Diseases of the musculoskeletal system in almost all cases are accompanied by dysfunction of its organs, which causes a lot of inconvenience to the patient.
An important symptom of pathologies of the musculoskeletal framework is pain. Joint injuries are especially unpleasant.
The hip is the largest of them. Pain in case of its defeat can be localized both around it and give it to various anatomical structures: to the organs of the small pelvis, lower back or thigh.
General classification of causes
The etiology of hip pain is varied.
In medicine, the following causes of arthralgia are conditionally distinguished:
- Inflammatory and infectious processes inside the joint and its surrounding tissues.
- Degenerative diseases of the musculoskeletal system.
- Injuries.
- Neoplasms of bones and soft tissues.
There are additional specific causes of arthralgia:
- Piriformis Syndrome. Associated with her prolonged spasm.
- Necrosis of the femoral head (GBC). Most often it is a complication of another pathology of TBS.
- Legg-Calve-Perthes disease. She is osteochondropathy of the GBC.
- Dissecting osteochondrosis. In different sources it can be called Koenig's disease.
- Diabetic osteoarthropathy. Complication of diabetes.
- Pseudogout. Also chondrocalcinosis.
- Intermittent hydrarthrosis is an overproduction of synovial fluid.
- Synovial chondromatosis (Lotsch syndrome).
Also, the leg in the hip joint area in pregnant women often hurts.
During this period, complex hormonal changes occur, the growing uterus displaces neighboring organs and strains the ligamentous apparatus of the hip joint. In addition, weight gain increases the load on the legs. If dietary recommendations are not followed, a pregnant woman may develop a lack of calcium, because of this mineral imbalance, the structure of bones and joints is disturbed.
Causes of pain
The prevalence of arthralgia increases with age.In children, symptoms of TBS disease (hip joint) occur with a frequency of no more than 10%, and in the elderly - from 50%. Mostly women suffer from this pathology. This is due to age-related hormonal changes after menopause.
Why does the hip joint hurt? There is no definite answer to this question, since the list of reasons is quite long.
The main factors causing arthralgia in hip joint:
- Pathological process inside the muscular-ligamentous apparatus. Most often, this is a consequence of direct mechanical action: a bruise of the joint with subsequent inflammation of its components.
- Anatomical changes in the joint. They can be congenital or post-traumatic (dislocations, fractures).
- Pathology of other systems. Inflammation of the MT (pelvic organs) can spread to the pelvic bones. Neurological disorders are manifested by pain of any localization. Metabolic disorders cause mineral imbalance. The bone-ligamentous connection weakens, the risk of injury increases.
Inflammatory and infectious processes in the joints and surrounding tissues
The most common cause of arthralgia of any localization is suppuration of the musculoskeletal joint.
Inflammation in the hip joint is classified into:
- Primary. It is formed with direct penetration of pathogens into the joint: a blow with a sharp or blunt object with the formation of a wound.
- Secondary. TBS infection occurs from a distant focus of inflammation: by contact or by hematogenous route.
Arthritis TBS
Mostly occurs in elderly patients.Aching pain in the hip joint, aggravated by walking, radiates to the groin, perineum and thigh. It is difficult for the patient to stand up from a chair or climb stairs without assistance. Discomfort worse in the morning.
Therapy involves taking anti-inflammatory drugs and introducing glucocorticoids into the intraarticular bursa. If necessary, its cavity is drained.
Rheumatoid arthritis (RA)
This is a chronic systemic connective tissue disease similar to polyarthritis.The essence of this pathological process is the inflammation of the synovium, cartilage and joint capsule. The reason is a dysfunction of the immune system. Characterized by polyarthralgia, stiffness of movements in the morning, high fever is possible.
Shoulder and hip joints are affected extremely rarely, pain appears only at a late stage of RA after a couple of years from the onset of the disease.
Acute septic arthritis
This is an infectious childhood disease, 70% of cases occur in babies under 4 years old. The causative agent is usually Staphylococcus aureus. The child refuses to walk because of severe acute pain in the hip joint and groin when moving. Characterized by high temperature and increased excitability.
Treatment involves removal of the effusion from the joint cavity and antibiotic therapy.
The risk of developing osteomyelitis and sepsis is high.
Tuberculous coxitis or arthritis
Most often, pediatricians face this disease. In young children, the immune system is poorly developed, which leads to the possibility of infection.
This disease is characterized by slow progression. Initially, the child gets tired very quickly, his activity decreases, he stops running. Gradually, atrophy of the thigh muscles occurs. Movements are hindered. Pain in the hip joint in a child acquires an intense aching character, the limb becomes longer than a healthy one.
If pus melts the synovial membrane, then the exudate spreads along the muscles and tendons, forming phlegmon and fistulas.
In the absence of complications, conservative treatment is carried out.
Tendovaginitis in the area of hip joint
This pathology is an inflammation of the tendon of the muscle and its vagina. Caused by prolonged overuse or injury to the leg.
The main complaints: the femoral joint hurts when moving, the lesion swells, change in gait - lameness becomes noticeable.
Treatment - medication: anti-inflammatory drugs, intra-articular injections of corticosteroids.
Bursitis
Of all the synovial bags, the bursa of the acetabulum is most often inflamed.It partially covers the femur. With hip bursitis, pain radiates to the thigh and gluteal region. The patient is not able to lie on the affected side: the pressure in the synovial sac increases and the pain intensifies.
If there are no complications with bursitis, then the treatment consists in unloading the lower limb with a cane or crutch.
Medications: Painkillers and corticosteroids.
Idiopathic ankylosing spondylitis
This is a chronic inflammation of the spine and elements of the sacroiliac joints.
The disease is dangerous for its complications that reduce the standard of living and lead to disability.
If you find such a problem, you should immediately contact a specialist for the appointment of the correct treatment.
The etiology is not completely clear. Modern medicine suggests that the leading cause is hereditary predisposition. Most often people under 30 get sick.
Symptoms of idiopathic ankylosing spondylitis:
- Increased body temperature, fever.
- Intoxication syndrome: general malaise, weakness, lack of appetite, weight loss, sleep disturbance.
- Constant dull pain in the hip joint, as well as at the level of the sacrum and buttocks, spreading along the back of the thigh. Usually bilateral, at night their intensity increases.
- Limited mobility in the lower back and hips. This symptom gradually passes to the overlying sections of the spine along the entire back, including the neck. As a result, the patient takes a forced "beggar's position".
Rehabilitation therapy is based on special physiotherapy exercises for the development of the joints.
Medications: NSAIDs to relieve pain and inflammation, corticosteroids.
Tendinitis
Athletes or people whose work is associated with heavy physical labor are prone to inflammation of the tendons. Feature of the manifestation: aching pain in the hip joint occurs with a large load on it. At rest, discomfort is usually not observed.
It is recommended to reduce the load on the leg, in advanced cases - bed rest.
Drug treatment: NSAIDs, topical analgesic gels, glucocorticosteroids, chondroprotectors.
Syphilis
In the late stage of the disease, bones and joints are affected. The formation of gum is characteristic. Their excessive pathological mineralization occurs. TBS is extremely rare.
Gumma - a node in the tissues, formed during advanced syphilis, destroying the surrounding tissues. The process ends with the formation of rough scars.
Treatment is ineffective, the risk of developing complications in the form of osteomyelitis is high.
Fungal arthritis of the hip
It occurs as a result of prolonged use of antibiotics and with pathologies of the immune system.
People who are HIV-infected or have AIDS are especially susceptible to fungal arthritis.
Pain in the joint is present constantly, have aching character.
Fungal lesions of the bones are characterized by a tendency to fistula formation, duration and difficulty of treatment.
Therapy: systemic antimycotics.
According to indications, surgical intervention is performed.
Tumors of bones and soft tissues
Oncological diseases of the hip joint can be metastases of cancer of a distant organ or arise independently.
- Benign bone tumors are called osteomas.
The formation alien to the body grows, squeezing the nerves and blood vessels. The clinic is similar to piriformis syndrome.
- Malignant bone tumors - osteosarcomas.
The neoplasm rapidly increases in size, necrotic and disintegrates, spreading metastases throughout the body.Pain in the hip joints at night is unbearable, they do not stop even after taking NSAIDs or trying to anesthetize.
- Mesenchymal tumors are formed by soft tissues. Benign ones rarely recur and do not metastasize. Depending on the aggressiveness of malignant cells, the intensity of pain is variable.
Degenerative diseases of the joint
Coxarthrosis
Hip osteoarthritis is a chronic disease characterized by a change in the integrity of the articular surfaces, due to a violation of metabolic processes. It develops very slowly, over several years. Initially, cartilage tissue is affected, then bone tissue, followed by varus deformity of the joint and limb. Occurs at the age of 40 years.
Symptoms:
- The hip joint hurts only when walking.
- Stiffness of movements in the TBS.
- As the process progresses, a shortening of the length of the limb is observed.
- Weakness and atrophy of the muscle mass.
- Lameness.
- When walking, a crunch is heard.
- With a bilateral lesion, a "duck gait" occurs - transferring from one leg to another.
Medicines: NSAIDs, vasodilators, muscle relaxants, chondroprotectors, injections of hormonal drugs into the joint cavity.
Local effects: ointments, lotions, compresses.
At the last stage of the disease, surgery is in progress.
Osteochondrosis
Degenerative changes in the intervertebral discs cause damage to surrounding tissues.
Symptoms:
- Pain in the lower back radiating to the hip joint and thigh.
- It is sudden, sharp and sharp. It starts in the lumbar region and buttocks, descends down the back of the leg.
- Unilateral localization of pain is more common.
- The patient takes a forced position - lying on a healthy side.
- Probably decreased sensitivity of the skin of the leg.
Treatment is complex. Anti-inflammatory drugs and analgesics, moderate physical activity (swimming), physiotherapy after subsiding of the most acute phenomena.
With pronounced pain, it is recommended to make an anesthetic blockade.
Injuries
Injury
Pain of moderate intensity is characteristic, during active movements its intensity increases. The first time after injury to the hip joint, lameness appears, which quickly passes.
At rest, the symptoms disappear.
In order to quickly get rid of pain in case of a pelvic joint injury, it is necessary to apply cold to the injury site: an ice pack or a frozen product.
hip dislocation
May be:
- Congenital. It is the result of unsuccessful birth or pathologies of intrauterine development. The child has uneven gluteal folds and shortening of the limb, possibly a pinched nerve, manifested by convulsions. If the dislocation is not corrected in infancy, then later the child may become disabled.
- Traumatic. Signs: sharp severe pain, complete shutdown of joint function, massive edema and extensive hematoma appear above the damaged area. Getting up from a chair or bed becomes impossible for the patient without assistance.
In case of hip dislocation, you should immediately go to the emergency room or hospital.
fractures
The hip joint is formed by powerful strong bones.
The most common diagnosis from this subgroup is a fracture of the surgical neck of the femur. It is put mainly to women after 60 years.
The cause of such damage is a fall or impact in the area of the TBS.
The strongest pain is felt, the hip joint pulls and abscesses, movement in it is almost impossible. The upper thigh area swells, an extensive hematoma appears. The injured leg is shortened, the patient limps. When moving, a characteristic click is heard.
When a fracture occurs, the surrounding tissues are damaged, which is accompanied by a burning sensation. In the absence of treatment, an inflammatory process can begin here. If the nerve is pinched, you may experience a feeling of numbness in the thigh.
Treatment is complex: surgical and medical.
Specific causes of arthralgia
Piriformis Syndrome
With the localization of pathological processes in the area of the hip joint, the surrounding tissues are also affected. A long-term spasmodic piriformis muscle compresses the sciatic nerve and its vessels, which causes a number of symptoms:
- Pain in the leg in the region of the hip joint. She goes to the buttocks and the lumbosacral joint.
- Increased discomfort when relying on the affected leg.
- Compaction of the piriformis muscle.
- Sudden pain "lumbago" along the nerve.
Etiology: injuries and infectious and inflammatory diseases of the pelvic organs, vertebrogenic pathologies, muscle overtraining, long-term preservation of a non-physiological posture.
Medications: NSAIDs, muscle relaxants, analgesics, blood circulation improvers, glucocorticoids.
After the subsidence of acute phenomena, rehabilitation measures can be prescribed: physiotherapy, massage, acupuncture.
Aseptic necrosis of the femoral head
The vast majority occurs in young men. The etiology of the disease is ischemia of the upper thigh. With insufficient blood supply to the tissues, their oxygen starvation occurs and their necrosis (necrosis) begins.
Clinical picture: the hip joint hurts and gives to the leg and perineum. Reliance on the injured leg is not possible. After a few days, the nerve endings melt and the pain disappears. This is a terrible sign! With necrosis of the deeper layers of the bone, the risk of rapid development of osteomyelitis and sepsis is high.
Treatment is surgery and drug therapy.
Koenig's disease
Dissecting osteochondritis - exfoliation of a small necrotic cartilaginous area from the bone and its protrusion into the articular cavity.
This is a rare disease. Typical for men 15-35 years old.
Patients complain of mild aching pain in the hip joint. The joint "sticks" when moving.
Treatment is conservative (duration 10-18 months) and surgical. During surgical intervention, the exfoliated masses are removed, the congruence (comparability) of the articular surfaces is restored.
Diabetic osteoarthropathy
Violation of glucose metabolism leads to circulatory disorders and innervation of all organs. Changes in the hip joint are more often unilateral: on the right, it occurs more often than on the left. The immune response is reduced, which facilitates infection of the body.
Clinical picture:
- Swelling of the joint.
- The skin over it is cold to the touch.
There is no pain syndrome in diabetic osteoarthropathy!
Treatment consists of careful monitoring of blood glucose levels and the timely administration of insulin.
pseudogout
This pathology is the deposition of calcium salts in the articular cartilage.
Doctors associate it with endocrine pathologies: hyperparathyroidism, diabetes mellitus, gout, etc.
Symptoms:
- Beginning with acute pain in hip joint.
Several types of calcium salts are known. With some of them (pyrophosphates), there is no pain.
- Movement in it is limited, abduction of the leg to the side is difficult.
- Edema and hyperemia are characteristic.
- Increased body temperature and fever.
To date, there is no specific treatment. An acute attack is stopped by intra-articular administration of corticosteroids and NSAIDs.
Intermittent hydrarthrosis
This is a chronic disease, manifested by bouts of increased production of synovial fluid. prone to frequent relapses.
It is diagnosed mainly in women 20-40 years old.
The etiology is unknown. There are two theories of the occurrence of this disease: associated with injuries and caused by endocrine disorders.
The joint increases in size, becomes stiff.
Attacks pass on their own in 3-5 days.
Medical treatment is ineffective. Relapses occur even after surgery.
Synovial chondromatosis
This benign metaplastic disease is the replacement of synovial collagen with cartilage. The structure of the articular surface changes, as do its properties.
The chance of getting chondromatosis is much higher in men, predominantly of middle and older age.
The etiology is unclear.
There is local swelling, limited function of the joint, crunching during its work, arthralgia.
Treatment is only surgical.
Hip pain in children and adolescents
epiphysiolysis
This pathology is most typical for children during puberty (from 11 to 16 years). At this time, there is a sharp jump in growth. Due to the weak growth zone, the HBA slips onto the neck, which results in discomfort in the hip joint.
The child feels pain in the thigh, passing into the groin and knee. Lameness is noted, but reliance on the limb is maintained.
The disorder is corrected surgically. Therapy should be started as early as possible. Otherwise, the slippage of HBA can cause the development of arthrosis and inflammation of the joints.
Dysplasia
It is an excessive formation of connective tissue that can replace bone elements. As a result, solid anatomical structures become plastic, flexible. Ligaments, menisci and tendons become weak. An unstable hip is formed, which is distinguished by frequent dislocations.
Dysplasia is a hereditary disease that usually occurs in infants from 3 months to 1 year. Orthopedists can easily cope with the correction of the setting of the legs.
The latent form may show up in adolescence.
If you notice manifestations of clubfoot or foot deformity in a child, then you need to quickly go to the hospital for an examination of the baby's musculoskeletal system!
The later dysplasia is detected, the more problematic its treatment.
Osteochondropathy
This group of diseases includes lesions of bone and cartilage tissue, in which the most loaded areas undergo aseptic necrosis.
Etiology: genetic predisposition, hormonal imbalances and infections can provoke this pathology.
In 30% of cases, the hip joint is affected. These are predominantly childhood diseases that are common in adolescents during the growth spurt.
An adult should at the initial stage determine the localization and nature of pain, contact a pediatrician and obtain the necessary information to prevent the development of complications.
Legg-Calve-Perthes disease
The syndrome is characterized by HBK necrosis in children under 15 years of age. The right hip joint is more commonly affected.
The cause of the pathological condition is a violation of blood circulation in the upper part of the leg with the addition of cartilage tissue to the process.
Clinical picture:
- Initially, the head of the femur hurts. With the progression of necrosis, arthralgia suddenly disappears. This indicates the death of sensitive organ receptors.
- Change in gait - the child begins to limp.
- Movement in TBS is limited.
- Most often unilateral.
Complications: dislocation, coxarthrosis, deformity of the lower limb, muscle atrophy.
Diagnostic measures
Before prescribing treatment, the doctor must carefully study the complaints, anamnesis and conduct an examination.
In case of hip joint disease, the following studies are necessary:
- Laboratory blood tests (with inflammation, the ESR increases and leukocytosis is noted).
- Plain radiography of the joint in two or more projections.
- MRI with or without contrast.
- MSCT. It is used to check for the presence of a sarcoma.
- Osteoscintigraphy. radionuclide method. The most common and informative type of bone tissue examination.
- Ultrasound of the hip joint.
- Densitometry. Required to determine bone density and strength.
If the patient cannot sit or stand, and it is useless to relieve pain, then he is immediately sent to hospital for further surgical treatment.
When to see a doctor urgently
- When there is a sharp pain when moving in the hip joint.
- If it is impossible to support the affected leg.
- Detection of edema of the lumbar and femoral region.
- Redness or bruising in the affected area.
There are folk ways to relieve pain in the pelvic joint. Relying on these tips for a quick cure is not worth it. Without a thorough diagnosis, it is impossible to determine the cause of arthralgia, and self-medication will lead to the development of complications.