Hip Pain

Causes

Traumatic injuries

Hip bruising occurs upon impact or fall, manifested by moderate local pain. At first, the pain is sharp, then - dull, aching, aggravated by palpation and movements. Due to the large array of soft tissues, pronounced edema often develops. Possible bruising. The function of the limb is usually limited slightly, the support is preserved.

A hematoma is also formed after bumps and falls, in its manifestations it resembles a bruise. It differs from a bruise in the bursting or pressing nature of pain, the formation of dense local edema, in the zone of which, after a while, a fluctuation area appears. With deeply located hematomas, the edema is nonspecific, fluctuation may be absent. Hematoma can be suspected by a significant increase in swelling in the early days or its persistence for a long time.

Damage to the tendon of the quadriceps muscle is observed in athletes, less often develops in everyday life. It is characterized by acute pain along 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, pain, swelling of soft tissues, a defect at the site of the rupture are revealed. With a complete rupture, support and self-straightening of the lower leg are impossible, with an incomplete one, it is difficult.

The cause of a diaphyseal fracture of the femur is high-energy impacts: falls from a height, road and industrial injuries. Damage is accompanied by unbearable explosive pain. In the future, the pain is very intense, aggravated by attempts to move, palpation, passive shifting of the limb. The thigh is edematous, deformed. The leg is shortened. Crepitus, pathological mobility are revealed. The general condition is disturbed, traumatic shock is possible.

A pathological fracture of the femoral diaphysis can be diagnosed with bone cysts, tumors, some hereditary and infectious diseases. It is characterized by mild symptoms. Pain is mild or moderate. Displacement, pathological mobility and bone crunch are absent, which is why the injury is often mistaken for a bruise. Distinctive features of a pathological fracture are the long-term persistence of symptoms, the presence of previous pain during exercise or at rest.

Inflammatory diseases

Myositis of the thigh muscles occurs after an unusual physical activity: a long walk or run, the first training after a long break. It is characterized by aching pain in the projection of the affected muscle or muscle group. There is an increase in pain on palpation, muscle tension. When palpating, a diffuse thickening of the muscle is determined, slight edema, slight local hyperthermia are possible.

Tendinitis of the tendon of the quadriceps is usually found in active people over 40 years old, manifested by vague, non-intense pulling pains in the lower parts of the front of the thigh. Pain is aggravated by unbending the leg. With tendinitis of the biceps tendon, characteristic of runners, the pain is localized deep in the buttock, spreads behind the thigh, and intensifies during running, especially when accelerating. Subsequently, the pain becomes prolonged, constant, 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 pains are aching, dull, non-localized, accompanied by soreness in the groin and buttocks, limitation of movement, difficulty walking.

Bone infections

Periostitis of the femur develops infrequently, as a rule, it becomes the result of injuries (bruises, fractures) or purulent lesions (deep infected wounds, abscesses , cellulitis , arthritis). In the first case, the process is aseptic in nature, accompanied by moderate pain, aggravated by palpation. There is a slight swelling. The general condition is not broken.

Sometimes there is a serous post-traumatic periostitis, characterized by a significant accumulation of fluid under the periosteum. Pathology is manifested by moderate arching pains, swelling, deformity. With purulent inflammation of the periosteum, an acute onset is observed with intense jerking, throbbing pains. Local hyperemia, significant swelling of the segment, fever, chills, fever are detected.

The femur is one of the most common locations for hematogenous osteomyelitis . Inflammation of the bone develops in childhood, often on 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 onset of hyperthermia, intense localized deep pain in the thigh occurs. The pain increases, becomes unbearable, forcing 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 general symptoms. Post-traumatic and postoperative osteomyelitis are also manifested by pain, edema, hyperemia, and general disorders, but the pain appears against the background of suppuration of an open fracture or postoperative wound, progresses more slowly, and does not reach the degree of unbearable.
Vascular and soft tissue infections

Pain in the thigh is noted with purulent lesions of soft tissue structures. Initially, it has a bursting or pressing character. The intensity of the pain syndrome increases rapidly, the pains become pulsating, tearing, twitching, sharply limiting movements, disrupting night sleep. Puffiness, increase in local temperature are revealed. The severity of general manifestations (hyperthermia, fever, symptoms of intoxication) depends on the prevalence of the purulent process. Pain is caused by:

•    Furuncle . A limited focus of inflammation, which is a convex, sharply painful formation, covered with cyanotic-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 spaced 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 vary from 2-3 to 10 or more centimeters. Accompanied by weakness, weakness, fever to febrile figures

•    Phlegmon. Widespread purulent inflammation without clear boundaries. It is characterized by intense pain throughout the thigh, severe intoxication.

From the foci in the soft tissues, the infection can spread through the lymphatic vessels. The manifestation of reticular lymphangitis is evidenced by increased pain, worsening of the general condition, the appearance of a marble pattern around the primary inflammatory focus. With stem lymphangitis, a longitudinal strip appears on the thigh, along which pain on palpation, edema, hyperemia, and cord-like tissue thickening are determined. When deep vessels are affected, the bands on the limbs are not detected, there is a rapidly growing arching pain, lymphedema of the underlying sections.

With phlebitis and thrombophlebitis of the superficial veins of the thigh, which develops against the background of infectious lesions or varicose veins , rapidly progressive pain along the vein is found. Pain increases with walking, usually localized in the lower third of the segment. Phlebitis and thrombophlebitis of deep veins are manifested by constant increasing pain, swelling, general hyperthermia, milky-white color of the skin of the limb.

A special form of vein damage is postpartum thrombophlebitis , which occurs in the first weeks after childbirth. Intense pain on the inside of the thigh is observed with inflammation of the great saphenous vein, combined with edema, deterioration of the general condition. When the deep femoral veins are involved, unbearable sharp pains are noted along the anterior-inner surface of the thigh, significant edema, pallor of the skin of the limb, and fever.

Oncological diseases

For benign tumors of the femur, slow growth and a long, often long-term course are typical. Osteomas and chondromas are manifested by slight transient, unclear pains; with chondromas in children, deformations and shortening of the limb are possible. With osteoid osteomas, pain is intense, sharp. The growth of neoplasia is accompanied by increased pain, the appearance of palpable formations of bone density.

The most common malignant tumors of the hip include osteosarcoma , 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, quickly intensifies, becomes unbearable, combined with the appearance of a venous pattern, deformity, weight loss, and general weakness.

Neurological causes

Hip pain is often caused by neurological diseases. Distinctive features of such pain are shooting, burning, shooting or penetrating in nature (some patients compare the sensations with a "dagger strike"), a combination with paresthesia, weakening of muscle strength, and sensitivity disorders. Pain in the thigh area provokes the following pathologies:

•    Neuropathy of the femoral nerve . There are pains along the anterior-inner surface of the thigh and in the groin, aggravated by extension of the knee joint.

•    Neuropathy of the sciatic nerve . The patient complains of pain along the back of the thigh, which spreads from the buttock to the lower leg and foot, increases when trying to raise a straight leg while lying on his back.

•    Piriformis Syndrome . Occurs when the nerve trunk is compressed in the subpiri-shaped foramen. Pain - as with neuropathy of the sciatic nerve, combined with constant pulling, aching, aching pains in the buttock.

•    Neuropathy of the external cutaneous nerve . It is characterized by pain that spreads along the outer side of the thigh, makes it difficult to walk, and decreases in the supine position with bent legs. Due to the pain syndrome, gait changes are formed, resembling intermittent claudication.

•    Radicular syndrome . It develops with osteochondrosis , spondylosis, intervertebral hernia , and other diseases of the lumbar spine. It is manifested by pains spreading from the center to the periphery, aggravated by exertion, sudden movements, coughing, sneezing. Localization of pain is determined by the level of exit of the affected root.

•    Lumbosacral plexitis . Manifests with sharp pains in the thigh, buttock, sacrum, lower leg, inguinal region. With the defeat of the lumbar plexus, the pain is disturbed mainly in the front, with the defeat of the sacral - in the back of the leg.

Other reasons

Sometimes pain in the thigh is provoked by diseases of neighboring structures or distant organs, mental disorders. Possible causes of pain may include:

•    Coxarthrosis . Pain aching, pulling, occur at the beginning of movements and after exercise, combined with pain in the hip joint.

•    Renal cell carcinoma . Pain syndrome imitates neuropathy of the sciatic nerve, due to compression of the nerve trunk by an increasing neoplasm.

•    Mental disorders. Pain can appear with depression, hysterical neurosis , and some other conditions. Typical signs are fuzziness, unusualness and variability of complaints that do not fit into the picture of a particular somatic disease.
 

Treatment

In case of traumatic injuries, they provide rest of the limb. 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, in case of severe injuries, painkillers are administered, according to indications, anti-shock measures are taken. The severity of the symptoms of myositis and tendonitis is reduced with the help of anti-inflammatory, analgesic gels and ointments. Sharp pains, significant edema, violations of the general condition are the reason for an immediate visit to the doctor.

Conservative therapy

Patients with fractures are blocked , the hip is fixed with skeletal traction , which, after the appearance of clinical and radiological signs of adhesion, is replaced with a plaster cast. The tactics of treatment for other lesions are determined based on the nature of the disease. Conservative treatment for most hip pathologies includes:

•    Protective mode. The mode of motor activity is chosen taking into account the type and severity of the disease. Fixation with a plaster splint, use of splints, crutches or canes are possible.

•    Therapeutic exercise . To maintain 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, and stimulate healing.

The listed activities are supplemented with massage , sometimes with manual therapy , taping . For purulent diseases, antibiotics are prescribed, for inflammatory pathologies - NSAIDs, for neurological lesions, blockades are performed.

Tests Required for Diagnosis

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:

•    X-ray of the hip . The basic diagnostic method that allows you to identify all major bone pathologies: fractures, oncological diseases, osteomyelitis, periostitis. With lesions of soft tissue structures, it is performed to exclude bone lesions, to conduct 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. Sonography of soft tissues in myositis and tendinitis reveals areas of inflammation or degeneration. Ultrasound of the veins of the lower extremities is effective in assessing the condition of the veins and lymphatic vessels in patients with phlebitis and lymphangitis, detecting blood clots in thrombophlebitis.

•    MRI of soft tissues . Recommended for ambiguous results of other diagnostic procedures. It is carried out to determine the localization of deep hematomas, confirm degenerative or inflammatory changes in tendonitis 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 the nervous and muscle 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.
 

Useful info

Surgery:

Operations are indicated when conservative therapy is ineffective, to reduce the duration of recovery, early activation of the patient, and reduce the risk of complications. Taking into account the characteristics of the lesion, the following are carried out:

• Traumatic injuries : osteosynthesis of the femur , opening of a hematoma, suture of the quadriceps tendon.

• Infectious diseases : autopsy, drainage of abscesses, sequestrectomy .

• Neurological diseases : nerve decompression , discectomy , puncture disc decompression, facetectomy .

• Oncological processes : tumor excision, bone resection, hip disarticulation .

In the postoperative period, antibacterial and painkillers are used, complex rehabilitation measures are carried out. For oncological diseases, radiation therapy, chemotherapy are prescribed.