Hip pain

One of the common symptoms of patients coming to health facilities is pain in the hip joint. The causes, treatment and possible diseases that cause such manifestations cannot be identified without qualified medical care. Discomfort in any part of the musculoskeletal system may indicate the development of serious pathologies, so hip joint dysfunction 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 supporting heavy loads both in a standing position and walking upright.

Bones that form joints

The hip joint is formed by the head of the femur and the acetabulum of the innominate pelvic bone - the strongest and largest part of the human skeleton. The minimum number of anatomical elements of the joint ensures its strength and reliability, the ability to withstand body weight during movement. Most hip joint pathologies begin with damage to the acetabulum, the immobile part of the joint. Its shape is like a bowl, the center of which is directed upwards at a slight angle, which ensures an even distribution of load between the pelvic bones.

The glenoid cavity is a strong and sturdy formation, consisting of 3 types of pelvic bones:

• ileum
• ischia
• genitals

The most vulnerable areas of the articular cavity are in children whose bone tissue is less strong. Due to the presence of a small bony protrusion 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 moving part of the joint is the femur (head, neck, greater and lesser trochanter). The shape of the head corresponds to the cavity of the articular cavity. It is covered with cartilage tissue, which ensures perfect alignment of the joint elements and their unhindered 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 joint mobility and even load distribution between the limbs. The trochanter is a bony prominence where muscle tendons attach.

Fabric and structure

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

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

1. Ligaments and tendons surround the joint on all sides, covering and protecting its femur and neck bones, as well as the socket itself.
2. Cartilage covers the head of the femur and part of the acetabulum.
3. The subcartilaginous area is bone tissue consisting of cells and connective extracellular substances.
4. The joint membrane or capsule is a source of special secretions - synovial fluid to lubricate the parts of the joint.
5. The acetabular labrum connects the edge of the acetabulum and the transverse ligament.

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

Anatomical formation located next to 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 layers of the body
2. The muscles of the thighs, hips, lower back and buttocks provide joint mobility and also strengthen them from the outside
3. Extra-articular ligaments - perform a strengthening function, are located around the joint capsule
4. The periarticular bursa is a collection of connective tissue that prevents friction between soft and hard tissues

Risk factors

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

Typically, one or more structures become inflamed:

• skin
• muscle
• ligaments (extra-articular, femoral head)
• periarticular bursa
• TBS capsules
• cartilage
• acetabular labrum
• subcartilaginous area

Pain in the hip joint is often caused by harmful microorganisms that trigger 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, which may indicate the root cause of the problem.

Pain in the hip joint and radiating to the leg

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

• joint tumors
• Infectious arthritis - occurs due to damage by pathogens
• femur fracture (in the head or neck area)
• Legg-Calvé-Perthes pathology - necrosis of the cartilage tissue of the femoral head
• Juvenile epiphysiolysis - violation of the structure of the joint head and its inflammation

Pain in the hip joint, radiating to the leg, can signal pathology of cartilage tissue and periarticular structures, lack of joint lubrication, and damage to the synovial membrane. Pain symptoms can occur suddenly or increase gradually.

Pain when walking

Pain in the hip joint can occur when walking if the acetabulum comes into contact with the cartilage tissue of the head of the femur, resulting in an inflammatory process. The cause of this phenomenon can be mechanical damage, inflammation of the anatomical formations located next to the joint.

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

• discomfort that occurs at the beginning of walking, gradually subsides - a sign of inflammation of the periarticular bursa
• 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 joint function - occurs with dislocations and fractures
• pain occurs towards evening - due to deformation of the cartilage of the femoral head and (or) the acetabulum, which rub against each other and become inflamed
• pain of moderate intensity is a sign of minor injuries and bruises

Pain when abducting the leg

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

Reason

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

• arthritis
• coxarthrosis
• bursitis of the trochanteric bursa
• tendinitis
• infectious pathology
• congenital disease
• tumor formation in the pelvic area

Without timely treatment, any of these causes can lead to severe complications, including loss of joint mobility.

Arthritis

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

Arthritis symptoms:

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

This disease occurs in acute, subacute and chronic forms.

Coxarthrosis

Another name for coxarthrosis is osteoarthritis of the hip joint. This pathology is caused by metabolic disorders in cartilage tissue, resulting in its death. The causes of this phenomenon may be injuries, impaired blood supply, excessive physical activity, age over 45 years, and hereditary factors. The main symptom of coxarthrosis is pain in the lower back, groin and buttocks, which gradually increases during physical activity and causes lameness. Discomfort is reduced during periods of inactivity.

Bursitis of the trochanteric bursa

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

Tendinitis

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

Usually, tendinitis is a complication of another disease:

• thyroid pathology
• metabolic disorders
• arthritis
• arthritis
• inflammatory processes of systemic or infectious origin
• hip dysplasia

Tendonitis causes patients to feel discomfort when moving, pain, changes in gait, and clicking sounds when walking in the joint area.

Infection

Some infectious diseases cause inflammation of the joint tissue, as well as the surrounding anatomical structures, resulting in severe pain in the hip joint. Most often, the following pathologies have similar symptoms:

1. Aseptic necrosis of the femoral head is a disruption of the blood supply to the groin area, resulting in tissue death. The pain associated with this disease is very acute and intense. This problem occurs more often in men.
2. Purulent arthritis is a serious disease that requires immediate treatment. If you do not seek medical attention immediately, sepsis may occur. Accompanying symptoms are general intoxication, pain and swelling in the affected joint area, difficulty in motor activity.
3. Tuberculous arthritis often occurs 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 cause severe complications and therefore require immediate treatment.

Hereditary disease

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

Bone and soft tissue tumors

Benign or malignant growths of bone and soft tissue in the hip joint can cause pain when walking or at rest. Tumors can occur in bone tissue (osteomyelitis), cartilage tissue (chondroblastoma, chondroma), osteochondral tissue (osteochondroma). Usually, neoplasms cause discomfort and are felt on palpation. Benign tumors are treated with surgery; 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 tumors in the hip and pelvis.

What to do

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

Particular attention should be paid to the intensity of pain:

1. Lungs- occurs with bruising after injury. Cold should be applied to the painful area to reduce swelling. To reduce pain, it is recommended to take non-steroidal anti-inflammatory drugs. It is recommended to consult a doctor.
2. Currently- usually occurs in diseases of the hip joint, accompanied by difficulties in motor activity and an increase in body temperature. Discomfort increases during physical activity. It is important to consult a rheumatologist.
3. Strong- Arises due to dislocations and fractures. Accompanied by limitation or impossibility of physical activity. In case of severe pain in the hip joint due to injury, you should call an ambulance.

There are many traditional recipes used to treat pain in the hip joint. It is important to remember that all of them are suitable for symptomatic treatment and pain reduction, but will 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 pain in the hip joint, 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- joint pain that appears suddenly for no apparent reason

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

Diagnostic

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

• radiography- use of x-rays to examine certain areas of the body
• CT and MRI- a modern accurate diagnostic method that allows you to obtain highly informative images of the joint and the area around it
• microbiological examination of samples of biological materialmakes it possible 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, possible sampling of joint tissue for further research
• Effusion laboratory examination- taking a sample of intra-articular fluid during puncture and identifying the causative agent of infectious diseases in it, checking for sterility

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

Treatment

Treatment of pain in the hip joint should be prescribed by a doctor based on examination and diagnosis. Usually, drug therapy or surgery is prescribed.

Treatment

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

• non-steroidal anti-inflammatory drugs- Helps reduce pain, relieve swelling
• means improving microcirculation- Helps restore blood circulation and nutrition of joint tissue
• chondroprotector- promotes the restoration of cartilage tissue
• muscle relaxant- Reduces pain, improves 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, cryo-therapy and laser. Special therapeutic exercises and manual therapy are also used.

Surgery

Surgical intervention is indicated in advanced cases when conservative treatment does not help the patient. This involves replacing part or all of the diseased joint with a prosthesis.

Prevention

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

Preventive measures will help reduce pain in the hip joint:

• running regularly
• physiotherapy
• balanced diet rich in vitamins A, C, E

Timely consultation with a doctor at the first stage of the disease increases the effectiveness of treatment and also reduces the risk of complications and serious consequences for the body.