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 musculoskeletal pathologies is pain. Joint injuries are especially unpleasant.
The hip is the biggest one. Pain in case of defeat can be localized both around and 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 within the joint and its surrounding tissues.
- Degenerative diseases of the musculoskeletal system.
- injuries.
- Bone and soft tissue neoplasms.
There are additional specific causes of arthralgia:
- Piriformis Syndrome. Associated with its prolonged spasm.
- Femoral head necrosis (GBC). Most often it is a complication of another pathology of TBS.
- Legg-Calve-Perthes disease. She is GBC osteochondropathy.
- Dissection of osteochondrosis. In different sources it can be called Koenig's disease.
- Diabetic osteoarthropathy. Complication of diabetes.
- Pseudogout. Also chondrocalcinosis.
- Intermittent hydrathrosis is an overproduction of synovial fluid.
- Synovial chondromatosis (Lotsch syndrome).
Also, the leg in the area of the hip joint 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, due to 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 (hip joint) disease occur with a frequency of not more than 10%, and in the elderly - from 50%. Mainly women suffer from this pathology. This is due to age-related hormonal changes after menopause.
Why does the hip joint hurt? There is no definitive answer to this question as the list of reasons is quite long.
The main factors that cause arthralgia in the hip joint:
- Pathological process within the muscle-ligament apparatus. Most often this is a consequence of direct mechanical action: a contusion 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 TM organs (small pelvis) can spread to the pelvic bones. Neurological disorders are manifested by pain from any location. Metabolic disorders cause mineral imbalance. The bone-ligament 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 location 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 via the hematogenous route.
TBS arthritis
It mainly occurs in elderly patients.Painful pain in the hip joint, aggravated by walking, radiates to the groin, perineum, and thigh. It is difficult for the patient to get up from a chair or climb stairs without assistance. Discomfort worse in the morning.
Therapy involves the administration of anti-inflammatory drugs and the introduction of glucocorticoids into the intra-articular pocket. If necessary, your cavity is drained.
Rheumatoid arthritis (RA)
This is a chronic systemic connective tissue disease similar to polyarthritis.The essence of this pathological process is 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.
The shoulder and hip joints are affected extremely rarely, the pain only appears in a late stage of RA after a few years of the disease onset.
acute septic arthritis
This is a childhood infectious 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 sharp pain in the hip joint and groin when moving. Characterized by high fever 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.
Tuberculosis 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 slows down, he stops running. Gradually, atrophy of the thigh muscles occurs. Movements are impeded. Pain in the hip joint in a child acquires an intense character of pain, the limb becomes longer than a healthy one.
If the pus melts the synovial membrane, the exudate spreads along the muscles and tendons, forming phlegm and fistulas.
In the absence of complications, conservative treatment is performed.
Tendovaginitis in the hip joint area
This pathology is an inflammation of the muscle tendon and your vagina. Caused by prolonged overuse or leg injury.
The main complaints: the femoral joint hurts when moving, the lesion swells, change in gait - lameness becomes noticeable.
Treatment - medications: anti-inflammatories, intra-articular injections of corticosteroids.
bursitis
Of all the synovial bursa, the acetabular bursa is the most inflamed.Partially covers the femur. With hip bursitis, the pain radiates to the thigh and gluteal region. The patient is unable to lie down on the affected side: pressure in the synovial sac increases and the pain intensifies.
If there are no complications with bursitis, treatment consists of unloading the lower limb with a cane or crutch.
Medications: Analgesics 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 lower the standard of living and lead to disability.
If you encounter such a problem, immediately contact a specialist for the appointment of the correct treatment.
The etiology is not completely clear. Modern medicine suggests that the main cause is hereditary predisposition. Most of the time, people under the age of 30 get sick.
Symptoms of Idiopathic Ankylosing Spondylitis:
- Increase in body temperature, fever.
- Intoxication syndrome: general malaise, weakness, lack of appetite, weight loss, sleep disturbances.
- Constant dull pain in the hip joint, as well as at the level of the sacrum and buttocks, spreading to the back of the thigh. Usually bilateral, at night its intensity increases.
- Limited mobility in the lower back and hips. This symptom gradually passes into the overlying sections of the spine along the entire back, including the neck. As a result, the patient assumes a forced "petitioner pose".
Rehabilitation therapy is based on special physical therapy exercises for joint development.
Medications: NSAIDs to relieve pain and inflammation, corticosteroids.
tendinitis
Athletes or people whose work is associated with heavy physical work are prone to tendon inflammation. Feature of 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. Gum formation is characteristic. Its excessive pathological mineralization occurs. TBS is extremely rare.
Gum - a knot 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 infected with HIV or with AIDS are especially susceptible to fungal arthritis.
Joint pain is constantly present, has a painful character.
Fungal lesions of bones are characterized by a tendency to form fistulas, duration and difficulty of treatment.
Therapy: systemic antimycotics.
According to the indications, surgical intervention is carried out.
Bone and soft tissue tumors
Oncological diseases of the hip joint can be cancer metastases from a distant organ or arise independently.
- Benign tumors of bone tissue - osteomas.
The foreign formation in the body grows, compressing 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.The hip joint pain at night is unbearable, they don't stop even after taking NSAIDs or trying to numb.
- Mesenchymal tumors are formed by soft tissue. Benign ones rarely recur and do not metastasize. Depending on the aggressiveness of the malignant cells, the intensity of pain is variable.
Degenerative joint diseases
Coxarthrosis
Hip osteoarthritis is a chronic disease characterized by a change in the integrity of joint surfaces, due to a violation of metabolic processes. It develops very slowly, over several years. Initially, cartilaginous tissue is affected, then bone tissue, followed by varus deformity of the joint and limb. Occurs at age 40.
Symptoms:
- The hip joint hurts only when walking.
- Rigidity of movements in TBS.
- As the process progresses, a shortening of the length of the limb is observed.
- Weakness and atrophy of muscle mass.
- Lameness.
- When walking, you hear a pop.
- With a bilateral injury, a "duck gait" occurs - transfer from one leg to the other.
Medications: NSAIDs, vasodilators, muscle relaxants, chondroprotectors, injections of hormonal drugs into the joint cavity.
Local effects: ointments, lotions, compresses.
In the last stage of the disease, surgery is in progress.
osteochondrosis
Degenerative changes in intervertebral discs cause damage to surrounding tissues.
Symptoms:
- Pain in the lower back radiating to the hip and thigh joint.
- It's sudden, sharp and sharp. It starts in the lower back and buttocks, goes down the back of the leg.
- Unilateral location of pain is more common.
- The patient assumes a forced position - lying on his healthy side.
- Probably decreased sensitivity of the skin of the leg.
Treatment is complex. Anti-inflammatories and analgesics, moderate physical activity (swimming), physical therapy after the disappearance of the most acute phenomena.
With pronounced pain, an anesthetic block is recommended.
injuries
Prejudice
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.
To quickly get rid of pain in case of injury to the pelvic joint, it is necessary to apply cold to the place of injury: an ice pack or a frozen product.
hip dislocation
Perhaps:
- Congenital. It is the result of unsuccessful birth or pathologies of intrauterine development. The child has irregular gluteal folds and limb shortening, possibly a pinched nerve, manifested by seizures. If the dislocation is not corrected in childhood, the child may later become disabled.
- Traumatic. Signs: sharp, severe pain, complete shutdown of joint function, massive swelling, 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 made up of strong and powerful bones.
The most common diagnosis in this subgroup is fracture of the surgical neck of the femur. It is mainly placed for women after 60 years.
The cause of such damage is a fall or impact on the TBS area.
The strongest pain is felt, the hip joint pulls and abscesses, movement is almost impossible. The upper area of the thigh 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 start here. If the nerve is pinched, you may feel a numb sensation in your thigh.
The 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 several symptoms:
- Leg pain in the hip joint region. It goes to the buttocks and the lumbosacral joint.
- Increased discomfort when relying on the affected leg.
- Piriformis muscle compression.
- Sudden "lumbago" pain along the nerve.
Etiology: Infectious and inflammatory injuries and diseases of Organs pelvic organs, vertebrogenic pathologies, muscle overtraining, long-term preservation of a non-physiological posture.
Medications: NSAIDs, muscle relaxants, analgesics, blood circulation enhancers, glucocorticoids.
After the disappearance of the acute phenomena, rehabilitation measures can be prescribed: physiotherapy, massage, acupuncture.
Aseptic necrosis of the femoral head
The vast majority occur in young men. The etiology of the disease is ischemia of the upper thigh. With insufficient blood supply to the tissues, a lack of oxygen occurs and necrosis (necrosis) begins.
Clinical picture: the hip joint hurts and affects the leg and perineum. The injured leg cannot be trusted. After a few days, the nerve endings melt and the pain disappears. This is a terrible sign! With necrosis of the deeper layers of bone, the risk of rapid development of osteomyelitis and sepsis is high.
Treatment consists of surgery and drug therapy.
Koenig's disease
Osteochondritis dissecans - exfoliation of a small necrotic cartilaginous area of bone and its protrusion into the joint cavity.
This is a rare disease. Typical for men 15 to 35 years old.
Patients complain of mild pain in the hip joint. The joint "sticks" when moving.
Treatment is conservative (duration 10-18 months) and surgical. During the surgical intervention, the exfoliated masses are removed, the congruence (comparability) of the joint 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 makes it easier for the body to become infected.
Clinical condition:
- Joint swelling.
- The skin over it is cool to the touch.
There is no painful syndrome in diabetic osteoarthropathy!
Treatment consists of careful monitoring of blood glucose levels and 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, gout, etc.
Symptoms:
- Starting with sharp pain in the hip joint.
Various 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.
- Increase in 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 crises of increased production of synovial fluid. prone to frequent relapses.
It is mainly diagnosed in women aged 20 to 40 years.
The etiology is unknown. There are two theories for the occurrence of this disease: associated with injuries and caused by endocrine disorders.
The joint increases in size, becomes rigid.
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 middle-aged and older.
The etiology is unclear.
There is local swelling, limited joint function, grinding while working, arthralgia.
Treatment is surgical only.
Hip pain in children and adolescents
epiphysiolysis
This pathology is more typical for children during puberty (from 11 to 16 years old). Right now, there is a sharp jump in growth. Due to the weak growth zone, the HBA slips into the neck which results in discomfort in the hip joint.
The child feels pain in the thigh, moving to the groin and knee. Lameness is noted, but trust in the limb is maintained.
The disorder is surgically corrected. You should start therapy as soon as possible. Otherwise, slippage of HBA can cause osteoarthritis and joint inflammation to develop.
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 an inherited disease that usually occurs in babies aged 3 months to 1 year. Orthopedists can easily handle leg configuration correction.
The latent form may appear 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 is its treatment.
osteochondropathy
This group of diseases includes lesions of bone and cartilage tissue, in which the most heavily loaded areas undergo aseptic necrosis.
Etiology: genetic predisposition, hormonal imbalances and infections can cause this pathology.
In 30% of cases, the hip joint is affected. These are predominantly childhood diseases that are common in teenagers during the growth spurt.
An adult should, at an early stage, determine the location and nature of the pain, contact a pediatrician, and obtain the necessary information to prevent complications from developing.
Legg-Calvé-Perthes disease
The syndrome is characterized by necrosis of HBK in children younger than 15 years. The right hip joint is most commonly affected.
The cause of the pathological condition is a violation of blood circulation in the upper leg with the addition of cartilaginous tissue to the process.
Clinical condition:
- Initially, the head of the femur hurts. As necrosis progresses, the arthralgia suddenly disappears. This indicates the death of sensitive organ receptors.
- Change in gait - the child begins to limp.
- Movement on TBS is limited.
- Mostly one-sided.
Complications: dislocation, coxarthrosis, lower limb deformity, muscle atrophy.
diagnostic measures
Before prescribing treatment, the doctor should carefully study the complaints, anamnesis and carry out an examination.
In case of disease of the hip joint, the following studies are necessary:
- Laboratory blood tests (with inflammation, ESR increases and leukocytosis is noted).
- Plain radiograph of the joint in two or more views.
- 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 is unable to sit or stand, and pain relief is useless, he or she will be immediately sent to the hospital for further surgical treatment.
When to see a doctor urgently
- When there is sharp pain when moving 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 popular ways to relieve pelvic joint pain. Relying on these tips for a quick cure is not worth it. Without a complete diagnosis, it is impossible to determine the cause of arthralgia, and self-medication will lead to the development of complications.