The hip joints experience the greatest load in the body. They are created by weight during walking, jumping, running, lifting and carrying heavy objects. Patients often feel pain in the hip joint. Orthopedists at the Yusupov Hospital determine its cause using modern diagnostic equipment. Doctors determine the degree of joint damage, which allows them to make an accurate diagnosis and develop optimal treatment tactics.
Doctors at the Yusupov Hospital provide complex therapy for diseases that cause pain in the hip joint. Patients are individually selected effective medications that affect the cause and mechanism of development of pain. Rehabilitation clinic specialists provide rehabilitation therapy using the latest physiotherapeutic procedures, physical therapy, and acupuncture. The presence of special simulators allows you to reduce the load on the joint during training.
In the process of treating pain in the hip joint, doctors from many areas of medicine are involved: endocrinologists, rheumatologists, orthopedists, physiotherapists, chiropractors, acupuncturists. A multidisciplinary approach to the treatment of pain in the hip joint allows for rapid pain relief. Patients suffering from pathology of the hip joints often require outside care. It is professionally carried out by the staff of the Yusupov Hospital who have undergone special training.
Causes
Pain in the hip joint is caused by the following pathological processes:
- Tendinitis (inflammation of tendons);
- Muscle rupture;
- Iliotibial band syndrome;
- Other local changes in surrounding tissues;
- Systemic diseases (rheumatoid arthritis, polymyalgia).
Because the gluteus medius and minimus muscles play a major role in hip abduction, damage to them causes hip pain.
The gluteus medius and minimus tendons attach to the greater trochanter. If an inflammatory process develops in them due to microtraumas resulting from excessive load, the patient will be bothered by pain in the hip joint. Such disorders may be caused by an infectious process (tuberculosis), sports or stereotypical professional stress, or the deposition of crystals. Hip pain is a symptom of the following diseases:
- Osteoarthrosis;
- Radicular syndrome;
- Rheumatoid arthritis;
- Coxita.
Pain in the hip joint can bother people who are overweight, have different leg lengths, or have flat feet.
Pain syndrome can occur after lower limb amputation or hip replacement. With avascular necrosis of the head and fracture of the femoral neck, patients complain of acute pain in the hip joint. Pain syndrome often develops with dysplasia (disorder of the anatomical structure) of the hip joint. Acute pain in the hip joint, radiating to the leg, occurs in the case of pinched nerves due to diseases of the spine, malignant bone tumors, and age-related changes. Make an appointment
Causes of coxarthrosis
More often than others, the cause of pain is the progression of coxarthrosis. The cartilage surfaces break down and rub against each other, causing pain. It is very important to understand what caused the pathology:
- age-related changes in the joint;
- metabolic disease;
- congenital dislocations;
- injuries;
- rheumatoid arthritis or other causes.
If the original source cannot be found, idiopathic coxarthrosis is diagnosed. Typically, it affects both joints. Secondary – called post-traumatic arthrosis. It occurs due to major or minor damage to the hip joint and can only spread to one side.
Excess weight and lack of physical activity greatly accelerate the progression of coxarthrosis
Examination methods
During the first consultation, rheumatologists at the Yusupov Hospital conduct a comprehensive examination of the patient:
- Collection of complaints, clarification of the nature of pain in the hip joint;
- Obtaining information about the course of the disease, the onset of pain, the progression of pain, household and professional factors that, in the patient’s opinion, caused the pain;
- An external examination allows the doctor to determine visible deviations from the norm. To understand the nature of the pain and the area of its spread, the doctor asks the patient to perform various movements of the lower limb in the hip joint. The presence of pathology of the hip joint may be indicated by poor posture;
- Palpation (feeling). The doctor can find rheumatoid and rheumatic nodules, detect the exact location of pain during leg movements, determine the humidity and temperature of the skin in the hip joint area.
Next, the doctor conducts goniometry - an examination using a goniometer device.
It allows you to determine the range of joint mobility. Then the rheumatologist prescribes clinical and biological blood tests and a general urine test. Laboratory assistants at the Yusupov Hospital perform research using high-quality reagents and modern equipment, which allows them to obtain accurate test results. With inflammation of the hip joint, the number of leukocytes in the blood increases and the erythrocyte sedimentation rate increases. The inflammatory nature of the disease is indicated by an increase in the content of C-reactive protein in the blood serum.
An immunological blood test shows the presence of antinuclear antibodies in the blood in rheumatic inflammatory diseases. In patients suffering from arthritis, the concentration of uric acid in the blood serum increases sharply. The content of lysosomal enzymes (acid proteinase, acid phosphatase, cathepsins, deoxyribonuclease) in blood serum and synovial fluid changes in patients with rheumatism, psoriatic polyarthritis, rheumatism, and ankylosing spondylitis. In severe forms of hip joint pathology, significant deviations from the norm are observed in urine analysis.
Doctors at the Yusupov Hospital conduct x-ray examinations of patients with pain in the hip joints. It is indicated in the following cases:
- The presence of chronic or acute pain in the hip joint at rest and during movement;
- The occurrence of difficulties when moving the lower limb;
- The appearance of swelling and discoloration of the skin in the hip joint area.
Using computed tomography, doctors at the Yusupov Hospital evaluate the bones that participate in the formation of the hip joint.
On computed tomograms, the radiologist finds changes in the structure of bone tissue, cartilaginous growths, and osteophytes. Using magnetic resonance imaging, doctors evaluate the condition of the soft tissues that surround the hip joint.
Radionucleotide research methods make it possible to recognize pathology using radiopharmacological drugs.
Ultrasound examination of the hip joint is performed for injuries, inflammatory diseases, rheumatism and rheumatoid arthritis. The attending physician individually selects in each case the research methods necessary to determine the cause of pain in the hip joint.
How to find the cause
Since pain in this joint can have a variety of origins, the doctor will recommend undergoing a diagnosis in several stages:
- Examination by a specialist. The doctor will determine the acute or chronic condition, the presence or absence of inflammation, joint deformation, assess the level of pain and how limited mobility is.
- Plain X-ray of the pelvis. X-ray covers the sacral spine and hip joints at the same time. Using special quantitative criteria, already at this stage it is possible to calculate whether the patient has arthrosis of the hip joint.
- Blood tests for markers of inflammation. Indicated if the doctor suspects the patient has an autoimmune nature of arthrosis, rheumatoid arthritis or other diseases. As a rule, they are prescribed for minimal changes on the radiograph, as well as for people with coxarthrosis under 50 years of age.
- MRI. Using magnetic resonance therapy, it is determined whether the patient has an intervertebral hernia, which can also cause joint pain. This examination is also indicated when other methods have not made it possible to establish the original source of pain.
The younger the patient, the more tests may be needed to find the cause of the pain.
Differential diagnosis
Pain in the hip joint when walking is the main complaint with which patients consult a doctor.
It can be located in the joint area or extend to the thigh, buttocks, or knee joint. If pain occurs in the hip joint during movement, the patient is forced to use a cane. Often, due to pain, there is a limitation of mobility when moving the hip joint, especially when externally and internally rotating the leg. Pain in the hip joint, buttock and groin area is a symptom of aseptic necrosis of the femoral head. The disease is often associated with long-term use of hormonal drugs and alcohol abuse. With the development of deformity of the femoral head, the mobility of the hip joint is limited. At an early stage of the pathological process, the range of motion may be normal.
Pain in the anterior part of the hip joint and clicking noises when moving the joint bother patients suffering from iliopectineal bursitis. It radiates to the thigh and is accompanied by paresthesia (tingling, burning, crawling sensations) due to compression of the femoral nerve. The patient feels pain in the hip joint when flexing and extending the lower limb. Pain is also detected on deep palpation in the area of the femoral triangle (a formation limited by the inguinal ligament, the outer edge of the adductor longus muscle, the inner edge of the sartorius muscle).
Pain in the outer hip joint is a sign of iliotibial band syndrome. It is accompanied by a clicking sound when moving, pain in the outer part of the knee joint, which intensifies with movement.
Roth's myalgia is manifested by burning pain in the anterior outer part of the hip joint and thigh, which intensifies when walking and straightening the leg. Pain in the hip joints occurs with dysplasia. Over time, the patient develops a characteristic “duck” gait (he walks, waddling from side to side).
Pain with coxarthrosis
Pain in the hip joint occurs with coxarthrosis, a disease characterized by degenerative processes in the bones that form the joint.
More often the disease affects older people. With age, the cartilage tissue of the joint loses its elasticity, becomes thin, and begins to wear out. When the load on the joint increases, the thin cartilage tissue is destroyed. The articular surfaces of the bones rub against each other, resulting in aseptic inflammation. Growths appear on the bones. They significantly limit movement in the joint. Deformation of the articular surfaces develops, resulting in severe pain. Treatment of the disease depends on the severity of the joint damage. Doctors provide drug therapy. If it is ineffective, endoprosthetics is performed or palliative treatment is used.
After determining the cause of pain in the hip joint, doctors at the Yusupov Hospital begin treating the disease that caused the pain syndrome. Severe cases of diseases in which the patient is bothered by pain in the hip joint are discussed at a meeting of the expert council with the participation of professors, doctors and candidates of medical sciences, doctors of the highest category.
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Treatment
An important condition for the successful treatment of diseases that cause pain in the hip joint is the elimination of factors that cause structural changes in bone, cartilage and soft tissue in the joint area.
For acute pain, rheumatologists at the Yusupov Hospital prescribe non-steroidal anti-inflammatory drugs. The well-being of patients significantly improves with the use of local treatment methods - external applications of gels and ointments, patches that contain non-steroidal anti-inflammatory drugs. They reduce pain in the hip joints during inflammatory processes of soft tissues (tendinitis, bursitis, epicondylitis), after injuries. If such therapy is not effective enough, doctors inject glucocorticoids into the cavity of the hip joint. The joint space with deforming coxarthrosis is narrowed, it is difficult to get into it. For this reason, rheumatologists at the Yusupov Hospital perform the procedure under X-ray control. In the presence of pain caused by inflammation of muscles and tendons, glucocorticoid hormones are injected into the periarticular tissues.
In order to improve the condition of cartilage and reduce pain in the hip joint, chondroprotectors (glucosamine and chondroitin sulfate) are used. The therapeutic course lasts several months. For spasms of the muscles that take part in movements in the hip joint, muscle relaxants (sirdalud, mydocalm) are prescribed.
Drug therapy is supplemented with physiotherapeutic procedures. They are of secondary importance for pain in the hip joint. The effectiveness of physiotherapeutic treatment methods is reduced due to deep location. The severity of pain in the hip joint decreases after ultraviolet irradiation with medium-length waves.
In the presence of an inflammatory process, high-intensity centimeter wave therapy, infrared laser treatment, and low-intensity UHF are performed. High-intensity high-frequency magnetic therapy, ozone therapy, shock wave therapy stimulate tissue restoration. The intensity of pain that occurs due to circulatory disorders and nutrition of the hip joint is reduced under the influence of various types of electrotherapy (exposure to currents) and ultrasound.
To reduce the load on the hip joint, rheumatologists advise patients to use a cane if there is acute pain. After reducing the severity of the pain syndrome, rehabilitators conduct therapeutic exercises. An individual set of exercises is developed for each patient to quickly restore the function of the lower limb. When the structures that take part in the formation of the hip joint are destroyed, the pain can be so severe that the only method of eliminating it is to replace the joint with an endoprosthesis.
Non-steroidal anti-inflammatory drugs are prescribed to relieve pain. Treatment depends on the disease that affects the hip joints. The patient is prescribed chondroprotectors for cartilage tissue damage. An orthopedic doctor prescribes effective treatment, diet, and exercises to improve blood circulation in the joint, restore cartilage tissue, and maintain joint mobility. In severe cases, joint replacement with an endoprosthesis is required, which significantly improves the quality of life and eliminates pain.
Causes of back pain when lying down
Pain in the back that appears after sleep causes severe discomfort and does not depend on physical activity, so it can intensify in a stationary position. Based on their localization and accompanying signs, one can judge the nature of the pathology - whether it is of vertebrogenic or non-vertebrogenic origin.
In 85% of people, back pain is due to diseases of the spine, joints or muscles, in 9% - kidney diseases, 6% - other internal organs.
Shpidonov Gennady Stanislavovich
Neurologist
Rostov State Medical University (neurology)
10 years of experience
Causes of pain when lying on your back:
- excessive physical activity during the day;
- incorrectly selected mattress, pillow;
- lying in an uncomfortable position for a long time;
- excess weight, which causes strong pressure on the spinal structures when lying down;
- 2-3 trimester of pregnancy;
- pathologies of the musculoskeletal system: spinal deformity, osteochondrosis, arthrosis, rheumatism, spondylosis, ankylosing spondylosis, infectious bone diseases, hernia, displacement or degenerative changes in intervertebral discs, pinched nerves;
- back injuries, pelvic bone fractures, muscle tissue damage;
- diseases of internal organs, including cancer.
Back pain at night can appear in any part of the spine. The
intensity of the pain can be mild, moderate or intense, the duration can be short or long, the nature is sharp, reminiscent of a lumbago, or aching, the location can be one-, two-sided, at the top. or lower back.
Pain in the cervical region often occurs due to diseases of the spine, in the chest area - heart and lungs, in the peritoneum - pancreas, gastrointestinal tract, in the lumbar area - urinary, reproductive system in men and women.
Let's look at the most common causes of back pain when lying down.
Scoliosis
In the early stages, the pathology does not manifest itself, the intensity of pain increases as the curvature intensifies. Associated symptoms occur:
- decreased range of motion, stiffness in the spine;
- muscle spasm, which is accompanied by increased pain;
- breathing problems due to compression and deformation of the chest;
- asymmetry of the shoulders and shoulder blades.
Severe forms of scoliosis are accompanied by disruption of the functioning of internal organs.
Osteochondrosis
It is the most common cause of back pain. At first, the pain is aching, moderate, and may go away after warming up and applying painkillers. However, as the inflammatory process intensifies and the elasticity and strength of the intervertebral discs decrease, the pain becomes sharp and acute.
Severe pain may indicate a pinched nerve
In addition to pain, the patient feels a burning sensation, tingling, and numbness in the affected area. These symptoms occur after prolonged sitting or lying down and spread to the limbs.
Pyelonephritis
Aching, nagging pain in the lower back, which intensifies when lying on your back, is accompanied by an increase in body temperature, weakness, and difficulty urinating, indicating kidney disease. With pyelonephritis, pain increases at night, is localized on the right or left, and can radiate to the lower abdomen.
Shpidonov Gennady Stanislavovich
Neurologist
Rostov State Medical University (neurology)
10 years of experience
Ankylosing spondylitis
If back pain in a lying position intensifies in the second half of the night, after a long period of lying down is accompanied by stiffness, then we are probably talking about ankylosing spondylitis or ankylosing spondylitis.
With ankylosing spondylitis, after getting out of bed, a person needs a warm-up to get rid of stiffness
The pathology is an inflammation of the intervertebral joints, which leads to their fusion (ankylosis). As a result, the mobility of the spine deteriorates, muscle spasm and pain occur. The spinal column is deformed, which disrupts the functioning of internal organs.
Duodenal ulcer
The pain can be aching or cutting, causes a person to wake up at night, subsides after eating, but returns 2-3 hours after eating. Accompanied by nausea, vomiting, flatulence, bloating, and sour belching.
Appendicitis
Pain syndrome with appendicitis depends on the location of the appendix. When the vermiform appendix is located behind the cecum, wrapped towards the kidney and ureter, the pain radiates to the lower back, groin, and pelvis.
The pain occurs suddenly, its intensity can increase gradually, but more often it is too strong from the first minutes of the attack.
Prostatitis
Pain in the spine in men when lying on their back may indicate inflammation of the prostate gland. It is localized in the lumbar region, lower abdomen, and is accompanied by problems with urination.
Shpidonov Gennady Stanislavovich
Neurologist
Rostov State Medical University (neurology)
10 years of experience
Back injuries
If it hurts to lie down at night after excessive exercise or lifting heavy objects, then there is likely damage to the muscles and other tissues surrounding the spine.
When a person has “broken his back,” the pain is severe, shooting, and does not allow him to roll over on his side, straighten up, or get out of bed.
Treatment with exercise therapy
The use of rehabilitation techniques in the treatment of the hip joint allows you to maintain its mobility, improve blood circulation in the joint, and accelerate the restoration of cartilage tissue. Specialists at the rehabilitation department select a set of physical therapy exercises taking into account the patient’s joint disease. Rehabilitation classes are conducted daily under the supervision of an instructor. For rehabilitation therapy, special simulators are used, and physiotherapeutic procedures are prescribed in combination with physical education.
Treatment of hip diseases
Depending on the degree of damage and the individual characteristics of the human body, complex treatment is prescribed, which includes a set of measures to improve the condition of the musculoskeletal system. Important course factors: Taking medications
.
Medicines aimed at restoring cartilage tissue (chondroprotectors), anti-inflammatory drugs and analgesics are prescribed if necessary. In addition, doctors prescribe general strengthening agents, vitamins and calcium. Physiotherapy.
Procedures affecting the lesion have a beneficial effect on the condition of the cartilage and help improve blood flow and metabolism.
Physiotherapy.
It will allow you to develop the joint and speed up metabolic processes.
Diet.
It is prescribed individually for each case and includes the elements necessary for the body, contained in certain food products.
If a person experiences a dislocation or fracture, then the connection must be given the correct position and then fixed. Healing medications will allow you to quickly rehabilitate, and warming up will speed up this process. If the disease is advanced and the person remains bedridden, there is a reliable way to get rid of the problem. Since all medication courses do not provide a permanent guarantee that the disease will not return, it is necessary to constantly monitor the joint. Some types of operations can also temporarily restore functionality. However, endoprosthetics is considered the best guarantee that the connection will work correctly for decades without problems. It consists of completely removing the dead part of the joint and installing a prosthesis. The installed part is made individually for each patient, depending on the size of his joint. The installation is performed surgically, after which a long period of rehabilitation begins. Advice. At first, in order to protect against various inflammations after surgery, a person needs to keep the operated area at rest, only occasionally performing light movements to prevent thrombosis and thromboembolism, as well as to improve metabolism, which is very important in the first days of rehabilitation. This is when a huge amount of medications enter the body, and they are best absorbed if the blood flow is normal.