Anatomy of the pelvic bone
Each pelvic bone is divided into the following three:
- The ilium is an opening bone that forms the upper pelvic lobe of the bone. You can feel (touch) it by simply placing your hands on your hips.
- The ischium is the part of the hip bone that is located at the back below, resembling an arch in appearance.
- Pubic - the anterior lobe of the base of the pelvic bones.
When connected, these bones create the acetabulum, the main socket that houses the head of the femur.
In childhood (up to 16–18 years), these bones are united with each other by cartilage; at an older age (after 18 years), this tissue hardens and gradually turns into a solid bone, which is called the pelvic bone. The photo shows the body of the ischium.
Interesting! At the base of the ischium there are tubercles - rough, thickened bones. They are popularly called sitting bones because in a sitting position, the human weight is distributed on the pelvic bones.
Normal pelvic anatomy
The pubic joint in front and the sacroiliac joints, which are formed from the ear-shaped plane of the back of the bone and the base of the sacrum, are the normal anatomy of the pelvic bone. In the video you can see in detail the structure of the human pelvis.
Anatomically, the pelvis is divided into two sections:
- Large - an extremely large part of the bone (located at the top of the pelvis).
- The small pelvis is its narrow part (located at the bottom of the pelvis).
Both pelvises are conventionally separated by the so-called boundary line, running along the top of the sacrum, then to the arcuate contour of the ilium, which also covers the outer part of the pubic bone and the symphysis of the same name.
Numerous muscles of the abdominal cavity, back and spine are attached to these bones on both sides. Some leg muscles originate from them. Thus, a muscular frame is obtained.
The structure of the small and large pelvis
The pelvis is a constituent part of the lower region of the human skeleton. In addition to the coccyx and sacrum, it is formed by two pelvic bones. In addition to the bones, the pelvic joints and ligaments act as support for the entire body.
The large pelvis is open in the front, with the planes of the ilium on both sides, and the lumbar vertebrae and the place where the sacrum forms at the back.
The small pelvis is a cylindrical space, on the sides of which are the lower parts of the ilium and ischium. The pubic bones form the anterior walls of the pelvis, while the posterior ones are made up of the bones of the sacrum and coccyx.
Converting large to small creates an overhead passage. And the lower passage is made of the pubic bones, coccyx and ischial tuberosities.
Pelvic joints and ligaments
The hip joint has a complex structure and performs an extremely important function in human life. Thanks to this connection, a person can perform the following actions:
- walk;
- stand;
- sit;
- run;
- jump;
- tilt.
The joint consists of the head of the femur and the acetabulum. Those parts of the recess that are in close contact with the femoral head are densely covered with cartilage tissue. In the middle part of the acetabulum there is a fossa, which at the bottom is filled with connective tissue and surrounded by a synovial membrane. It is in this fossa that the ligament of the femoral head is attached.
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).
Pathological anatomy
There are quite a lot of bone anomalies and they depend on a variety of factors, ranging from intrauterine bone underdevelopment (most often found in premature babies) and ending with injuries (dislocations, fractures), which subsequently led to pathology of the pelvic bones.
The most common anomalies are a wide, narrow or deformed pelvis.
- Wide. Today, a clinically and anatomically wide pelvis is distinguished. This pathology is most likely in tall, overweight people.
- Narrow. Just like wide, they are divided into clinically and anatomically narrow. The causes of a narrow pelvis may be impaired development inside the womb, insufficient nutrition, or some serious diseases, for example, rickets.
- Deformation (displacement of bones). In 99% of cases, displacement occurs in the baby’s body at birth (if the child’s mother has deformed pelvic bones, then the child’s bones, as they pass through the birth canal, become bent and displaced, not only in the pelvis, but also in the entire skeleton). This pathology is transmitted from mother to child. And in only 1% of patients, pelvic deformation occurred as a result of injury.
- Aplasia or hypoplasia - this disease, transmitted by inheritance, is quite rare, characterized by the absence or underdevelopment of one of the pelvic bones.
- Deep acetabulum - the head of the femur is located more deeply. The pathology can be either unilateral or bilateral (most common).
- Divergence of the pubic symphysis is most often observed in patients with disorders of the central nervous system, bladder or spinal exstrophy.
A clearer idea of the extent of the anomaly is provided by X-ray data.
Arthrosis of the hip joints (coxarthrosis) - symptoms and treatment
Treatment of arthrosis of the hip joints can be either conservative (medicinal or non-medicinal) or surgical. Conservative treatment is used at stages 1-2 of the disease, surgical treatment at stages 3. Surgical treatment may also be recommended at stage 2 in case of persistent pain and lack of response to conservative therapy [3][9].
Goals of conservative therapy:
- improve quality of life - reduce pain and increase joint mobility;
- stop or slow down the progression of the disease [7].
Non-drug treatments include:
- unloading the hip joint (reducing body weight, creating additional support and transferring part of the body weight to a cane or crutches);
- physical therapy;
- physiotherapeutic methods of treatment.
Treatment of coxarthrosis begins with non-drug methods, and physical therapy plays an important role. If the pain is severe, the patient should use a support. If the disease is severe and there are contraindications to endoprosthetics, the support must be used for life.
Drug therapy for coxarthrosis includes drugs that reduce the symptoms of the disease. These are analgesics, which include paracetamol, as well as drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are divided into non-selective (indomethacin, voltaren, ibuprofen) and selective (nimesulide, meloxicam).
Analgesics and NSAIDs for arthrosis of the hip joint are used short-term to relieve pain and inflammation. Currently, there is no proven advantage of one non-steroidal anti-inflammatory drug over another, so the choice of a specific drug depends on the side effects it causes and the specific clinical situation [7].
It must be remembered that NSAIDs have a number of side effects. When taken, the mucous membrane of the stomach and duodenum is affected, which may result in ulcers and bleeding. A number of NSAIDs have a toxic effect on the liver and kidneys. In addition, NSAIDs interfere with platelet aggregation, and, as a result, the patient has impaired thrombus formation and a tendency to bleeding. NSAIDs, when taken for a long time, suppress hematopoietic processes and can cause aplastic anemia and agranulocytosis. Taking selective NSAIDs causes significantly fewer complications.
Ointments and gels applied topically cause fewer side effects than oral medications. To treat arthrosis, drugs with a warming and pain-reducing effect are used. They may contain turpentine, menthol, nicotinic acid esters, salicylates, bee venom, capsicum. Applications of NSAIDs (indomethacin, diclofenac, voltaren) also have a good effect.
If there is no effect from paracetamol and NSAIDs or if it is impossible to find the optimal dose of the drug, centrally acting painkillers can be prescribed for a short time. These drugs include tramadol, which is prescribed in a dose of 50-200 mg/day. Dose selection is carried out by gradually increasing it by 25 mg.
If inflammation occurs, intra-articular injection of corticosteroids (diprospan, dexamethasone, kenalog) is used. Corticosteroids are used no more than 2-3 times a year, since more frequent use can lead to cartilage degeneration.
Slow-acting drugs that reduce the symptoms of the disease include chondroitin sulfate, glucosamine, avocado or soybean unsaponifiable compounds, and hyaluronic acid. These drugs are included in the recommendations of the European League Against Rheumatism for the treatment of arthrosis of the hip joints [7]. The drugs reduce pain and improve joint mobility.
Hip replacement is used in severe cases of stage III, when pain cannot be eliminated and joint mobility is significantly limited. Hip replacement leads to a reduction in pain, improvement in the functional state of the joint and the patient’s quality of life. The effect lasts for 10-15 years, after which repeated surgery may be required. During the operation, the hip joint is replaced with an artificial imitation made of ceramic, metal (titanium prostheses are most often used) or polymer [14].
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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