Hip pain

One of the most common symptoms with which patients come to a medical facility is pain in the hip joint. The causes, treatment and possible diseases causing such a manifestation cannot be identified without qualified medical care. Discomfort in any part of the musculoskeletal system can indicate the development of serious pathologies, therefore dysfunction of the hip joint should not be ignored.

Anatomy of the hip joint area

The hip joint plays an important role in motor activity. This is one of the largest human joints, capable of withstanding heavy loads both in a standing position and when walking upright.

Bones that form a joint

The hip joint is formed by the head of the femur and the acetabulum of the innominate pelvic bone, the most powerful and largest parts of the human skeleton. The minimum number of anatomical elements of the joint guarantees its strength and reliability, the ability to withstand body weight during movement. Most hip joint diseases begin with damage to the acetabulum, the immobile part of the joint. It has the shape of a bowl, the center of which points upwards at a slight angle, ensuring even distribution of the load between the pelvic bones.

The glenoid cavity is a strong and solid formation, composed of 3 types of pelvic bones:

• ileal
• ischial
• pubic

The most vulnerable area of the joint cavity is in children whose bone tissue is not strong enough. Due to the presence of a small bony ridge at the edge of the socket, the head of the femur is completely immersed in the "bowl", which provides strong support to the limb. The movable part of the joint is the femur (head, neck, greater and lesser trochanter). The shape of the head corresponds to the cavity of the joint cavity. It is covered with cartilaginous tissue, which guarantees the perfect alignment of the joint elements and their smooth sliding. In the center of the head is a strong ligament that connects the bone to the acetabulum, providing additional grip and support.

The neck emerges from the head of the femur at an obtuse angle, which ensures the mobility of the joint and uniform distribution of the load between the limbs. Trochanters are bony projections to which muscle tendons are attached.

Fabrics and structures

The normal functioning of the joint is ensured by a variety of structures, each of which performs corresponding functions.

Blood supply, performance and decreased sensitivity of the joint are provided by:

1. Ligaments and tendons surround the joint on all sides, covering and protecting the femur and its neck, as well as the socket itself.
2. Cartilage covers the head of the femur and part of the acetabulum.
3. The subcartilaginous areas are bone tissue made up of cells and extracellular connective substance.
4. The joint membrane or capsule is the source of a special secretion: synovial fluid to lubricate the parts of the joint.
5. The acetabular labrum connects the rim of the acetabulum and the transverse ligament.

The hip joint is supplied with nutrients through a fairly isolated network of vessels and arteries. The blood supply to the internal parts of the joint is provided by the acetabular branch of the obturator artery, while the surrounding capsules, ligaments and muscles are supplied through the deep arteries of the thigh and buttocks.

Anatomical formations located near the hip joint

Often the cause of pain in the hip joint is damage to the anatomical structures located next to it. These elements include:

1. Skin and subcutaneous tissue: the outer covering of the body
2. The muscles of the thigh, pelvis, lower back and buttocks provide joint mobility and further strengthen it from the outside
3. Extra-articular ligaments: perform a strengthening function, located around the joint capsule
4. Periarticular bursae are bundles of connective tissue that prevent friction between the soft and hard tissues

Risk factors

Inflammatory processes in the pelvic area occur due to mechanical damage or damage to certain types of bacteria. In this case, both the elements of the joint and the anatomical formations surrounding them can be exposed to pathological effects.

As a rule, one or more structures become inflamed:

• skin
• muscles
• ligaments (extra-articular, femoral heads)
• periarticular bags
• TBS capsule
• cartilage
• acetabular labrum
• subcartilaginous areas

Hip joint pain is often caused by harmful microorganisms that provoke the development of infectious arthritis. Other reasons are also common:

• immune system disorders
• joint injuries due to excessive physical activity
• old age
• metabolic disorders
• other diseases

Characteristics of pain

When diagnosing hip pain, additional symptoms play an important role and may indicate the root cause of the problem.

Pain in the hip joint and radiates to the leg

If pain from a sore joint radiates to the groin, knees, or buttocks, the problem is most likely caused by damage to the nerve that innervates the leg area for one of the following reasons:

• joint tumor
• Infectious arthritis: occurs due to damage caused by a pathogen
• femur fracture (in the head or neck area)
• Legg-Calvé-Perthes pathology - necrosis of the cartilaginous tissue of the femoral head
• juvenile epiphysiolysis - disruption of the structure of the head of the joint and its inflammation

Pain in the hip joint, radiating to the leg, may signal pathologies of the cartilaginous tissue and periarticular structures, lack of joint lubrication and damage to the synovial membrane. Painful symptoms may come on suddenly or increase gradually.

Pain when walking

Pain in the hip joint can occur during walking if the acetabulum comes into contact with the cartilaginous tissue of the femoral head, causing an inflammatory process. The cause of this phenomenon can be mechanical damage, inflammation of anatomical formations located near the joint.

Based on the intensity of pain in the hip joint when walking, you can identify the root cause of the problem:

• discomfort that occurs at the beginning of walking, gradually disappears - a sign of inflammation of the periarticular bag
• discomfort that gradually increases from the moment you start walking - inflammation of the articular surfaces of the hip joint
• continuous pain of high intensity, accompanied by impaired function of the joint - occurs with dislocations and fractures
• pain occurs closer to night - a consequence of deformation of the cartilage of the femoral head and (or) acetabulum, which rub against each other and become inflamed
• Pain of moderate intensity is a sign of minor injuries and bruises

Pain during abduction of the leg

Pain during abduction of the leg is caused by inflammation of the tissues and structures that provide movement: muscles, periarticular bags, tendons. Similar symptoms often result from myositis (inflammation of muscle tissue), bursitis (inflammation of the periarticular bursa), and tendinitis (inflammation of the tendons).

Causes

In most cases, pain in the pelvic area is caused by the patient having one of the following problems:

• arthritis
• coxarthrosis
• bursitis of the trochanteric bursa
• tendinitis
• infectious diseases
• hereditary diseases
• formation of tumors in the pelvic area

Without prompt treatment, each of these causes can lead to serious complications, including loss of joint mobility.

Arthritis

Arthritis (coxitis) is a disease of the joint tissue caused by disorders of the immune system or damage to pathogens: viruses and bacteria.

Arthritis Symptoms:

• temperature increase
• pain and swelling in the joint area
• motor impairment

The disease occurs in acute, subacute and chronic forms.

Coxarthrosis

Another name for coxarthrosis is arthrosis of the hip joint. This pathology is caused by metabolic disorders in the cartilaginous tissues, which lead to their death. The cause of this phenomenon can be injuries, impaired blood supply, excessive physical activity, age over 45 years and heredity. The main symptom of coxarthrosis is pain in the lower back, groin and buttocks, which gradually increases during physical activity and leads to lameness. Discomfort decreases during periods of inactivity.

Bursitis of the trochanteric bursa

The presence of an inflammatory process in the bursa (trochanteric bursa) is characterized by the appearance of intense pain in the joint area. Athletes and the elderly are susceptible to the disease. The main symptom of trochanteric bursitis is pain in the area of the greater trochanter, which increases when trying to lean on the affected leg.

Tendinitis

Inflammation of the tendons is called tendinitis. This is a disease that occurs in acute or chronic forms and leads to degenerative changes in tissues. Often the pathology occurs in athletes who do not follow their running technique, as well as after a heavy load on the hip muscles.

Typically, tendonitis is a complication of another disease:

• thyroid disease
• metabolic disorders
• arthritis
• arthrosis
• inflammatory process of systemic or infectious origin
• hip dysplasia

Tendinitis causes the patient discomfort during movement, pain, changes in gait and clicking when walking in the joint area.

Infections

Some infectious diseases cause inflammation of joint tissues and nearby anatomical structures, causing intense pain in the hip joint. Most often, the following pathologies have similar symptoms:

1. Aseptic necrosis of the femoral head is an interruption of the blood supply to the groin area, resulting in tissue death. The pain associated with this disease is sharp and intense. The problem is more common in males.
2. Purulent arthritis is a serious disease that requires immediate treatment. If medical care is not sought promptly, sepsis can occur. The associated symptoms are general intoxication, pain and swelling in the area of the affected joint, difficulty in motor activity.
3. Tuberculous arthritis is common in children and is characterized by slow progression. Associated symptoms are increased fatigue, decreased motor activity and muscle atrophy. Pain of varying intensity increases when a purulent abscess occurs.

Infectious pathologies of the hip joint lead to serious complications and therefore require immediate treatment.

Hereditary diseases

Hereditary hip joint disorders usually appear between 1 and 10 years of age and are characterized by pathological changes in the tissue of the glenoid cavity and/or femoral head. The most common hereditary disease affecting the hip joint is Legg-Calvé-Perthes syndrome, characterized by pain and gait disturbances due to the death of the cartilage tissue in the joint.

Bone and soft tissue tumors

Benign or malignant growths of the bones and soft tissues in the hip joint can cause pain when walking or at rest. The tumor can occur in bone tissues (osteomyelitis), in cartilaginous tissues (chondroblastoma, chondroma), in osteochondral tissues (osteochondroma). As a rule, neoplasms cause discomfort and are felt upon palpation. Benign tumors are treated surgically; some of them can turn into cancerous tumors.

Soft tissue tumors of the thigh:

• lipoma
• rhabdomyoma
• fibroma
• hemangioma
• neuroma

An oncologist is involved in the diagnosis and treatment of cancers of the hips and pelvis.

What to do

With severe pathologies of the hip joint, a person feels severe pain. Discomfort in the pelvic area is a reason to visit a medical facility for examinations and treatment.

Particular attention should be paid to the intensity of pain:

1. Lungs- occur with bruises after an injury. Apply cold to the painful area to reduce swelling. To reduce pain, it is recommended to take a non-steroidal anti-inflammatory drug. It is advisable to consult a doctor.
2. Moderate- usually occur in diseases of the hip joint, accompanied by difficulties in motor activity and increased body temperature. Discomfort increases during physical activity. It is necessary to consult a rheumatologist.
3. Strong- arise due to dislocations and fractures. Accompanied by limitation or impossibility of physical activity. In case of severe pain in the hip joint caused by an injury, you should contact an ambulance.

There are many popular recipes used for pain in the hip joint. It is important to remember that all of them are suitable for symptomatic treatment and pain relief, but do not help eliminate the cause of the problem. Effective treatment is carried out exclusively under the supervision of a qualified doctor.

Which doctor should I contact?

If you experience hip joint pain, you should contact your family doctor or general practitioner, who will refer you to a specialist. Diseases of the musculoskeletal system are treated:

• traumatologist— pain in the hip joint due to physical activity, sprains, falls and other injuries
• rheumatologist- sudden onset of joint pain for no apparent reason

You may also need to consult other doctors: a surgeon, an oncologist, an infectious disease specialist, etc.

Diagnostics

The first important stage in the diagnosis of pain in the hip joint is an external examination, which necessarily includes anamnesis and palpation. Depending on the severity of the disease and the patient's complaints, laboratory tests and instrumental diagnostic methods are prescribed:

• radiography- the use of X-rays to examine a specific area of the body
• CT and MRI- modern accurate diagnostic methods that allow you to obtain highly informative images of the joint and the surrounding area
• microbiological examination of a sample of biological materialallow us to detect the presence of pathogenic microorganisms: viruses and bacteria
• immunological blood test- allows you to identify immune disorders, determine the presence of certain autoantibodies
• arthroscopy (endoscopic examination)— examination using a probe, possibility of taking a sample of joint tissue for further research
• laboratory examination of the effusion- take a sample of intra-articular fluid during the puncture and identify the causative agent of an infectious disease in it, checking sterility

The combined use of several diagnostic methods allows you to identify the cause of pain in the hip joint with high accuracy.

Treatment

Treatment of hip joint pain should be prescribed by a doctor based on examination and diagnosis. Drug therapy or surgery is usually prescribed.

Drug

Treatment of pain in the hip joint should be comprehensive, aimed at eliminating the symptoms and, most importantly, eliminating the cause of the problem. For this purpose, drug therapy is used, which involves the use of:

• non-steroidal anti-inflammatory drugs- helps reduce pain, relieves swelling
• it means improving microcirculation- helps restore blood circulation and nutrition of joint tissues
• chondroprotectors- promotes the restoration of cartilaginous tissue
• muscle relaxants- reduce pain, improve blood flow to the damaged area
• hormonal drugs- to relieve pain and suppress inflammation

In the treatment of pain in the hip joint, physiological procedures are very effective: massage, acupuncture, cryotherapy and laser therapy. Special therapeutic exercises and manual therapy are also used.

Surgical

Surgery is indicated in advanced cases when conservative treatment does not help the patient. This involves partially or completely replacing the diseased joint with a prosthesis.

Prevention

Reducing the load on the legs will slow down the pathological processes inside the joint, so obese people are advised to start losing weight.

Preventive measures will help reduce pain in the hip joint:

• regular walking
• Physiotherapy
• a balanced diet rich in vitamins A, C, E

Timely consultation with a doctor in the early stages of the disease increases the effectiveness of treatment, and also reduces the risk of complications and serious consequences for the body.