to full movement.
Prevention of coxalgia
A set of preventive measures will help prevent the appearance of pain in the hip joints, including:
- regular feasible physical activity to strengthen muscles and ligaments;
- nutritious and balanced nutrition;
- control of body weight, since overweight and obesity create additional stress on the musculoskeletal system;
- avoid injuries and excessive physical activity;
- rejection of bad habits;
- timely and adequate treatment of inflammatory and infectious diseases;
- Periodic preventive examinations with a doctor.