Hip pain is an unpleasant or painful sensation caused by a pathological process in the bones, soft tissues, nerves and vessels of the thigh. It can be permanent, periodic, short-term, weak, intense, dull, acute. It is often combined with edema, impaired limb function. It is caused by injuries, inflammatory, degenerative, tumor diseases, and other factors. The etiology of pain is established on the basis of complaints, examination data, radiography, CT, MRI, and other studies. Until the cause is clarified, rest is indicated, sometimes analgesics can be taken.
Causes of hip pain
Hip contusion occurs on impact or fall, manifested by moderate local pain. At first, the pain is sharp, then dull, aching, increasing with palpation and movements. Due to the large array of soft tissues, pronounced edema often develops. Bruising is possible. The function of the limb is usually slightly limited, the support is preserved.
A hematoma is also formed after bumps and falls, and resembles a bruise in its manifestations. It differs from a bruise by the bursting or pressing nature of pain, the formation of dense local edema, in the zone of which a fluctuation area appears after a while. With deeply located hematomas, the edema is nonspecific, fluctuation may be absent. A hematoma can be suspected by a significant increase in swelling in the first days or its preservation for a long time.
Damage to the quadriceps tendon is observed in athletes, less often develops in everyday life. It is characterized by acute pain on the anterior surface of the thigh, just above the knee joint, sometimes with a crack at the time of injury. Subsequently, the pain subsides, but remains quite intense. In the area of damage, soreness, swelling of soft tissues, a defect at the site of rupture is revealed. With a complete rupture, support and independent straightening of the lower leg are impossible, with an incomplete one, they are difficult.
The cause of a diaphyseal hip fracture is high-energy impacts: falls from a height, road and industrial injuries. The damage is accompanied by unbearable explosive pain. In the future, the pain is very intense, it increases with attempts to move, groping, passive shifting of the limb. The hip is swollen, deformed. The leg is shortened. Crepitation and pathological mobility are revealed. The general condition is disturbed, traumatic shock is possible.
A pathological fracture of the hip diaphysis can be diagnosed with bone cysts, tumors, some hereditary and infectious diseases. It is characterized by low severity of symptoms. The pain is minor or moderate. Displacement, pathological mobility and bone crunch are absent, which is why the injury is often mistaken for a bruise. The distinctive features of a pathological fracture are the long-term preservation of symptoms, the presence of previous soreness during exercise or at rest.
Myositis of the thigh muscles occurs after unusual physical exertion: prolonged walking or running, the first workouts after a long break. It is characterized by aching pains in the projection of the affected muscle or muscle group. There is an increase in pain during palpation, muscle tension. When feeling, diffuse muscle compaction is determined, slight edema, minor local hyperthermia are possible.
Tendinitis of the quadriceps tendon is usually found in active people over 40 years of age, manifested by vague non-intense pulling pains in the lower parts of the anterior side of the thigh. The pain increases with the extension of the lower leg. With tendinitis of the biceps tendon, characteristic of runners, the pain is localized in the depth of the buttock, spreads from behind along the thigh, increases during running, especially when accelerating. Subsequently, the pain becomes prolonged, permanent, occurs after a slight load, at rest, at night.
Pain on the outer surface of the thigh is sometimes accompanied by aseptic arthritis of the hip joint of various etiologies (reactive, allergic, post-traumatic). The pain is aching, dull, non-localized, supplemented by soreness in the groin and buttock, limited movement, difficulty walking.
Periostitis of the femur develops infrequently, as a rule, it becomes the result of injuries (bruises, fractures) or purulent lesions (deep infected wounds, abscesses, phlegmon, arthritis). In the first case, the process is aseptic in nature, accompanied by moderate pain, which increases with palpation. Minor edema is detected. The general condition is not disturbed.
Sometimes there is serous posttraumatic periostitis, characterized by a significant accumulation of fluid under the periosteum. Pathology is manifested by moderate bursting pains, swelling, deformation. With purulent inflammation of the periosteum, an acute onset is observed with intense twitching, pulsating pains. Local hyperemia, significant segment edema, body temperature rise, chills, fever are detected.
The femur is one of the most frequent localizations of hematogenous osteomyelitis. Bone inflammation develops in childhood, often against the background of a minor injury or after an acute infection. It proceeds with a sharp increase in temperature, fever, chills, delirium. A day after the appearance of hyperthermia, intense localized deep hip pain occurs. The pain increases, becomes unbearable, forces the patient to freeze in bed.
There is a local form of hematogenous osteomyelitis, in which the pain syndrome is less pronounced, the general condition is slightly disturbed. In some cases, there is a severe hurricane course of the disease with a predominance of common symptoms. Post-traumatic and postoperative osteomyelitis are also manifested by pain, swelling, hyperemia, disorders of the general condition, but the pain appears against the background of suppuration of an open fracture or postoperative wound, progresses more slowly, does not reach the degree of unbearable.
Vascular and soft tissue infections
Hip pain is noted with purulent lesion of soft tissue structures. At first it has a bursting or pressing character. The intensity of the pain syndrome increases rapidly, the pains become pulsating, tearing, jerking, sharply restrict movement, disrupt night sleep. Puffiness and an increase in local temperature are detected. The severity of the general manifestations (hyperthermia, fever, symptoms of intoxication) depends on the prevalence of the purulent process. The cause of pain is:
- Furuncle. A limited focus of inflammation, which is a convex sharply painful formation covered with bluish-purple skin. In the center of the formation is a black rod surrounded by pus. The general condition usually does not suffer.
- Carbuncle. It consists of several closely located small foci merging into one infiltrate with a diameter of up to several centimeters. Severe hyperthermia and fever are observed.
- Abscess. A limited purulent focus, the diameter of which can range from 2-3 to 10 centimeters or more. It is accompanied by weakness, weakness, an increase in temperature to febrile numbers.
- Phlegmon. Widespread purulent inflammation without clear boundaries. It is characterized by intense pain throughout the thigh, severe intoxication.
From foci in soft tissues, the infection can spread through the lymphatic vessels. The manifestation of reticular lymphangitis is indicated by increased pain, deterioration of the general condition, the appearance of a marble pattern around the primary inflammatory focus. With stem lymphangitis, a longitudinal stripe appears on the thigh, along the course of which soreness during palpation, edema, hyperemia, cord-like tissue compaction is determined. When deep vessels are affected, the stripes on the limb are not detected, there is a rapidly increasing bursting pain, lymphedema of the underlying departments.
With phlebitis and thrombophlebitis of the superficial veins of the thigh, developing against the background of infectious lesions or varicose veins, rapidly progressive soreness along the vein is detected. The pain increases when walking, usually localized in the lower third of the segment. Phlebitis and thrombophlebitis of deep veins are manifested by constant increasing pain, edema, general hyperthermia, milky-white coloration of the skin of the limb.
A special form of venous lesion is postpartum thrombophlebitis, which occurs in the first weeks after childbirth. Intense pain on the inner side of the thigh is observed with inflammation of the large saphenous vein, combined with edema, deterioration of the general condition. With the involvement of deep femoral veins, unbearable acute pains along the anterior-inner surface of the thigh, significant swelling, pallor of the skin of the limb, fever are noted.
For benign tumors of the femur, slow growth and a long, often long-term course are typical. Osteomas and chondromes are manifested by minor transient unclear pains, with chondromes in children, deformities and shortening of the limb are possible. With osteoid osteomas, the pain is intense, sharp. The growth of neoplasia is accompanied by increased pain, the appearance of palpable bone density formations.
The most common malignant tumors of the hip include osteogenic sarcoma, chondrosarcoma and Ewing’s sarcoma. Chondrosarcomas are usually localized in the upper part of the bone, osteogenic sarcomas – in the upper or lower, Ewing’s sarcomas – in the lower. Pain with such neoplasms is initially dull, unclear, rapidly intensifies, becomes unbearable, combined with the appearance of a venous pattern, deformation, weight loss, general weakness.
Hip pain is often caused by neurological diseases. Distinctive features of such pain are shooting, burning, shooting or piercing nature (some patients compare sensations with a “dagger strike”), combination with paresthesia, weakening of muscle strength, sensitivity disorders. Pain in the hip area provokes the following pathologies:
- Femoral nerve neuropathy. There are pains on the anterior-inner surface of the thigh and in the groin, which increase with the extension of the knee joint.
- Sciatic nerve neuropathy. The patient complains of pain on the posterior surface of the thigh, which extends from the buttock to the shin and foot, increases when trying to lift a straight leg while lying on his back.
- Piriformis muscle syndrome. It occurs when the nerve trunk is compressed in the subcrush-like opening. Pain – as with sciatic nerve neuropathy, combined with constant pulling, aching, cerebral pain in the buttock.
- Neuropathy of the external cutaneous nerve. It is characterized by pains that spread along the outer side of the thigh, make walking difficult, decrease in the prone position with bent legs. Due to the pain syndrome, gait changes are formed, resembling intermittent lameness.
- Radicular syndrome. It develops with osteochondrosis, spondylosis, intervertebral hernias, and other diseases of the lumbar spine. It is manifested by pains spreading from the center to the periphery, increasing with exertion, sudden movements, coughing, sneezing. Localization of pain is determined by the level of output of the affected root.
- Lumbosacral plexitis. Manifests with sharp pains in the thigh, buttock, sacrum, lower leg, groin area. With a lesion of the lumbar plexus, pain is mainly bothered along the anterior, with a lesion of the sacral – along the back of the leg.
Sometimes hip pain is provoked by diseases of neighboring structures or distant organs, mental disorders. Possible causes of soreness may be:
- Coxarthrosis. Aching, pulling pains occur at the beginning of movements and after exertion, combined with pain in the hip joint.
- Renal cell carcinoma. Pain syndrome mimics sciatic nerve neuropathy, caused by compression of the nerve trunk by an increasing neoplasm.
- Mental disorders. Pain can occur with depression, hysterical neurosis, and some other conditions. Typical signs are the vagueness, strangeness and variability of complaints that do not fit into the picture of a certain somatic disease.
The examination is usually carried out by orthopedic traumatologists. With purulent processes, patients are examined by a surgeon, with neurological pathology – by a neurologist. At the initial stage, the doctor finds out the anamnesis of life and disease, conducts an external examination. The following additional studies are assigned:
- Radiography of the hip. A basic diagnostic method that allows you to identify all major bone pathologies: fractures, oncological diseases, osteomyelitis, periostitis. In case of lesions of soft tissue structures, it is performed to exclude bone damage, differential diagnosis.
- CT of the bone. It is used at the final stage of the examination to clarify the results of radiography, planning conservative therapy or surgical intervention. It makes it possible to accurately determine the size, configuration and structural features of the pathological focus in the bone tissue.
- Ultrasound. Soft tissue sonography in myositis and tendinitis detects areas of inflammation or degeneration. Ultrasound of the veins of the lower extremities is effective in assessing the condition of veins and lymphatic vessels in patients with phlebitis and lymphangitis, detecting blood clots in thrombophlebitis.
- MRI of soft tissues. It is recommended for ambiguous results of other diagnostic procedures. It is performed to determine the localization of deep hematomas, to confirm degenerative or inflammatory changes in tendinitis and myositis.
- Electrophysiological studies. Patients with pain of neurological origin are shown ENMG, ENG or EMG to clarify the level of nerve damage, to study the state of nervous and muscular tissue.
- Laboratory tests. They are performed to determine the severity of the inflammatory process in purulent diseases, to assess the state of organs and systems in malignant neoplasms.
Help before diagnosis
In case of traumatic injuries, the limbs are provided with rest. In case of fractures, the leg is fixed using two splints: the inner one from the foot to the groin, the outer one to the armpit. Cold is applied to the leg, painkillers are injected with severe injuries, anti-shock measures are carried out according to indications. The severity of the symptoms of myositis and tendinitis is reduced with the help of anti-inflammatory, analgesic gels and ointments. Sharp pains, significant swelling, disorders of the general condition are a reason for immediate medical attention.
Patients with fractures are blockaded, the hip is fixed with skeletal traction, which, after the appearance of clinical and radiological signs of fusion, is replaced with a plaster bandage. Treatment tactics for other lesions are determined based on the nature of the disease. Conservative treatment of most hip pathologies includes:
- Protective mode. The mode of motor activity is chosen taking into account the type and severity of the disease. Possible fixation with a plaster splint, the use of splints, crutches or canes.
- Physical therapy. To preserve muscle strength and joint mobility, prevent complications and improve the general condition, individually selected exercise therapy complexes are prescribed.
- Physiotherapy procedures. UHF, electrophoresis, laser therapy and other techniques are used to reduce pain, accelerate resorption, improve blood circulation and tissue nutrition, stimulate healing.
These activities are supplemented with massage, sometimes with manual therapy, taping. With purulent diseases, antibiotics are prescribed, with inflammatory pathologies – NSAIDs, with neurological lesions, blockades are performed.
Operations are indicated when conservative therapy is ineffective, to reduce the duration of recovery, early activation of the patient, and to reduce the risk of complications. Taking into account the characteristics of lesions are:
Traumatic injuries: osteosynthesis of the hip, opening of a hematoma, suture of the quadriceps tendon.
Infectious diseases: autopsy, drainage of ulcers, sequestrectomy.
Neurological diseases: nerve decompression, discectomy, puncture disc decompression, facetectomy.
Oncological processes: excision of the tumor, bone resection, exarticulation of the hip.
In the postoperative period, antibacterial and painkillers are used, complex rehabilitation measures are carried out. Radiation therapy and chemotherapy are prescribed for oncological diseases.