The hip , or coxo-femoral joint, is an anatomical site constantly subjected to considerable stress, as it allows you to maintain the erect position, to walk, run, jump and again a large part of your body weight is discharged on it.
All these elements suggest that hip pain (or coxalgia ) is a rather common phenomenon that mainly affects elderly subjects, overweight people, pregnant women , and in those who practice sports very often.
The hipand a joint of the lower limb consisting of two bony elements: the femur and the pelvis bones, held together by a dense network of ligaments, tendons, muscles, nerves and blood vessels, acting as a bridge between the pelvis and the legs, and allowing the execution of complex movements such as rotation, abduction (removal of the leg from the center of gravity), adduction (bringing the leg closer to the center of gravity), extension and flexion.
In most cases, the pain does not indicate a pathology of particular importance, rather the consequence of a small trauma or physical effort, therefore these are transient phenomena of little clinical significance, which however can result in acute pain ( usually unilateral) which can extend to the back, legs, in the gluteal region, in the groin, associated with skin redness, swelling, presence of bruises, walking restrictions and mild lameness.
Sometimes, however, the cause of coxalgia can be linked to a systemic or degenerative disease, and in these cases the pain is persistent, worsening, spread to other joints, causes walking disturbances (which is undulating or limping), bone deformities and can affect one or both hips.
In other cases, however, the pain in the hipand caused by a very intense trauma, such as to cause dislocations or fractures, both conditions that must be subjected to immediate medical treatment, by contacting the emergency room, by virtue of the possible bleeding that accompany the trauma and to limit the possibility of irreversible disabilities .
Provided an overview of the functions, anatomy and main mechanisms at the origin of hip pain , we can deepen some of the most frequent causes of coxalgia.
What are the most common causes of hip pain
Trauma
This is the most common condition at the origin of hip pain (coxalgia). We have seen that the hip is subject to numerous and continuous stresses that can lead to chronic trauma in the long run.
Overweight subjects overload this joint, causing degeneration of the cartilage and chronic injuries to soft tissue damage (tendons, ligaments, blood vessels). In the same way, those who carry out work or sports activities in which they usually lift weights, or in any case stress and strain the joint, in the long term it is easy to manifest pictures of inflammation or degeneration.
In addition to chronic trauma, there are obviously all those phenomena of acute and direct trauma caused by falls, blows and bumps, capable of generating bruises, dislocations or even fractures of the femur, in which pain is associated with functional limitations, inability to move, swelling and haemorrhages. .
Rheumatoid arthritis
Autoimmune disease that leads to conditions of chronic inflammation that damage the joints of the whole body, causing limitations in movement, very acute pain and deformity of the bones. It is necessary to clarify that this pathology affects all joints, therefore the pains extend to the whole body;
Gout
Pathology typical of those who are used to a high-protein diet and eat a lot of red meat. This habit leads to an elevation of thevalues ​​of uric acid in the blood and its aggregation in the form of crystals that are deposited in the joints, especially in the lower limbs, causing severe pain that tends to occur during the night.
Trochanteric bursitis
Inflammation of the synovial membrane, which encloses the synovium, a liquid that allows to cushion the trauma to the hip. This is a very common phenomenon in sportsmen.
Coxarthrosis
It is a process of arthrosis, therefore of degeneration of the cartilage component of the hip with also involvement of the soft tissues, therefore of the ligaments, of the tendons, and of the synovial membrane that collects the synovium, that is that buffer of liquid that serves to cushion the trauma to the hip. It is a very frequent pathology, so much so that it affects about 80% of people over the age of 65. Two forms of hip arthrosis ( coxarthrosis ) can be identified, one primary or idiopathic and one secondary.
- Primary coxarthrosis : this form is due to the establishment of multiple concomitant conditions, among which a genetic component certainly stands out, age, body weight which tends to overload and therefore wear out the joint, carrying out heavy work that requires lifting weights, and sporting activity practiced with excessive frequency (typical of professional sportsmen).
- Secondary coxarthrosis: resulting from different pathologies such as congenital hip dysplasia, trauma or inflammatory arthropathies.
In both cases the patient experiences pain in the hip that extends to the leg, groin, buttock and back, limitation of movements that involve the typical “waddling gait” that imitates the swaying gait of a duck, or a real one. and own lameness.
Perthes disease
It is a phenomenon of osteochondrosis, that is a degenerative process that is not caused by inflammation, but by an alteration of the arteries that reach the hip.
This pathology mainly affects the male population of childhood, both in unilateral and bilateral modalities, and the symptoms that characterize the condition are: acute pain in the hip, groin or knee that increases slowly and progressively leading to lameness , and which decreases until it disappears during rest, therefore at night.
Epiphysiolysis of the femoral head It causes
a weakening of the cartilages of the hip, causing the head of the femur to slide relative to its lower portion of the neck, triggering severe pain and consequent lameness.
The alteration of the position between the head and the neck of the femur in fact determines a decrease in the length of the gluteus muscles and therefore less force in supporting the pelvis. It occurs above all in subjects in the age of growth, therefore during adolescence, and also in this case the disorder can manifest itself in a mono or bilateral modality.
Hip osteonecrosis
In this condition, a blockage of circulation occurs in the circumflex arteries, which leads to ischemia and consequent necrosis of the femoral head. Also in this case the most affected subjects are male, but in adulthood.
This disorder can be caused by a fracture of the femur, a traumatic event, an embolism, a thrombosis, alcohol abuse, chemotherapy and smoking, and in a high percentage of cases requires a hip replacement.
At an early stage of the disease there is a dull and very sharp pain that increases during the execution of rotational and flexing movements, and again during the night. In the later stages the pain tends to decrease, but limitations in movement and lameness arise.
Congenital dysplasia of the hip
It is a congenital anomaly, therefore already present at the birth of the child, in which there is no correct development of the hip joint (coxo-femoral). Therefore, the relationships between the joint components are lacking. This condition is also associated with other malformations, such as clubfoot and adductus metatarsus.
Hip dysplasia has repercussions throughout the child’s growth phase, and develops in different stages:
- Pre-dislocation : malformations of the cartilages and laxity of the ligaments are established, which are no longer able to hold the joint in place;
- Sub-dislocation : there is an increase in the tone of the hip and thigh muscles;
- Real dislocation : occurs after the first year of life and there is a loss of joint relationships between the pelvis bone and the head of the femur.
Gradually the pelvis falls down on the opposite side to that affected by dysplasia and a lameness develops. It is a condition that has excellent chances of healing, this if the treatments begin immediately after birth and accompany the entire growth phase, providing the aid of retractors, bridles, rigid pillows and correction maneuvers.
If the treatments begin after the first 4 years, the possibilities of resolution are considerably reduced and require the execution of rather painful corrective maneuvers, in the adult instead there is no longer the possibility of correcting or limiting the dysplasia, and the only possible option is installing a hip replacement.
Diagnosis and Therapy: what to do
Any inflammatory, degenerative or traumatic process, given the functions of the hip, can negatively compromise the normal performance of normal daily activities, therefore, unless it is the result of a small trauma or fatigue following an intense physical activity, hip pain is an event that deserves a doctor’s attention and evaluation.
A simple bruise, or strain from exertion, are generally conditions that are resolved without leaving consequences, using simple remedies such as cold ice packs, limb rest, the application of an anti-inflammatory cream, the intake of painkillers by way of oral taking into account the side effects to the stomach that it may entail.
On the other hand, when the pain arises without apparent triggering reasons, it manifests itself as continuous or frequent and is accompanied by limitations of movement, it is necessary to consult a specialist in orthopedics as soon as possible, avoiding delaying in the hope that the symptoms will resolve themselves and above all. without risking worsening your condition by relying on some advice or remedy found on the internet.
The visit to the orthopedist generally takes place in two stages, a first part of data collection (anamnesis), and a second part of evaluation and visit. During the medical history phase, the orthopedic doctor asks a series of targeted questions on the symptoms perceived by the patient, therefore: how much pain is felt, if this is localized to the hip or if it extends to the back, legs, in the groin, buttock or other joints of the body, and when it arises ( at night , during movement, after sports). Once this precious information has been collected, the doctor proceeds to visit the patient, verifying the mobility of the joint, the presence of malformations, the muscle tone, the gait of the subject, how he stretches his leg and how he places his feet on the ground.
The doctor, on the basis of more precise diagnostic suspicions, may request further investigations, for example through a blood sample, useful in identifying rheumatic diseases, infections or high levels of uric acid. Instrumental diagnostic investigations (magnetic resonance, radiography, bone scan) are the most useful and used type of examination in the orthopedic field, because they provide a very precise overview of the bone structures and soft tissues that surround them, being able to clearly verify the presence of degeneration, necrosis, fractures, wear and anatomical alterations. Thus allowing to obtain accurate diagnoses.
The most commonly used therapies are usually of a pharmacological nature, with the administration of substances that help to counteract the symptoms, therefore anti-inflammatory and painkillers. Obviously the treatments depend on the triggering cause, and sometimes require corrective maneuvers, the use of containment means, orthopedic supports or even the need to proceed with surgery.
In case of coxarthrosis(arthrosis of the hip) you can initially resort to a conservative treatment in which anti-inflammatory drugs and painkillers are administered, to which functional gymnastics exercises (especially in water) are added, to strengthen the muscles and improve movement. In addition, weight loss is indicated for overweight subjects, to put less load on the joint.
In the advanced stage of the disease, on the other hand, surgical treatment is indicated.
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