Why Hip Pain: Possible Causes, Diagnosis, and Treatment

The hip joint is the largest joint in the human body. He performs thousands of movements every day, including walking, running, climbing stairs and exercising. Continuous loading, inflammatory processes, injury, and disease can all lead to hip pain. It is necessary to identify the cause of its occurrence as soon as possible to avoid restricted mobility and disability.

Classification of pain

When visiting a doctor, it is necessary to describe in detail the nature of the pain: its severity, intensity, frequency - the accuracy of the diagnosis depends on this. Depending on the nature of the pain, the pain may be:

• Spicy.In this case, the pain is severe and even unbearable. It can appear suddenly and disappear suddenly. Often, patients with acute pain can indicate their localization area fairly accurately. Acute pain can radiate, spreading to areas closest to the source of the pathology.
• pain.The pain is not very severe, sometimes uncomfortable, and not exactly localized. The pain may worsen during or after exercise and disappear temporarily.
• Chronic.This category typically includes pain that occurs with varying regularity over six months. Chronic pain is often the most difficult to treat.

Possible sources of pain

The main causes of hip pain are:

• Injuried,
• infectious diseases,
• inflammatory process,
• degenerative tissue changes,
• Pathology of the development of the musculoskeletal system.

Injuried

When the hip joint and femur are injured, pain occurs immediately, accompanied by tissue redness and swelling, limited limb movement, and the formation of extensive hematoma. Depending on the severity of the lesion, the pain may be more or less severe.If you hit your side or fall, you may develop soft tissue bruising. It is characterized by the formation of a hematoma and increased pain at the lesion during palpation. Unlike dislocations and fractures, with a bruise the movement of the injured leg is unrestricted, there is no visually discernible deformity, and the limb fully retains its function.

Hip dislocation in healthy people only occurs after a very strong physical impact, such as a fall from a height or a car accident.

The limb adopts a forced rotational position, most commonly inward and less commonly outward. The pain is severe, accompanied by swelling, numbness (if the nerve is affected), and the victim being unable to move the injured limb.

Femoral neck fracture

Hip pain may be caused by a violation of the integrity of the femoral neck, an injury that primarily affects older women over the age of 60 years. Age-related hormonal changes in the body after menopause speed up the calcium leaching process, making bones weak and brittle from even the slightest contact. A fall, scrape, or even a careless movement can cause a fracture at the thinnest point of the femur, where the backbone connects to the head embedded in the hip joint.Symptoms of hip fracture are:

• Pain in the pelvic area, radiating to the groin and lower back, worsened by tapping the heel;
• shorten the injured leg;
• Limited movement and inability to lean on the injured leg;
• The outwardly rotated position of the limb;
• "Stuck Heel" Syndrome - Inability to lift a straight leg from a lying position.

Fractures of the femoral neck can occur due to impact - in which case the bone fragments become wedged against each other. In this case, the limb's function may be partially or even completely preserved, but when the fragment is crushed, signs of injury are fully apparent. This injury requires immediate intervention, so if you suspect a fracture, you should seek medical help as soon as possible.

inflammatory process

One of the main causes of hip pain is an inflammatory process in the joint or the tissue surrounding it.Arthritis is inflammation of the cartilage tissue of the joints. Causes may be infection, chronic injury, metabolic disorders, excessive stress, or systemic connective tissue diseases. Symptoms of the disease, in addition to pain that worsens after exercise or at night, include tissue redness and swelling in the affected joint area, increased local temperature, and limited leg movement.Rheumatoid arthritis is an autoimmune systemic connective tissue disease. Women are more susceptible to this disease. It affects both small and large joints, usually in pairs. Characteristic symptoms of rheumatoid arthritis:

• Joint pain, aggravated at night and subsided after activity;
• The formation of subcutaneous compactions, so-called rheumatic nodules, in the affected joint areas;
• Redness, swelling, and localized temperature increase in the affected joint.

Bursitis is an inflammatory process occurring in the synovial bursa of a joint, accompanied by a pathological accumulation of exudate in the joint tissue. The main reasons for the development of the disease are considered to be injuries, excessive physical activity, infections and complications of arthritis of various etiologies. The pain caused by bursitis occurs deep inside and spreads to the outer surface.

Ankylosing spondylitis is an idiopathic disease, which means that in most cases the exact cause of its occurrence cannot be determined. There is a hypothesis that the pathology is genetically determined and that genetic predisposition plays an important role in its development.

Most often, manifestations of the disease occur in 20-30 years of age, with the first symptoms being pain in the lower back, buttocks and buttocks, worsening at night, stiffness, rapidly progressing to ankylosis - immobility of the joints. In the later stages, if left untreated, this disease can cause severe deformation of joint tissue, leading to severe disability.

degenerative tissue changes

Hip arthrosis or hip osteoarthritis (degenerative changes in cartilage tissue) is a common cause of hip pain in people over the age of 40-45. The disease is chronic and steadily progressive. The causes of its occurrence are thought to be chronic injury, genetic predisposition, age-related changes, and concomitant joint inflammatory diseases. In young people, coxarthrosis may occur due to congenital hip dysplasia.Pathological symptoms:

• Pain in the groin, lower back, buttocks, and thighs that worsens with exercise and decreases at rest;
• muscle weakness;
• Intermittent lameness, "duck" gait, and bilateral joint injuries;
• Limb dysfunction, difficulty in abduction, adduction, and rotation.

infectious diseases

Infectious arthritis is also a common cause of hip pain and may be caused by pathogenic microorganisms entering the joint tissue through the bloodstream from distant lesions of viral or bacterial infection. It can be caused by pathogens such as Streptococcus, Staphylococcus, Pseudomonas aeruginosa, Mycobacterium tuberculosis, Treponema pallidum, and influenza viruses.

With septic arthritis, joint pain is accompanied by redness and swelling of surrounding tissues, as well as general symptoms - fever, malaise, and weakness.

other reasons

In addition to injury, inflammation, and infection, hip pain can be caused by:

• Innervation disorders.Inflammation and compression of nerve roots, especially the sciatic nerve, can lead to pain in the buttocks, inguinal triangle, and buttocks.
• tumor formation, including malignant lesions in joints and surrounding tissues.
• Aseptic necrosis of the femoral head.Chronic poor circulation in the tissues leads to degenerative changes in cartilage and bone tissue and may lead to complete destruction of the bone structure.
• Juvenile epiphyseal dissolution.Chronic hip pain in children and adolescents may be caused by the development of epiphyseolysis, a pathological displacement of the femoral head caused by hormonal disturbances in the body. Boys are more susceptible to this disease, but in rare cases, girls can be diagnosed. Often, the pathology is accompanied by retardation of sexual development and endocrine disorders.

Hip pain is a common symptom among women in the third trimester of pregnancy. Causes of hip pain in pregnant women:

• Weight gain and weight shift, redistribution of load on the musculoskeletal system;
• Natural hormonal changes: Shortly before giving birth, a woman’s body begins producing a hormone that relaxes ligaments;
• The enlarged uterus puts pressure on large blood vessels and nerves, disrupting innervation and blood circulation of the pelvic organs and lower limbs;
• Expectant mothers are deficient in calcium.

If pain during pregnancy is caused by the above factors, then the pain will disappear without a trace a few weeks after birth. If pain persists after one month after the birth of your child, you should consult your doctor.

Alarming symptoms

Hip pain is a worrying symptom and a reason to see your doctor. The sooner the cause of hip pain is identified, the higher the chance of complete recovery. However, there are certain situations where medical help should be sought immediately:

• Pain in the joints and impaired mobility of the limbs after a fall, blow, bruise or any other injury;
• The tissues around the joints are red and swollen, and the body temperature generally rises to fever levels (above 38°C);
• Problems with bowel movements and urination.

diagnosis

The first step in determining the cause of hip pain is to see your doctor. The surgeon or orthopedic doctor takes a history to determine the nature of the pain, the frequency and extent of its manifestations, and examines 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 may be prescribed:

• General, biochemical, serological, immunological blood tests;
• Radiographic examination of the pelvic bones, thighs, and hip joints;
• Ultrasound examination of joint tissue and surrounding tissue;
• MRI and computed tomography to obtain accurate three-dimensional images of the affected area;
• Endoscopy of the joint using a probe inserted into the joint cavity;
• A puncture to study effusion - a pathological accumulation of fluid in the joint capsule;
• Tissue biopsy.

treatment method

Treatment of conditions that cause hip pain depends on the underlying cause. If the pain is caused by trauma, the main conservative treatment is arthrodesis; surgery may be required in some cases. If the pain is of an inflammatory nature, nonsteroidal or hormonal anti-inflammatory drugs may be taken; for general infectious diseases, antibiotic treatment or antiviral drugs may be required.

Pain syndromes, regardless of their cause, can be relieved by taking analgesics or injectable blockade.

Immobilized

Immobilization is most commonly used to treat joint injuries. Immobilization can be done with bandages, plaster splints, or plastic orthotics.

medical treatement

Depending on the cause of hip pain, the following may be prescribed:

• NSAIDs or corticosteroids to relieve the inflammatory process;
• Chondroprotectants slow degenerative changes in joint tissue;
• Use of antibiotics and antiviral drugs in cases of septic arthritis;
• Muscle relaxants reduce muscle spasms.

physical therapy procedures

During the rehabilitation stage after injury and the disease remission period, the following physical therapy methods are used to restore joint mobility, improve blood circulation, and restore limb function:

• physiotherapy,
• massage,
• magnet therapy,
• balneotherapy,
• Laser Treatment,
• Ultra high frequency heating,
• Leech therapy.

endoprosthesis

In some cases, conservative treatments for hip pain may not be effective. Aseptic necrosis, advanced hip joint, and femoral neck fractures in the elderly are direct indications for endoprosthetic surgery, which is to replace the head and acetabulum of the hip joint with a prosthesis made of chemically and biologically inert materials.

This surgery can shorten the recovery process and allow patients to return to full activity.

Prevent hip pain

A number of preventive measures will help prevent hip pain from occurring, including:

• Engage in feasible physical activity regularly to strengthen muscles and ligaments;
• Rich and balanced nutrition;
• Weight control, as overweight and obesity place additional stress on the musculoskeletal system;
• Avoid injury and excessive physical activity;
• Say no to bad habits;
• Prompt and adequate treatment of inflammation and infectious diseases;
• Have regular preventive checkups with your doctor.