Trochanteritis - inflammation of the femoral tendons, periarthritis of the femoral tendons

Quadriceps femoris (quadriceps)

belongs to the anterior muscle group of the thigh, the extensor muscle, which is responsible for straightening the leg at the knee joint. The quadriceps consists of four muscle bundles (heads): the rectus femoris, vastus lateralis (external), vastus medialis (internal), and vastus intermedius. The longest muscle is the rectus femoris, which originates on the pelvic bone. Together, these muscle heads form a single tendon that attaches to the patella. The tendon is a fairly strong and elastic formation. More vulnerable to damage are the areas where the tendon passes into the muscle or where the tendon attaches to the bone.

Causes

If the load on muscles and ligaments during active sports training is so strong that the muscles and tendons do not have time to rest and restore micro-damage caused by stress, then they are destroyed - a so-called chronic (fatigue) injury is formed.

The most common of these injuries is tendinosis - progressive dystrophy, areas of degeneration in the tendon area.

The most common causes of tendinosis:

• microtrauma of tendons,
• excessive, increased motor load on the tendons.

The result is the formation of areas of necrosis, fatty degeneration of tendons and cartilage, and deposition of calcium salts. As the process progresses, the tendon ossifies, loses elasticity and leads to dystrophy and inflammation.

Tendinosis is evidence of excessive load on these muscles, very hard training.

Types of injuries and damages.

The most common tendon injuries include:

• Tendonitis is a disease in which inflammation and degeneration of tendon tissue occurs. The disease most often affects those tendons that regularly and frequently experience constant physical stress.
• Sprains are the most common injury in which tendons and muscle fibers are damaged due to physical impact, but their integrity is not compromised.
• Partial rupture of the tendon, the integrity of the soft tissues is partially preserved
• Complete tendon rupture

Symptoms of tendinosis

Common symptoms of tendinosis include:

• pain during movement, which goes away with rest,
• passive movements of the limb are practically painless,
• palpation of the affected tendon is unpleasant, painful,
• it is compacted, redness is visible on the surface, an increase in temperature over the affected area,
• When moving, you can hear a crunching or crackling sound.

Depending on the location, there are characteristic features of tendinosis.

Tennis elbow (lateral epicondylitis)

- damage to the wrist extensors. In this case, pain occurs in the elbow area and radiates upward, into the shoulder, along its outer part and along the forearm. There may be weakness in the hand, difficulty in lifting cups, shaking hands or wringing out clothes.

Golfer's hand , baseball player's hand (medial epicondylitis)

– damage to the extensors and muscles that rotate the forearm. It manifests itself as pain in the inner part of the elbow, pain when bending the hand down, pressing on the hand.

Querwen's disease

– tendinosis of the tendons of the thumb, manifested by pain when extending and abducting the thumb. Pain when palpating the base of the thumb, as well as pain when connecting the pad of the thumb to the little finger.

Patellar tendinosis (jumper's knee)

– pain in the knee area, tendon swelling, swelling. Untreated tendinosis can cause patellar tendon avulsion.

Quadriceps tendinosis

resembles a patella problem, but usually occurs in older athletes.

Post-tibial tendinitis

with damage to the tibialis muscle it gives pain in the tendons, pain in the heel, in the arch of the foot. May lead to flat feet and heel spurs. The pain intensifies when running and carrying heavy objects.

Hip tendinosis - what is it?

The hip joint is complex in composition and has its own characteristics. Several types of muscles are involved in the work of the joint. There are two options.

Tendinosis of the greater trochanter of the femur

The end of the femur at the top, called the greater trochanter (trochanter major), is adapted for optimal attachment of the gluteus medius muscle, which belongs to the group of external pelvic muscles.

The superficial and deep layers of muscle bundles are fan-shaped and are designed to abduct the hip (or pelvis, if the hip is fixed). The muscle is also involved in straightening the back if the body is tilted forward.

For reference. The muscle is attached to the trochanter in such a way that the anterior bundles, if the thigh is abducted, rotate it inward, and the posterior bundles rotate it outward. Therefore, if the integrity of the tendon is violated, the pain syndrome is activated when the leg rotates. Bending over is problematic for the patient.

Lesser trochanteric tendinosis

The tubercle for the attachment of muscles (iliopsoas, psoas major), located below the head of the femur, is called the lesser trochanter.

For reference. If tendinosis occurs, the pain spreads through the lower abdomen, down the inside of the thigh to the knee.

Treatment of tendinosis

Orthopedic traumatologists treat tendinosis.

Conservative or surgical therapy is prescribed. In the early stages, conservative measures of a primary and secondary nature are indicated.

The primary ones include:

• ensuring complete peace,
• cold and rest the tendon,
• applying tight or supportive bandages and placing the limb in an elevated position.

Secondary measures for conservative treatment of tendinosis include the use of:

• physical therapy and physiotherapy,
• drug injections,
• rehabilitation methods,
• anti-inflammatory drugs.

All methods of therapy at all stages are prescribed by a doctor; special bandages and bandages are used based on the specific location of the injury and type of injury. Sometimes it is necessary to use a special type of fixing bandages.

Anti-inflammatory gels and ointments are used in the first three days of injury, then they will be most effective.

For advanced tendinosis, surgical treatment is used - areas with altered tissues are excised, followed by plastic surgery to restore the tendon.

Diagnostics

Determining the fact of joint pathology involves interviewing the patient, examination, and performing functional tests. Endoscopic verification of pathology is relevant only if necessary. Laboratory methods are secondary.

Informative sources of the condition of the hip joint are x-ray examination, MRI and ultrasound.

Dr. Epifanov about hip joint testing:

The specialist can also expand diagnostic prescriptions based on the expected stage of the disease and associated disorders.

Preventive actions

To prevent the occurrence of the disease, experts recommend adhering to certain rules:

1. Elimination of any excessive stress – when playing sports or active recreation, patients often neglect proper rest. The result of ignoring the body's demands is a slow recovery of microtraumas received during exercise.
2. Performing a number of exercises requires an even distribution of loads on muscle tissue. Violation of technique, ignoring pre-stretching invariably leads to minor injuries to the hip tissue. Proper preliminary preparation before any training will help avoid the danger of microtrauma.
3. Office employees and other representatives of mental work should take short (5-minute) breaks every hour. During this period, you are allowed to do light warm-up exercises, just walk around the office. Ideally, you should purchase a specialized orthopedic chair.
4. Controlling body weight – excess weight negatively affects the condition of the hip joint. For obesity of any severity, it is recommended to switch to dietary nutrition in order to normalize weight indicators.
5. Changing the daily diet - incoming food must contain a sufficient amount of vitamins and minerals.
6. Vitamin therapy - multivitamin complexes can compensate for the deficiency of any useful substances.
7. Timely treatment of infectious diseases, periodic visits to specialist consultations.

Hip tendinosis is difficult to treat; it is easier to follow doctors' recommendations about preventive measures. Therapy for pathology takes a long time and does not always guarantee absolute recovery. Timely contacting a medical facility at the first symptomatic manifestations is the key to successful treatment.

The disease can affect both teenagers and older people. The risk of possible development of an anomaly depends on the number of predisposing factors.

Forecast

• Provided the underlying biomechanical deficiency is corrected, the overall prognosis is favorable.
• Identifying this deficiency early may play a role in preventing the development of chronic symptoms. However, as mentioned earlier, the diagnosis of PPM tendinopathy is made approximately two years after symptoms develop. In these cases, recovery may take longer.
• The patient should not return to sports until they have achieved a full and pain-free range of motion.

Complications

Without timely treatment, tendinosis can cause complications, including:

• tenosynovitis - acute or chronic inflammation of the joint capsule and surrounding tissues, accompanied by severe pain;
• ossifying tendinosis - deposition of salts of various metals in the affected tissues, provoked by impaired blood circulation and lymph flow in this area;
• tunnel syndrome - compression of the nerve endings in the wrist due to severe tissue swelling.

Therapy methods

Treatment tactics for quadriceps tendinitis depend on the cause of this pathology. In the case of traumatic tendonitis, treatment will consist primarily of immobilization of the affected limb and pain relief. In other cases, therapy is aimed at eliminating the root cause of its appearance. Treatment of tendinitis of the adductor muscle of the thigh, as well as the rectus and vastus muscles, is predominantly conservative.

Surgical intervention is necessary only in late stages of diseases accompanied by severe pain.

With timely diagnosis and adequate treatment, the prognosis in the vast majority of cases is favorable.

Drug treatment

Non-steroidal anti-inflammatory drugs are used to stop the inflammatory process and relieve pain. They can be used either orally or in ointment, cream or gel format. In case of severe pain, glucocorticoids are prescribed by injection.

Physiotherapeutic methods

At the recovery stage, physiotherapeutic procedures are prescribed to speed up rehabilitation:

• electrophoresis with lidase;
• UHF heating;
• magnetic therapy;
• massage;
• physiotherapy.

Traditional methods of treatment

Alternative therapy can be used as an adjuvant in line with general therapy and only after consultation with the attending physician.

• A compress of raw potatoes and onions will help relieve inflammation and swelling in the area of ​​the affected tendon. Finely grated raw vegetables are mixed with cosmetic clay and applied to the affected area overnight.
• Turmeric helps reduce pain. It is added to food; the daily dose should not exceed 0.5 grams.
• Rubbing with castor oil infused with grated garlic helps relieve pain and improve blood circulation.
• Ginger tea will help reduce inflammation and strengthen overall immunity.

Symptomatic manifestations

The main signs of a pathological abnormality in the tendons do not depend on the muscle group affected:

• Severe pain - with any movement of the damaged joint;
• Bursts of pain resulting from palpation;
• Rattling and crunching, clearly audible during movements of the inflamed joint;
• Changes in the color shade of the skin in the affected area;
• Increased body temperature at the location of the problematic tendons;
• Reduced mobility or absolute blocking of the damaged hip joint.

Physical examination

Inspection

• The patient may hold the affected hip in a slightly flexed and laterally rotated position (a sign of psoas hypertonicity).
• Posture assessment may reveal anterior pelvic tilt and increased lordosis of the lumbar spine.
• When assessing gait, a decrease in step length may be observed on the affected side. Additionally, an increase in knee flexion may be observed during heel strike (initial contact) and mid-stance phase.

Palpation

• Increased pain on deep palpation of the iliopsoas muscular joint within the femoral triangle. Palpation of the inguinal lymph nodes in this area should be unremarkable.
• Pain may be present at the insertion of the PLM tendon on the lesser trochanter, which can be palpated under the gluteal fold (with the patient in the prone position).

Range of motion

• Passive hip extension may be limited and/or painful (normal ~15 degrees).
• Active hip flexion or flexion against resistance may cause pain.

Functional/orthopedic testing

• The Thomas test or modified Thomas test can detect excessive hypertonicity of the hip flexors.
• “Iliopsoas test”: hip flexion against resistance, with hip external rotation (performed with the patient in the supine position). Muscle weakness and/or pain symptoms indicate that the test is positive.
• Ludloff's sign (isolated assessment of the strength of the PPM): the patient is in a sitting position on the couch with his legs straightened, he needs to lift the heel of the affected leg off the table. The test is considered positive if muscle weakness and/or pain symptoms appear.
• Stinchfield test: the patient performs an active straight leg raise to 45 degrees. He then needs to resist the downward force that is applied to the front of the thigh. Pain and/or muscle weakness indicate damage to the psoas muscle or intra-articular pathology.
• Maneuver that triggers clicking in trouble: The affected hip is placed in flexion, abduction, and external rotation. The hip is passively moved into extension and internal rotation. A positive test is a palpable or audible clicking sound localized in the groin area. Pain caused by this maneuver may indicate tendinitis or bursitis in the pelvic area.

Other

Reciprocal inhibition of antagonist muscles and various dysfunctions located along the kinetic chain may be associated with hypertonicity of the RPM. Therefore, additional testing should include evaluation for hip abductor weakness, spinal instability, inferior crossed syndrome, overpronation of the foot, and dysfunctional breathing.

Epidemiology

In general, pathological conditions of the groin, such as tendonitis, bursitis, snapping, and impingement, are considered the main cause of chronic groin pain in approximately 12-36% of athletes and in 25-30% of athletes with acute groin injury.

• It is most common in athletes such as football players, but can also occur in non-athletic populations.
• The most commonly reported incidence is in young adults (peak age group is in the 30s).
• Slightly more common in women.

Story

The history often contains indications of deep pain in the groin or pain spreading along the anterior surface of the thigh. Pain may be initially triggered by the onset of activity, decreasing shortly thereafter. Symptoms may progress to constant pain during activity that improves only with rest, and finally to pain with both activity and rest. Diagnosis is usually delayed, and the average estimated time between initial symptoms and diagnosis is 32 to 41 months.

• Intermittent pain in the groin, usually described as a deep pain.
• Symptoms worsen with activity (especially kicking) and improve with rest. Other aggravating factors include tying shoelaces, standing up after sitting for a long time, and walking uphill.
• An audible clicking or pinching sensation in the hip or groin area.
• Radicular symptoms may be reported, extending along the front of the thigh to the knee.
• Psoas muscle dysfunction is usually associated with a variety of lumbosacral complaints, which may include low back pain, discomfort in the buttocks or thighs, and inability to stand completely upright.

Causes of tendinitis and mechanisms of development

The main cause of tendinitis of the thigh tendons is chronic microtrauma of the ligament tissues received during their functional overload. As a rule, if such microtraumas occur systematically and regularly, the body is not able to restore damaged tissue. An aseptic inflammatory process develops at the site of damage. Over time, the normal structure of tendon tissue is disrupted, and its elasticity and strength decreases. Changes in tendon tissue are accompanied by limited mobility and painful sensations that increase with movement.

Other causes of hip tendonitis include:

• autoimmune disorders that cause systemic damage to connective tissue (rheumatoid arthritis, etc.);
• reactive arthritis (Reiter's syndrome);
• metabolic disorders (gout, diabetes);
• degenerative changes in joint tissue;
• infection caused by a bacterial or viral agent;

• long-term use of glucocorticoid drugs;
• long-term antibiotic therapy;
• diseases of the hematopoietic system;
• chronic hypertension;
• chronic renal failure and other kidney diseases;
• age-related changes in the tissues of ligaments, tendons and joints;
• hereditary predisposition;
• general decrease in immunity.

A number of studies prove that a predisposing factor in the development of tendinitis is the excessive presence in the diet of foods containing purine bases: red meat and red fish, coffee, cocoa bean products.