The hip joint is the largest structure in the human musculoskeletal system. There are different causes for the development of diseases of the hip joint; the symptoms of these pathologies are largely similar. For treatment to be effective and to shorten the rehabilitation period, it is necessary to consult a doctor as early as possible without ignoring the first symptoms. Effective treatment methods are medications and physiotherapeutic procedures. In advanced stages of the disease, surgery may be necessary, followed by long recovery. You can get rid of pain in the hip joint without surgery with the help of comprehensive treatment at ArthroMedCenter.
Anatomy of the hip joint area
The hip joint is the largest joint in the human body. It connects the head of the femur to the acetabulum of the pelvis. The muscular and ligamentous apparatus, together with the joint, provides the motor function of the limb. Normally, the head of the hip bone is spherical in shape, with smooth cartilage tissue present on all surfaces of the joint.
The fluid inside a joint is called synovial fluid. It is located in the joint cavity, due to this, friction between the surfaces of the joint is reduced. Synovial fluid supplies cartilaginous structures with useful components, due to this there is depreciation and uniform load distribution.
There are such structures of the hip joint:
- femur - with its help a joint is formed;
- the hip joint is a kind of hinge, its surface is covered with a ball of smooth substance, thanks to which motor function occurs;
- femoral head;
- the acetabulum, which is bowl-shaped;
- cartilage - cushions the joint, allows smooth movement of bones, it is not visualized on radiographic images;
- The pelvis is a large, flattened bone. It has an irregular shape, narrows towards the center, widens upward and downward, the anterior surface of the parts is connected by the pubic symphysis, and the posterior surface is connected to the head of the femur.
Anatomy
The structure of the joint is determined by its function - to bear high static and dynamic loads. The joint is formed by the articular surfaces of the sacrum (5 fused sacral vertebrae) and the auricular articular surface of the ilium. The joint capsule is a dense fibrous tissue stretched tightly between the sacrum and the ilium.
The ligamentous apparatus that fixes the joint is represented by short and powerful ligaments, one of the strongest in the human body:
- Sacroiliac interosseous ligaments.
- Posterior sacroiliac ligaments.
- Ventral ligament.
- Iliopsoas ligament.
The blood supply to the joint is carried out by the lumbar, sacral and iliopsoas arteries, and innervation occurs through the branches of the lumbar and sacral nerve plexus.
What structures can become inflamed in the hip area?
In this area of the musculoskeletal system, an inflammatory process can develop, which affects specific structures or spreads to the entire pelvis.
With arthrosis of the hip joint or coxarthrosis, the inflammatory process directly affects the head of the joint. The development of the disease occurs over a long period of time. The reason is:
- overload;
- inflammation;
- injury;
- infectious process.
At first, discomfort appears, but later it develops into pain. As the disease progresses, the volume of synovial fluid decreases, gradual thinning and damage begins, and subsequently destruction of cartilage tissue. Movements are limited, joint deformation occurs, and osteophytes form.
With hip dysplasia, the acetabulum is affected. This pathology is congenital. Currently, this developmental anomaly can be diagnosed at an early age thanks to instrumental research methods. The consequence of untreated dysplasia is coxarthrosis and hip dislocation.
With aseptic or avascular necrosis of the head of the femur, blockage or compression of the vascular bundles that supply blood to the head occurs. Subsequently, calcium is washed out and cysts form. This is manifested by severe pain, fraught with complete immobilization and disability of a person.
The femoral neck most often suffers from a fracture. The provoking factor of this condition is osteoporosis, in which there is increased fragility of bones and thinning of tissues. Such an injury can occur even with a minor injury or fall from a small height. The fracture is accompanied by severe pain and deterioration in motor function.
Why do the pelvic bones diverge during pregnancy?
To answer this question, it is necessary to understand the structure of the female skeleton and the mechanism of childbirth itself. The pubic bone, where discomfort occurs, consists of the upper branches of two pubic bones, movably connected to each other by a cartilaginous ligament (symphysis). The ring formed by the pubic bones “encircles” the birth canal, maintaining the pelvic organs in a normal position and preventing them from descending (prolapse) under their own weight. It is through this opening that the fetus passes during birth.
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Due to the evolutionary characteristics of the human body (namely upright walking), the free passage of a child naturally in women is difficult compared to childbirth in animals. Wise nature has found a compromise - during pregnancy, the pelvic bones diverge, increasing the size of the birth canal by 5-6 mm. At the same time, during childbirth, the movably connected bones of the skull shift in a child, making its head narrower and facilitating its passage through the birth canal.
The divergence of the pelvic bones is facilitated by the softening of the symphysis ligament under the influence of the substance relaxin and female sex hormones. At the same time, the cartilage tissue becomes looser and more elastic (while maintaining the same strength), cavities filled with liquid appear in it, and the local capillary network increases.
Because this process is intended to facilitate labor, it normally occurs after the 20th week or toward the end of pregnancy. The exact time may vary depending on the individual characteristics of the woman.
Thus, the divergence of the pelvic bones during pregnancy is a natural process that facilitates childbirth. It relieves the woman from even more pain, and protects the baby from getting stuck in the birth canal and traumatic brain injuries.
Features of pain in the hip joint
Painful sensations that occur in the area of the hip joint can be different:
- aching;
- permanent or temporary, periodic, occurring after load;
- pulling;
- bursting;
- spasms;
- piercing;
- sharp or mildly expressed.
The pain can move to the groin, buttock, knee, lower back, ankle. It may be accompanied by a clicking or crunching sound, swelling, swelling, and hyperemia of tissue in the joint area. Local or general body temperature may also increase.
Main causes of hip pain
The causes and provoking factors for the appearance of an unpleasant symptom may be:
- arthritis – juvenile rheumatoid, osteoarthritis, psoriatic, rheumatoid, septic;
- injuries of various types - bursitis, dislocation, fracture, damage, bruise, tendinitis;
- pinching of nerve fibers or bundles - vertebrogenic Bernhardt-Roth meralgia paresthetica, sacroiliitis, sciatica, lumbago;
- oncological diseases - cancer with metastases, osteosarcoma, leukemia;
- development of avascular necrosis of the femoral head;
- Legg-Calvé-Perthes syndrome;
- development of osteomyelitis;
- development of osteoporosis;
- the presence of synovitis.
Pain syndrome can appear in the presence of pathologies or diseases of the muscular system. Each muscle has a specific effect on the functioning of the joint apparatus.
If hypertonicity or hypotonicity occurs, this makes it difficult to evenly distribute the load on the joint. The muscles of one group become too tense, and the other group become too relaxed. As a result of a malfunction in muscle tone, pain of a certain intensity may also appear in the thigh area. Usually it is short-lived and goes away on its own after changing body position or with rest.
There may also be radiating pain. It appears as a symptom of one of the diseases of the spinal column, groin (hernia). Systemic pathologies – myalgia, spondyloarthritis – can also cause pain in the hip joint.
Osteoarthritis of the hip joint
Arthrosis of the hip joint or coxarthrosis is a pathology of the musculoskeletal system. In an advanced stage, the disease leads to disability. The disease is accompanied by limitation or complete loss of motor function and joint deformation. The development of the disease involves thinning and destruction of cartilage tissue, as a result of which mobility deteriorates. This is a very common pathology.
The provoking factor is the person’s age. As the body ages, its tissues gradually wear out. The cartilage becomes thinner and begins to break down.
The development of coxarthrosis can be caused by:
- injuries of various types - fractures, bruises, dislocations;
- genetic predisposition;
- diseases of the spine;
- overweight, obesity;
- disturbances in the endocrine system, hormonal imbalances;
- maintaining a sedentary lifestyle;
- deterioration of blood microcirculation in tissues;
- infectious diseases.
All these provoking factors lead to the fact that the cartilaginous structures are worn out and the articular surfaces begin to rub against each other. The bones become damaged and begin to deform. Movement is constrained and may be completely limited in the future.
This pathology can be primary or secondary. According to most doctors, primary coxarthrosis occurs when blood microcirculation in the joint area is disrupted. In the first two stages, the disease can be successfully treated with conservative methods. In the second two stages, a person needs surgery.
The key manifestation of this disease is severe pain that appears in the thigh and groin area. At first, this symptom appears only after physical exertion, after prolonged standing or walking. In the future, the pain becomes more pronounced and persists constantly, even after rest.
It is very important to see a doctor in the early stages of the disease. This will stop further progression of the pathological process. If hip arthrosis is not treated, the severity of the disease will progress. The pain radiates to other areas - lower back, groin, spine, knee, lower leg.
Painful sensations are accompanied by:
- discomfort;
- feeling of fullness;
- crunch;
- clicks during movements.
At the initial stages of the disease, stiffness appears after waking up in the morning. In the future, mobility is limited, and gradually it becomes difficult for a person to move without a cane. At an advanced stage, the ability to move is completely lost.
The presence of this disease can be determined using radiography, computer or magnetic resonance imaging, and ultrasound. Treatment in the early stages involves the use of conservative therapy. In the later stages, radical intervention can help.
Causes of pelvic distortion (displacement)
First of all, pelvic distortion is caused by normal muscle imbalance. Technology is developing very quickly and a sedentary lifestyle is one of the main reasons for the development of imbalance, because our body requires a certain amount of movement, which it does not receive. Prolonged sitting and low physical activity are sufficient conditions for the development of muscle imbalance, leading to pelvic distortion and, as a result, the appearance of dysfunctional disorders in the spine and back pain.
Accidents and injuries are common causes of pelvic distortion , such as a side impact, lifting heavy objects while twisting, falling to one side, or carrying heavy objects from the side, such as carrying a child on your hip or carrying a heavy bag constantly on one shoulder. In women, the pelvis is less stable from birth than in men, since a certain flexibility and elasticity of the pelvic structures is necessary for normal pregnancy and childbirth. Therefore, pregnancy is often the main cause of pelvic displacement in women.
Damage to the pelvic muscles is the most common cause of misalignment. Injured muscles typically tighten and shift in order to protect surrounding structures. If the muscles in the pelvic area, such as the sacrum, are damaged, then the tightening of the muscles will lead to an impact on the ligaments attached to the pelvis and joints. As a result, structures such as the sacroiliac joints will also have a certain disposition. Muscle tightening after injury persists until the muscle is completely restored and during this period of time the pelvis remains in an abnormal position.
The difference in leg length can also be a cause of pelvic distortion and in such cases the distortion can be from right to left or vice versa. But the displacement may also be forward or backward, or there may be a twisting of the pelvis.
Many conditions can lead to muscle spasms that cause the pelvis to twist. A disc herniation can cause an adaptive muscle spasm and, in turn, antalgic scoliosis with functional pelvic distortion . Active people often experience tension in the calf muscles, which in turn creates tension around the pelvis. Surgeries such as hip replacement can also cause changes in the position of the pelvis.
Because the pelvis is one of the most stressful areas of the body due to movement and weight support, movements that cause pain and stiffness are a strong indicator of problems with the alignment of the pelvis. Back pain in particular is a common indicator of pelvic obliquity . In addition to participating in movement, the pelvic cavity contains: part of the digestive organs, nerves, blood vessels, and reproductive organs. Therefore, in addition to back pain, there may be other symptoms, such as numbness, tingling, bladder and bowel problems, or reproductive problems. Most often, changes in the following muscles lead to pelvic disposition:
M. Psoas major (psoas muscle) anatomically can lead to extension and flexion of the hip, which leads to anterior displacement of the pelvis.
The M.Quadriceps (quadriceps), especially the rectus muscle, can cause hip flexion.
M.Lumbar erectors can cause lumbar extension.
M. Guadratus lumborum with bilateral compaction can cause an increase in lumbar extension.
M.Hip adductors can cause anterior pelvic tilt as a result of internal rotation of the hip. This leads to shortening of the adductor muscles.
M.Gluteus maximus (gluteus maximus) is responsible for hip extension and is an antagonist of the psoas major muscle.
M.Hamstrings The muscle of the back of the thigh, this muscle can be tightened. The muscle can be weak, but at the same time thicken due to the fact that it is a synergist of the gluteus maximus muscle and this can be of a compensatory nature. The deep abdominal muscles, including the transverse abdominis and internal obliques, may become tight due to weakened lumbar erectors.
Diagnosis of the causes of pain in the hip joint
To diagnose and determine the cause of an unpleasant symptom, doctors prescribe the following types of examinations:
- radiography - it can be used to determine the condition of the bones, joints, and how narrowed the joint space is;
- computer and magnetic resonance imaging - using these methods, it is possible to establish in more detail the condition of bone and joint structures, determine the condition of cartilage tissue, ligamentous and muscular apparatus;
- laboratory blood tests, study of biochemical blood parameters;
- ultrasonography.
Sacroiliitis
Sacroiliitis is an inflammatory disease of the sacroiliac joint. Depending on the cause of the inflammation, sacroiliitis is divided into the following forms:
- Non-specific.
- Specific (caused by pathogens of syphilis, tuberculosis, brucellosis).
- Autoimmune (with ankylosing spondylitis).
- Caused by degenerative changes in joint tissues.
Symptoms
The following symptoms are common: pain in the buttock, radiating to the thigh; when the straight leg is moved back, the patient notes increased pain, stiffness in the lumbar spine, more often in the morning; after physical activity, pain in the sacrum appears (or intensifies).
Lying on your back with your knees bent and legs spread apart relieves pain, as the pressure on the sacroiliac ligaments is reduced. This sign is characteristic of sacroiliitis.
Diagnosis and treatment
The fastest diagnostic method is radiography of the pelvic bones in a direct projection with full coverage of both joint spaces. MRI is used when it is necessary to exclude tumors or the presence of purulent cavities in infectious sacroiliitis. Treatment for the disease depends on the cause. For example, for infectious processes, specific antibacterial therapy is used, taking into account the sensitivity of the pathogen, and for autoimmune processes, anti-inflammatory drugs are used.
Treatment of arthrosis of the hip joint
Conservative therapy involves the use of:
- non-steroidal anti-inflammatory drugs;
- painkillers;
- muscle relaxants;
- chondroprotectors;
- drugs to improve blood circulation.
After it is possible to stop the acute inflammatory process and reduce the severity of pain, physiotherapy and massage are prescribed. But therapeutic exercises cannot be performed. With this disease, it is necessary to limit the load on the diseased joint and use a cane when walking.
To restore full joint mobility and compensate for the deficiency of cartilage tissue, chondroprotectors are injected into the joint. To reduce pain and stop the inflammatory process, injections of hormonal drugs and painkillers are used.
Effective auxiliary treatment methods are:
- phonophoresis;
- ultrasound;
- kinesiotherapy;
- electrical stimulation;
- magnetic therapy;
- laser therapy;
- cryotherapy;
- massage;
- UHF;
- ozokerite;
- shock wave therapy;
- mud and radon baths;
- balneotherapy.
Treatment of arthrosis of the hip joint at ArthroMedCenter
At ArthroMedCenter, patients are prescribed the following procedures to effectively treat symptoms of pain due to arthrosis of the hip joint:
- SMT therapy. The procedure triggers the body's regenerative powers, improves tissue tone, and restores active blood circulation.
- Hivamat therapy. The procedure relieves pain and activates restoration processes in tissues.
- Electrophoresis. Medicinal substances are administered using current. This promotes effective pain relief and rapid recovery.
With the help of such procedures it is possible to stop further progression of the pathological process. It is very important to consult a doctor promptly when the first symptoms appear. This will quickly relieve pain in the hip joint and cure arthrosis.