Hip tendonitis: causes of the disease and its treatment

Tendinitis of the hip joint is the initial stage or one of the types of primary periarthritis of the hip joint. The pathological process is localized in the places of attachment to the greater trochanter of the thigh of the tendons of the gluteus maximus, gluteus medius and tensor thigh muscles. Diagnosis of the disease at the Yusupov Hospital is carried out using modern equipment from leading European and American manufacturing companies.

Rheumatologists use the latest medications for treatment, which are registered in the Russian Federation, are highly effective and have minimal side effects. Severe cases of hip tendinitis are discussed at a meeting of the Expert Council. Professors, associate professors, and doctors of the highest category take part in its work. Leading specialists in the field of rheumatology collectively determine patient management tactics, and individually select for each patient those drugs and methods of non-drug therapy that are most suitable for him. Rehabilitators draw up an individual rehabilitation treatment program.

Causes of tendinopathy

Tendinopathy can affect people of any age, but is more common in athletes. Older people are also susceptible to this condition because as they age, tendons tend to lose elasticity and become weaker. This means that the joint is no longer able to move and move freely. Age-related changes also occur in the blood vessels surrounding the tendons. This aggravates the severity of the disease.

Tendinopathy is classified into inflammation of the knee, shoulder, hip, wrist, and Achilles tendons (which connect the calf muscle to the heel bone). The patient experiences discomfort that makes it difficult to do basic things like putting on clothes. The disease requires early diagnosis, given the similarity of symptoms with manifestations of arthritis and inflammation of the ligaments. Making a preliminary diagnosis is quite difficult, and the inflammatory process becomes chronic.

The main reasons for the development of the disease:

• Rheumatoid arthritis.
• Excessive load on the muscle.
• Previous injuries (bruises, tendon rupture).
• Diseases of an immune nature.
• Metabolic disorders (obesity) or problems of endocrine origin (diabetes mellitus).
• Infectious processes affecting connective tissue.
• Inflammation, wear and tear of joints.

Predisposing factors also include thermal damage to the tendon - thermal injury. Climbers, rock climbers and tourists encounter this type of damage. Most cases affect the areas of the hands, wrists, ankles and feet.

Anatomical features are a rare cause of tendinopathy. If the tendons do not have a smooth surface, they become vulnerable and become inflamed and irritated quite easily. In this situation, surgery is often necessary to solve the problem.

Causes of hip tendinitis

The provoking factor that causes the development of tendonitis of the hip joint is dynamic overload of the muscles that attach to the greater trochanter after prolonged walking and sports. Static overload of the same muscles can occur due to congenital or acquired changes in the spine:

• Scoliosis;
• Hyperkyphosis;
• Hyperlordosis;
• Asymmetry of the length of the lower limbs.

Hip tendonitis most often affects people who are overweight or lead a sedentary lifestyle. Secondary tendonitis develops in patients with aseptic necrosis of the femoral head and coxarthrosis, infectious or systemic inflammatory processes, and congenital dysplasia of the hip joint. The cause of the disease may be a disorder of calcium metabolism, age-related aging of periarticular tissues, and dysfunction of the thyroid gland.

Types of tendinopathy

There are several types of tendinopathy: the classification is based on the location of the lesion.

Lateral epicondylitis (“tennis elbow”) causes pain on the outside of the elbow joint.

Medial epicondylitis (golfer's elbow) is a condition that causes pain on the inside of the elbow. It occurs in people with occupations that require repetitive movements of the elbow (for example, construction work).

Knee tendinopathy involves the tendon located at the inferior edge of the patella or the quadriceps tendon at the top of the kneecap. This is a common type of injury, especially in basketball players and long-distance runners.

Wrist tendinopathy most often presents as de Quervain's disease, a condition that causes pain in the back of the wrist at the base of the thumb. Sometimes the pathological condition develops during pregnancy.

Rotator cuff tendinopathy causes dull, aching pain that is not localized to just one area. It often radiates to the upper arm and chest projection. The pain intensifies at night, making it difficult to sleep.

Achilles tendinopathy is rarely caused by diseases such as ankylosing spondylitis, reactive arthritis, gout, or rheumatoid arthritis. The development of pathology is preceded by prolonged flexion and extension of the foot or wearing ill-fitting shoes. The pain is felt in the back of the heel or a few centimeters above it.

Biceps

A separate type of shoulder tendonitis that occurs when the biceps muscle becomes inflamed. There are different forms:

• aseptic (non-infectious damage);
• septic (as a result of infectious processes).

Symptoms:
significant pain in the shoulder, significant decrease in mobility, local increase in tºC, hyperemia, spasmodic, hard muscle.

Causes:

degenerative disorders in the muscle under high load, trauma (muscle ruptures, joint dislocation, microtrauma), ossification of tissues around the joint, trophic disorders.

Therapy:

medication (long-term anti-inflammatory course), physiotherapy, massage, gymnastics.

Treatment

The first step to properly treating tendinopathy is to stop all activities that involve the joint.

It is possible that you will need to wear a bandage over the affected area. This will allow the painful area to strengthen and protect it from further inflammation and deformation.

The doctor prescribes anti-inflammatory drugs. They will relieve pain and dilate blood vessels.

Ultrasound treatment is also practiced, which is used by doctors to destroy the accumulation of scar tissue around the tendon. Sound waves vibrating at a very high level increase blood circulation and soften the affected area. Ultrasound can also be used in the form of phonophoresis to help reduce pain and promote penetration of nutrient solutions into tissues.

The clinical picture is re-evaluated after at least 3 weeks.

Treatment with shock wave therapy

Shock wave therapy has a positive effect on joints. The method is unique because it helps restore the damaged structure and at the same time reduce pain. Supersonic shock waves are delivered at short intervals, which ensures their almost continuous impact. Its goal is to launch the mechanism of regeneration of inflamed and damaged tissue, normalize microcirculation, prevent the formation of calcium deposits, suppressing pain conduction from neurons. Improvements occur after the first procedure. Contraindications for the method are pregnancy, bleeding disorders, and the presence of a pacemaker.

Brachial

Pathology develops more often in the tendons of the biceps and supraspinatus muscles.
Symptoms:

pain in the shoulder and spreading to the surrounding soft tissues, elbow. Intensified by bending and rotation. With calcific tendovaginitis, a crunching sensation is felt in the joint.

Causes:

injury, monotonous movements, excessive physical activity,

Treatment:

outpatient. Minimize the load without reducing the range of motion (to avoid contracture). Therapeutic exercises, physiotherapy, anti-inflammatory drugs, topical ointments, compresses, blockades with anesthetics and corticosteroids. In advanced situations, surgical intervention is possible.

Diagnostics

Tendinopathy requires differential diagnosis. You need to see a doctor if:

1. The pain interferes with normal activities and persists for several days.
2. The painful sensation worsens even due to minor stress.
3. Fever (chills accompanied by increased body temperature) is noted.
4. Swelling, redness and swelling of the skin over the affected area.
5. Joint pain occurs in more than one place.

A doctor can usually diagnose tendinopathy based on your medical history and physical examination. In order to exclude other types of injuries, the specialist will refer you for an ultrasound, X-ray or MRI. Auxiliary methods are needed to ensure that there is no fracture, dislocation or bone marrow cancer. Laboratory diagnostics is an equally informative part of the study. Blood tests can detect infection, which is a rare cause of tendon injury.

Tendinopathy cannot always be cured quickly - you need to be prepared for this. Wearing a bandage, following the doctor's recommendations, using auxiliary therapy methods and limiting physical activity will help return the joint to its normal state.

Why is tendinitis dangerous?

One type of such inflammatory processes is tendonitis. This disease is not that rare, but its late detection can have serious health consequences.

Tendinitis and its characteristic features

Tendinitis is usually called acute inflammation of the tendon resulting from injury. The areas of large joints on the arms and legs are most susceptible to inflammatory processes, which is not surprising, because the limbs are most actively involved in physical activity. Men are twice as likely to develop tendonitis as women. Here again, the types of activities and traumatic professions where men are involved more often have an impact.

The risk of inflammatory processes increases under the following conditions:

• Physical activity associated with lifting weights;
• Metabolic disorders, vitamin deficiency and general weakness of the body (especially often observed with colds);
• Antibiotic therapy can also weaken tendon tissue in many cases;
• Mechanical injuries (mainly sports injuries);
• Some sexually transmitted diseases (such as gonorrhea and chlamydia);
• Joint diseases (various types of arthritis, arthrosis, lupus, scleroderma and others);
• The presence of pathological processes in the spine;
• Dystrophy of the body and postural disorders that are its consequence.

Despite the high probability of origin and development due to injury, tendonitis can also accompany other serious diseases.

Therapy used to treat cancer can also cause tendinitis. Exposure to small doses of radiation and drugs that inhibit the activity of cancer cells negatively affect the hematopoietic function of the body, and this leads to insufficient saturation of tissues with necessary substances.

The mechanism of the inflammatory process

It makes no sense to describe the complex process of the occurrence of the disease. But it is undoubtedly worth paying attention to the most important stages of the development of tendinitis.

As a result of prolonged and excessive physical activity, swelling occurs in the tendon and subsequent damage to the collagen fibers. The process of salt deposition leads to their calcification and tissue damage due to the resulting calcifications. Hence the full name of the disease – calcific tendonitis.

It is not easy to recognize the disease on your own, but this is indicated by a number of characteristic symptoms:

• Gradually increasing pain in the joint area;
• Limitation of joint movement due to pain and microscopic injuries;
• Due to the proliferation of fibrous tissue under the skin, small spherical formations of small diameter can be found;
• Redness and increased temperature in the affected area;
• The appearance of shortness of breath and irregular heart rhythms (arrhythmia);
• If tendonitis occurs against the background of a sexually transmitted infection, then it is characterized by the presence of purulent discharge in the urine;
• Also, in the joint affected by the disease, characteristic clicks appear when moving - the so-called auscultatory noise.

tendinitis diagnosis and treatment

The doctor makes a diagnosis based on an examination and a detailed medical history of the patient. Blood tests play an important role in diagnosing the disease (tendonitis can be indicated by any changes in the number of leukocytes, and rheumatoid factor is also taken into account). For traumatic tendinitis, ultrasound, radiography and magnetic resonance imaging (MRI) are prescribed.

tendonitis treatment

may differ slightly when taking into account the causes of its occurrence, but is often complex in nature and aimed at eliminating the causes of the disease. The main condition for successful recovery is immobilization of the damaged area. In case of traumatic tendinitis, the first step is to fix the affected tendon and apply ice or cooling lotions. This measure can significantly reduce the swelling of damaged tissues.

With rare exceptions, treatment includes:

• Drug therapy. The patient is prescribed anti-inflammatory drugs;
• Physiotherapy. Lost mobility is gradually restored to the damaged limb through various motor exercises;
• Laser therapy. Radiation allows you to quickly restore various microtraumas and protects damaged areas from infections. Magnetic therapy can also be used for the same purposes;
• UV therapy. Used to normalize blood circulation and, as a result, nourish injured tissues;
• Ultrasound. Prevents the proliferation of fibrous tissue and destroys the resulting calcifications.

Surgical intervention is advisable only in the presence of serious tendon ruptures resulting from injury and/or the formation of accumulations of pus due to the infectious nature of tendinitis. After the operation, the limb is fixed with a plaster cast, taking into account the severity of the disease.

Prevention

Unfortunately, there is no universal prevention against tendon injuries.

You can only reduce the risk of injury by choosing safer activities and strengthening your body. The musculoskeletal framework is strengthened through adequate physical activity, proper nutrition and vitamin intake.

It is believed that microtraumas received during regular exercise have a positive effect on the condition of the tendons - they become more flexible and elastic.

An active lifestyle, quitting smoking and frequent alcohol consumption keep the body in good shape and normalize the balance of microelements in muscles, bones, joints and tendons.
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Feet

Ankle tendinitis
is characterized by dystrophic lesions of the tendons of the foot. Risk group: athletes, age after 40 years, work associated with carrying heavy loads and being in an awkward position, obese people. The disease can begin in all or in specific tendons of the foot. When inflammation is localized in the ligament that attaches the triceps muscle to the heel bone, Achilles tendonitis develops.

Symptoms:

pain in the foot, worsens with movement or palpation, swelling, redness of nearby tissues, crunching, decreased mobility.

Motives:

stress, excess weight, injury, diseases of the joints and musculoskeletal system, infections, constant wearing of high-heeled shoes.

Therapy:

conservative, including medications, physiotherapy, massage, and the use of orthopedic shoes.

Conservative treatment of iliopsoas tendinitis

Conservative treatment of iliopsoas muscle tendonitis includes the following procedures: immobilization, cryotherapy, anti-inflammatory medications, vitamin and mineral complex, laser and magnetic therapy. Mineral, wax and mud applications help well. In addition, iliopsoas tendonitis can be successfully treated with physical therapy. It includes the following procedures: ultrasound treatment, heat therapy and massage. Physiotherapy improves range of motion, improves the quality of metabolic processes in tissues, relieves inflammation, restores elasticity of structures and normalizes joint function.

When there is inflammation, rest is important. It is needed in order to avoid actions that could make the pain worse. Sometimes novocaine blockade is used to reduce pain.

Gluteal muscles

Observed with dystrophic changes in the tendons of the gluteal muscles.
Factors:

loads in athletes, mechanical trauma, infections, diabetes mellitus, congenital changes in the hip joint, osteoarthritis.

Clinic:

impaired motor function of the lower limb, lameness, pain, swelling, difficulty moving in the hip joint.

Treatment:

symptomatic, anti-inflammatory, physiotherapeutic (UHF, laser, ultrasound therapy, electrophoresis), massage.

Surgical treatment of iliopsoas tendinitis

Surgical intervention is prescribed if conservative treatment is ineffective. During the operation, the affected tissue is excised. If we are talking about calcific tendinitis, then calcium deposits are destroyed with a needle. The operation is performed under anesthesia, then the inflamed area is absorbed.

If a tendon rupture occurs, a transplant is performed using one's own or donor tissue. After the operation, painkillers, antibiotics, and vitamins are prescribed. After surgery, a rehabilitation course is prescribed.

Knee

This is a degenerative-inflammatory process of the knee tendons. It often occurs in volleyball, basketball and cycling players. Possibly unilateral/bilateral development. The course can be acute/chronic. Pathology goes through the following stages:

• 1. Pain after high load (absent at rest).
• 2. Attacks during standard training.
• 3. Pain in a relaxed state.
• 4. Degeneration of the fiber structure with possible rupture.

Symptom complex:
pain (may be absent at the beginning of the disease), loss of motor function, swelling, redness, joint creaking when moving, unpleasant sensations due to atmospheric changes, sensitivity when feeling the knee.

Factors:

physical overload of the joint, heavy weight, trauma to the kneecap, infections, musculoskeletal disorders, age-related changes, obesity.

Therapeutic measures:

standard for this disease (medicines, gymnastics, physiotherapy). Treatment is possible at home (after consultation and doctor’s prescriptions).

Rehabilitation after iliopsoas tendinitis

Rehabilitation is a recovery period prescribed after the main course of treatment. Courses of massage, physiotherapy and physical therapy are prescribed. Physiotherapy is also used in the postoperative period, which helps speed up the recovery process.

Therapeutic taping of inflamed tendons is used. Tape is an adhesive tape that is used to support joints. As a rule, it is prescribed by physiotherapists and rehabilitation specialists. The main task of taping is to relieve pain and create an anti-inflammatory effect. When applied correctly, the patient's pain decreases and range of motion increases. The tape can be used during exercise therapy.

Physical therapy consists of performing certain exercises that will speed up the recovery process of the iliopsoas muscles. The exercises must be performed under the supervision of a doctor. You can increase the load gradually. It is worth avoiding sudden exercises, but it is important to do them smoothly and follow the correct technique. A set of exercises is compiled by a rehabilitation specialist individually, depending on the characteristics of the course of the disease.

Therapeutic massage helps restore blood supply to muscle fibers, increases their elasticity, promotes the delivery of oxygen and nutrients, thereby eliminating muscle discomfort. As a rule, a massage course consists of 10-15 sessions. Massage is often done before exercise therapy, as a result of which the muscles warm up well and become more elastic, or after exercise - to relieve tension.