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Hip Pain Explained – including structures & anatomy of the hip and pelvis.

The sciatic nerve can sometimes be compressed, irritated or entrapped as it runs through the soft tissues of the buttock. Traditionally, sciatic pain (neuralgia) generated from issues within the buttock has been termed “Piriformis Syndrome” (see Figure 5.7 to view the piriformis muscle and the sciatic nerve).

This was based on a finding that in about 20% of the population, all or part of the sciatic nerve runs through the piriformis muscle. Compression of the nerve within the piriformis muscle was thought to be the problem in all cases of nerve related buttock and leg pain that could not be associated with a problem in the back.

It is now thought that this is the case in only a relatively small number of cases and that this condition has been over-diagnosed. So much so, that some believe it does not exist at all.

The term “Deep Gluteal Syndrome”has been suggested recently as an alternative term to piriformis syndrome. It refers to any irritation of the sciatic nerve in the deep gluteal space, beneath the gluteus maximus muscle.

In this space, the sciatic nerve may be compressed or irritated at the level of the piriformis, as it runs over the deep external rotator muscles or by fibrous bands anywhere along its path through the buttock. The nerve can also be irritated as it leaves the pelvis to head down into the thigh.

Here it runs through a tunnel (ischial tunnel), between the outer side of the sitting bone (ischial tuberosity) and the upper thigh bone (femur) (Figure 5.7).

In this tunnel it may be squeezed between the bones or irritated by unhealthy hamstring tendons (tendinopathy).

Cluneal Nerve Neuralgia

Of the cluneal nerves, the superior and inferior are more likely to be at risk of compression.The superior cluneal nerve branches run from the spine, over the top of the back of the pelvis and down into the buttock.

They usually run through fibrous tunnels as they cross the top edge of the pelvis. This is where the small nerves may become compressed or irritated.

This is usually associated with a fairly localised area of pain in the upper buttock, in the region of its skin supply (Figure 5.8).

The inferior cluneal nerve branches run across the lower buttock, right over the sitting bone (ischial tuberosity). They can be compressed and irritated by a hard fall onto the bottom or sitting for prolonged periods on a hard surface, particularly if you don’t have much gluteal muscle bulk to cushion the bone.

Again, associated symptoms are usually fairly localised to the area of skin supply (Figure 5.8). Sometimes the nearby posterior femoral cutaneous nerve can also be affected. Symptoms may then extend into the back of the thigh (see Figure 5.8 for region of this nerve supply).

Everything You Need to Know About Hip Pain Caused by Running

Hip pain is a common injury that plagues many athletes, especially us runners. But determining what’s causing your pain can be tricky. If you’re experiencing hip pain, we’ve got everything you need to know about hip injuries, including how to treat and prevent them. But first, here’s a quick refresher on hip anatomy:

The hip is a basic ball-and-socket joint. The ball is the femoral head—a knob on the top of the thigh bone—and the socket is an indentation in the pelvic bone. There is cartilage lining the joint (called the labrum) and ligaments that attach the pelvic and thigh bones. Numerous muscles attach around the hip, too, moving the joint through the basic motions of flexion (bending), extension (extending the leg behind you), abduction (lifting the leg away from the body), adduction (moving the leg inward), internal rotation, and external rotation.

Identifying Hip Pain Symptoms

Pain in the front of the joint—where the leg attaches to the trunk—is typically caused by hip joint problems. You may also feel pain associated with a hip injury in the lower part of your glutes and the top of the back of your thigh. Other symptoms include the inability to move the leg at the hip, inability to put weight on one leg due to pain at the hip, or swelling around the joint. As runners, you may also experience pain in the hipo joint only when running due to a hip injury.

Common Causes of Hip Pain

The most common culprits of discomfort include hip flexor strains or hip flexor tendinitis, stress fractures, and osteoarthritis. Less commonly, labral (cartilage) tears may cause pain.

Hip flexors are a group of muscles that move the thigh forward and up. Strains (pulls) are often caused by a backward slippage of the foot. This may occur with one big slip or repetitive small slips while running on a slick surface, such as snow.

Tendinitis—which occurs when your psoas muscle (a deep hip muscle) is overused and pulls on a tendon that attaches it to the iliac bone, causing the tendon to become inflamed—is usually due to increased mileage, speed work, or hill work.

Pain on the outside of the hip is most commonly due to greater trochanteric bursitis. The greater trochanter is the protrusion where the thigh bone juts outward at the base of the neck (which connects the ball to the femur and is the site of hip stress fractures). A lubricating sac (or bursa) lies over the boney protrusion so that the surrounding muscles do not rub directly on the bone. The top region of the iliotibial (IT) band, known as the tensor fascia lata, is commonly involved in greater trochanteric bursitis.

Pain along the inside of the hip may be due to tendinitis or strain of the adductor muscles. Adductors (or inner thigh muscles) pull the leg inward as it is moving forward—the faster the movement, the greater the degree of adduction. Since footprints of a runner are almost single file as opposed to the side-by-side footprints of a walker, there is some degree of adduction occurring during running.

Pain in the inner hip and sometimes the front of the joint can be caused by osteitis pubis, sports hernias, infections, pubic stress fractures, or osteoarthritis.

Hip Pain Treatment

Persistent or worsening hip pain warrants a visit to your health care provider and possibly a sports medicine specialist. Some problems, particularly hip stress fractures, are commonly misdiagnosed due to the confusing presentation of symptoms.

A thorough evaluation is necessary and often includes X-rays and other studies, such as an MRI or bone scan. As with all injuries, the absence of pain does not mean that all is well. Strength and flexibility deficits must be addressed to allow a healthy return to running.

Tendinitis treatment includes decreasing training, applying ice, strengthening, and stretching. How much you decrease your training is based on the severity of your symptoms. If there is pain with walking, then cross train in a pool. Cycling, rowing machines, stair steppers, and elliptical trainers may also be used if they do not cause pain. In less severe cases, cut back on mileage by 25 to 50 percent and eliminate speed training and hill work.

Treatment for greater trochanteric bursitis includes stretching and strengthening your IT band, hip abductors, and gluteal muscles, all while avoiding running on banked surfaces. Applying ice to the painful area for 15 minutes, three to four times per day can help, too. A cortisone injection may be beneficial if your injury is severe. Worsening pain should raise suspicion for a stress fracture, in which case you should see your doctor right away.

For strains and tendinitis at the top of the hamstrings, treatment is the same as that used for hip flexor problems. Hamstring stretching and strengthening—such as side lunges, inward leg raises, and backward leg raises—is important. Deep tissue massage may also be beneficial, but in general, this is a difficult problem that usually takes a while to resolve.

Hip Pain Prevention

To prevent any hip injury, strengthening and stretching your hip flexors is key. And while stretching your hip flexors can be difficult, here are two that work well:

  1. Lie on your back on the edge of a table or high bed, and drop your outside leg off the edge.
  2. Lunge with your back leg fully extended. Lifrt arms up overhead and extend slightly backward if possible.

Adding leg lifts into your routine is an easy way to strengthen your hip flexors—you can add in weights or a resistance band to make this exercise harder. To maximize strength throughout the hip, do leg raises in each direction—back, forward, in, and out.

Issues in the hips are often related to weak glutes. Strengthening your gluteal muscles with squats and exercises like bridge pose can help. Finally, foam rolling daily will help keep your hip flexors loose and relaxed and less prone to injury.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Femoroacetabular Impingement (FAI)/Hip Impingement: Causes, Symptoms, & Treatment

If you’re diagnosed with FAI, your doctor will probably recommend treatment options that don’t require surgery first to see if your symptoms improve. These could include:

  • rest,
  • avoiding activities that make your symptoms worse (running, ballet, golf, and the like),
  • physical therapy exercises to build strength and improve range of motion,
  • anti-inflammatory medications, like ibuprofen or aspirin, or
  • cortisone injections.

These treatments can help relieve your pain, but they won’t fix the structural problems in your bones, so your symptoms might come back. If you have tried treating your symptoms with these options but continue to experience pain, you may need to consider surgery to correct the problems in your joint.

Hip Impingement Surgery

A specialist may recommend surgery if you have symptoms that are painful or affect your ability to participate in daily activities. The goals of surgery for FAI are to improve the function of your hip, decrease painful symptoms, and prevent or delay the need for a hip replacement in the future.

There are a few different options for surgery, depending on what is causing your hip impingement.

  • Arthroscopy

    If you have cam impingement (caused by extra bone growth on your thigh bone) and only mild damage to the cartilage in your joint, you may be a candidate for an arthroscopy. This is a minimally invasive surgery where the surgeon can shape or remove the extra bone and damaged tissue through a small incision in the side of your hip.

  • Osteotomy

    If you have pincer impingement, with the hip socket rotated toward the back, you will need a periacetabular osteotomy. A periacetabular osteotomy, or PAO, cuts and realigns the bone in your hip socket to a more forward-facing position. Your doctor can also remove any extra bone from the top of your thigh bone during this procedure, if needed.

  • Surgical dislocation and osteochondroplasty

    In this procedure, your doctor will make an incision on your hip and carefully cut your thigh bone to bring it out of the joint and provide better access during the rest of the procedure. Then, the head of the thigh bone and the rim of the hip socket can be trimmed or reshaped to fit together properly. After the impingement has been corrected, your doctor will use screws to hold the bone back together.

    This surgery is often used for more complex problems that require full labral reconstruction, or for large deformities like Perthes disease and slipped capital femoral epiphysis (SCFE).

  • Hip replacement (arthroplasty)

    If you have significant damage to the cartilage in your hip joint, you might need to have a total hip replacement. Your doctor will remove the damaged bone and replace the end of your thigh bone as well as the socket of your hip with an artificial joint.

Why does the front of my hip pinch?

 What can physiotherapy and exercise do to fix my hip?

Hip anatomy 101

Your hip joint is a “ball and socket” – the ball sits atop your femur, or thigh-bone – this round portion is called the “head” of the femur. The head fits into the socket in your pelvis. The socket fits tightly around like a baseball glove, and the joint is surrounded by a joint capsule made of strong connective tissue. The joint capsule ensures the ball stays within the socket, while your muscles guide the rod of the femur around the socket smoothly to allow full range of movement of the hip.

At least, that is what is supposed to happen!

What can go wrong?

If you ever feel hip pain or catching deep in the front of your hip, you could have femoroacetabular impingement (FAI). Simply, a ‘pinchy hip’.

The movements most often associated with this condition are pulling your knee up, turning it inward or bringing it across your body – especially when all of these are combined at the same time, as seen by the picture below. This impingement, or blocking of joint movement can be due to a malformation of the bones involved in the ball and socket, and can affect anyone, from the young and physically active to the middle-aged and above. It is both painful and limiting to your movement.

What does it feel like?

The pain typically occurs deep within your groin or the front of your hip, though it can affect your outer hip or buttock in rare cases. The joint usually feels stiff and sharply restricted in motion in the directions mentioned above. It may affect only one joint, so it could feel very different to your other hip by comparison. It may come on suddenly after an injury or build up over time with age and joint wear and tear.

Why does it happen? 

The deformation of the bones in the joint could be congenital (from birth) or build up over time in response to overuse or trauma. Some typically affect younger people, especially athletes. If the muscles surrounding the socket – typically the hip flexors and internal rotators – are overused and become tight, the ball is pulled forward in the socket, causing a shrinking of the back of the joint capsule. As the head of the femur is pushed toward the front of the hip and down, it grows larger and further down the bone.

These same factors can build up gradually over long periods of time, typically affecting older people.

Things that aggravate it: What makes it worse?

The movement(s) that cause the bones to knock together will result in a catching pain. If you have hip impingement, you will most likely notice it while:

-Sitting for a long period of time

-Walking, running

-Crossing your legs

-During or after leg exercise

How can physio/Pilates help?

If you think you may have this type of hip pain, see your Physiotherapist for a complete testing and diagnosis. If we suspect you have it, we can do the following such as:

  • applying pressure through your hip joint to stretch out your stiff joint capsule

  • massaging to loosen and release the tight muscles in the area of the hip, especially in the back of the hip and buttock area

  • provide you with a range of exercises to improve the range and control you have in your affected hip. These will help you to draw the ball back and down as you move into triggering positions thereby avoiding bone on bone catching as much as possible.

If necessary, you can consult a doctor to advise on pain and anti-inflammatory medicine, and in severe cases a surgical consult may be a necessary step to ensure best treatment and management of FAI. If surgery is required, your physio will play a vital role in your post-operative care to ensure you make a full recovery.

Exercises for hip impingement

Push the head of the femur back. Lie on your back and lift the knee of your affected leg directly above your hips. Clasp your hands over your knee and push directly down through the line of your thighbone towards the floor. Do two sets of ten, applying firm pressure.

Push the head down, socket out. Stand with your feet wide apart. While keeping your affected leg straight, bend your other knee and fold through the hips, pushing your bottom out as you go. Once you feel the inner thigh of your affected leg stretch, use your hand to firmly press down on your upper thigh – make sure your hand is as high up as possible, near the groin. Do two sets of ten.

Stretch the front of your hip. Kneel on the knee of your affected leg and bend your other leg up in front of you. Rest your hands on either side of your front foot and press your hips forward and down towards the ground. You should feel a stretch across the front of your affected hip, hold it for 30 seconds and repeat.

These mobilising and alignment exercises should be coupled with a precise exercise program of hip and pelvic stability strengthening exercises to optimally return good strength, support and movement control about the hip region.

Join an online class  from the comfort of your home – Katrina the principle physio at The Fix Program has designed a series of Pilates exercise programs that will help you immensely.

Hip Pain From Running – Hip Flexor Pain

Hip pain is a common injury that plagues many athletes, especially us runners. But determining what’s causing your pain can be tricky. If you’re experiencing hip pain, we’ve got everything you need to know about hip injuries, including how to treat and prevent them.

But first, here’s a quick refresher on hip anatomy: The hip is a basic ball-and-socket joint. The ball is the femoral head—a knob on the top of the thigh bone—and the socket is an indentation in the pelvic bone. There is cartilage lining the joint (called the labrum) and ligaments that attach the pelvic and thigh bones. Numerous muscles attach around the hip, too, moving the joint through the basic motions of flexion (bending), extension (extending the leg behind you), abduction (lifting the leg away from the body), adduction (moving the leg inward), internal rotation, and external rotation.

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6 Common Causes of Hip Pain

The most common culprits of discomfort include hip flexor strains or hip flexor tendinitis, stress fractures, and osteoarthritis. Less commonly, labral (cartilage) tears, bursitis, and hip impingement may cause pain.

Here’s a little more about each and what you need to know about treatment and prevention.

1. Muscle Strains and Tendinopathy

These account for about a third of all hip pain in runners. Strains, or pulls, often occur in the top of the hamstrings, the iliopsoas, the rectus femoris, and the adductors, while the gluteal tendons are prime targets for chronic damage and inflammation. Both are generally a function of muscle imbalances, which are typically caused by a lack of side-to-side training. “If [these muscles] are weak, they are constantly doing a tug of war, under load, while contracting,” says American Physical Therapy Association spokesperson Robert Gillanders, PT, DPT. That tug is exacerbated by big jumps in training volume or intensity.

Spot It: Muscle strains and tendinopathy both cause moderately sharp localized pain, swelling, weakness, and stiffness, says Janet Hamilton, CSCS, an exercise physiologist with Running Strong in Atlanta. They typically develop slowly, but if you trip on the trail, muscle and tendon tears can happen in a second, causing strong, piercing pain as well as bruising.

Treat It: Ice for 10 minutes, several times a day, and limit activity until your symptoms subside, then ease back into normal-distance runs. Mild muscle strains can take three to six weeks to fully heal. Tendons can take six weeks to several months. Avoid nonsteroidal anti-inflammatories (like ibuprofen) if possible, since inflammation actually prompts healing, Hamilton says. Significant tears require surgery.

Prevent It: Strength-train at least twice a week with an emphasis on eccentric lower-body exercises (like slowing the lowering phase of your squats to three or four seconds) to improve your muscles’ and tendons’ ability to lengthen under tension without pulling apart.

Sign up for Runner’s World+ for even more training tips and advice!


2. Hip Impingement

Femoroacetabular impingement (FAI) is a mismatch in the shape of the femur (ball) and the acetabulum (socket), which causes them to beat up the joint’s protective cartilage (labrum) and, over time, contribute to degenerative osteoarthritis. FAI is a leading cause of hip pain for athletes in their 20s and 30s.

Spot It: Start with the FADIR test: Lie flat on your back, draw your knee toward your chest, gently press your knee across your body, then rotate your foot as far out and away as possible. A pinch in the front of your hip is a sign of possible impingement, but you’ll need an MRI from an orthopedist to confirm.

Treat It: Correcting muscle weaknesses and abnormal movement patterns through physical therapy can curb discomfort. Physical therapy can also determine a safe range of motion to avoid pinched positions when running or cross-training. In some cases, surgery is needed.

Prevent It: FAI is believed to be partially genetic. But core and hip strength work like monster walks, single-leg deadlifts, and dead bugs will give your body more control and power to protect the hip and help prevent injury.


3. Osteoarthritis

“Wear and tear” arthritis is less common in active marathoners than it is in the general population, according to research from the Rothman Orthopaedic Institute (loading the joint may improve its health by strengthening the surrounding muscles). But in runners with structural hip abnormalities such as FAI, osteoarthritis in the hip can crop up as early as age 40, says Peter Moley, MD, a physiatrist with New York’s Hospital for Special Surgery.

Spot It: Joint stiffness, poor range of motion, and at least three months of deep, aching pain after sitting or running or at the end of the day are common symptoms, says Scott Paluska, MD, a sports medicine specialist at the University of Illinois at Urbana-Champaign. X-rays can confirm suspected arthritis.

Treat It: Most flare-ups will abate with RICE. In the long run, low-impact strength-training, and switching to softer running surfaces (treadmill, grass, sand, track, pool) can strengthen the supporting muscles without excessively loading the joint and causing pain and further joint damage, says Paul Sorace, MS, CSCS, a fellow of the American College of Sports Medicine. Even a softer shock-absorbing insole can help.

To further head off hip pain and eventual replacement, many doctors offer injections such as steroids, or regenerative treatments. In platelet-​rich plasma (PRP) therapy, doctors inject your own blood, minus the red blood cells, into the joint. In stem cell therapy, they use cells from your bone marrow. Some patients experience improvement with these therapies, but more research is needed to prove their effectiveness—and to get insurance to chip in, says Harrison Youmans, MD, a sports medicine specialist with Orlando Health.

Prevent It: Treating any existing hip injuries or imbalances is key. Try to maintain a healthy weight to further reduce stress on the hip joint.


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4. Labral Tear

A torn labrum is most commonly caused by FAI in younger runners, as it places them at a higher risk for injury or increased wear and tear, says Kristin Morrison PT, DPT, COMT, my therapist at IMPACT Physical Therapy in Chicago. Hip dysplasia, a genetic condition in which the hip socket is too shallow to fully cover the femur, can also tear the labrum.

Spot It: Labral tears can cause sharp or dull groin pain and a limited range of motion. You may hear a clicking as the loose labrum moves over bone, says Youmans.

Treat It: Start with rest and physical therapy that includes strengthening the hip and core (fire hydrants, stir-the-pots), says Shane J. Nho, MD, director of the Hip Preservation Center at Rush University Medical Center in Chicago. Steroid injections can curb the pain; if they don’t, you may need surgery.

Prevent It: Warm up the muscles protecting the joint with monster walks, single-leg bridges, deadlifts, and clam shells to help reduce midrun grinding.


5. Bursitis

More than a dozen little fluid-​filled sacs, called bursae, are a cushion between your hip bones and neighboring soft tissues. Repetitive motion, along with muscle imbalances or poor form, can inflame any one of them. Issues most often arise at the side of the hip, and are four times more common in women, says Paluska. The iliopsoas bursa (the front of the hip) is another prime target for inflammation.

Spot It: Inflamed bursae ache, feel warm and tender to touch, and get angrier with hill running or sprinting. The most common diagnostic method: injecting the bursa that’s suspected to be inflamed with numbing lidocaine. If the pain goes away, there’s your answer. MRIs are a less invasive but more time- and cost-intensive tool.

Treat It: Visit a physical therapist who specializes in running to see if strength deficits, faulty running gait, inadequate balance, or all of the above are to blame for the inflammation. When paired with corrective exercises, RICE and injections can help ease inflammation. In stubborn cases, surgeons can remove the swollen bursa. It will grow back after several months.

Prevent It: Strengthen your hips in all planes of motion with single-leg deadlifts, monster walks, high-knee raises, fire hydrants, and lying inner-thigh lifts.


6. Stress Fracture

About two-thirds of hip stress fractures in runners are caused by excessive mileage, and the injury is significantly more common in women. Because stress fractures develop slowly, they can take a long time to diagnose; untreated, they may develop into full breaks.

Spot It: Pain is usually sharp when walking, running, or jumping, and may feel dull the rest of the day. “It is not uncommon for it to present symptoms at rest and at night,” says Moley. You’ll need an X-ray and likely an MRI to confirm a stress fracture.

Treat It: Rest for four to six weeks and do low-impact exercise like cycling and swimming for another four to six. Then ease back into walking and running, Hamilton says.

Prevent It: Ramp up your mileage or intensity gradually, sticking with a “no more than 10 percent increase per week” rule. A bone-mineral density test can help determine if you need improved nutrition (more calcium and vitamin D) or medications to reduce your risk of breaks.


Hip Pain Prevention Protocol

To prevent any hip injury, strengthening and stretching your hip flexors is key. And while stretching your hip flexors can be difficult, here are two that work well:

  1. Lie on your back on the edge of a table or high bed, and drop your outside leg off the edge.
  2. Lunge with your back leg fully extended. Lift arms up overhead and extend slightly backward if possible.
    1. Adding leg lifts into your routine is an easy way to strengthen your hip flexors—you can add in weights or a resistance band to make this exercise harder. To maximize strength throughout the hip, do leg raises in each direction—back, forward, in, and out.

      Issues in the hips are often related to weak glutes. Strengthening your gluteal muscles with squats and exercises like bridge pose can help. Finally, foam rolling daily will help keep your hip flexors loose and relaxed and less prone to injury.

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      $44.99

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      How Endometriosis Causes Hip Pain: Florida Pain Medicine:

      Endometriosis is a common gynecological problem that affects at least 11% of women. Although endometriosis can cause severe pelvic pain, at least half of all women with endometriosis don’t experience pelvic or menstrual pain.

      Imagine that you have endometriosis without gynecologic-related pain. Then you suddenly develop hip pain without any evidence of a hip problem (because it’s caused by endometriosis).

      Now you have a pain problem that creates a really confusing clinical picture because hip pain is seldom associated with endometriosis, whether or not your endometriosis is diagnosed.

      As pain specialists, Florida Pain Medicine has the expertise to accurately identify the cause of your hip pain. More importantly, they can alleviate your pain even if you have extensive endometriosis by targeting the source of your pain: the pelvic nerves.

      Here’s a rundown on how endometriosis causes hip pain and the solutions we offer at our offices in Wesley Chapel, Zephyrhills, Brandon, Riverview, Ormond Beach, Port Orange, and Palm Coast, Florida

      About endometriosis

      Endometriosis develops when tissues that normally line the inside of your uterus start to grow outside your uterus. Though there are several theories about how that happens, many medical experts believe that when you menstruate, a small amount of blood can travel backwards and go out the Fallopian tubes.

      Endometrial cells from the uterine lining are carried out by the menstrual blood. Then the cells attach to organs and structures outside your uterus where they continue to grow. These patches of tissue are called endometriosis.

      The tissues that make up endometriosis respond to monthly hormonal changes just as if they were still inside the uterus. As a result, they thicken with blood for several weeks and then shed the extra blood at the same time you menstruate.

      How endometriosis causes hip pain

      When patches of endometriosis bleed, the fluid stays inside your pelvic cavity, where it causes inflammation, scarring, and adhesions. These changes typically lead to general abdominal pain as well as abdominal pain before and during your periods.

      However, your pelvic region contains a complex of nerves. As endometriosis grows and expands, it may directly affect these nerves or create scar tissue that presses against nerves. When endometrial lesions build around the nerves, they cause pain.

      Where you feel the pain depends on which nerves are affected by the endometrial lesions, but one of the most common problems is hip pain. In some cases, your hip pain may radiate to the buttock.

      Interventional medicine to relieve hip pain

      If we’re the first providers to diagnose endometriosis, we encourage you to see your gynecologist for the appropriate treatment. It’s essential to get a thorough gynecological exam,  because endometriosis is one of the top causes of infertility.

      In the meantime, we can help you get relief from your hip pain by targeting the nerves sending pain signals to your brain. Sensory nerves pick up pain signals from your hip and pelvic region and carry them to your spine. From there, the signals go to your brain.

      We use treatments such as nerve blocks, radiofrequency ablation, and spinal cord stimulation to stop pain signals at your spine. When your brain fails to get the message, it doesn’t perceive the pain. As a result, your hip pain is significantly diminished.

      You don’t need to keep suffering from hip pain. Our team at Florida Pain Medicine can get to the source of the problem and provide treatments that effectively alleviate the pain. To learn more, call one of our offices, or schedule an appointment online.

      Hip pain in young adults

      Miguel Fernandez

      Peter Wall

      John O’Donnell

      Damian Griffin

      Background

      Traditionally, the management of hip pain has been well defined by age groups such as the limping child and older patients with symptomatic osteoarthritis (OA). However, young adults (typically aged 16–50 years) with persistent hip pain who do not have OA or a childhood hip disorder have presented a diagnostic challenge and their management less well defined.

      Objective/s

      We present a clinical review intended as a guide for general practitioners to aid the identification of such patients through focused history taking and examination. We outline the primary care management and provide guidance on when to refer.

      Discussion

      Our understanding of the causes of hip pain in young adults has increased significantly over the last decade. This has led to the recognition that subtle hip shape abnormalities, termed femoroacetabular impingement, can cause symptomatic soft tissue damage and may initiate OA. This is important as it now raises the possibility of identifying and treating young adults with pre-arthritic symptoms (the ‘at-risk’ hip).

      There is a wide range of possible causes of hip pain in a young adult (Table 1). A specific diagnosis of the cause of pain is important to guide management. It is now understood that subtle hip shape abnormalities, termed femoroacetabular impingement (FAI), can cause soft tissue damage and may initiate osteoarthritis (OA).1,2 This understanding raises the prospect of identifying and treating young adults with pre-arthritic symptoms.



      Table 1. Differential diagnosis of hip pain in young adults
      Extra-articular Intra-articular
      Muscles

      • Abductor muscle injuries
      • Gluteus muscle tears         

      Nerves

      • Sciatica
      • Obturator nerve irritation
      • LFCN irritation     
      • Piriformis syndrome

      Tendons

      • Snapping hip (ITB or iliopoas)
      • Bursa
      • Trochanteric bursitis

      Ligaments

      • Inguinal ligament strain
      • Joint capsule*

      Referred pain*

      • Lumbar spine
      • Knee
      • Non-musculoskeletal pathology
      Bones

      • FAI
      • OA*
      • AVN*
      • DDH*
      • Fractures*
      • Perthe’s*
      • Septic arthritis*

      Soft tissues

      • Labral tear
      • Chondral defect
      • Ligamentum teres injury
      ITB = iliotibial band, LFCN = lateral femoral cutaneous nerve, FAI = femoroacetabular impingement OA = osteoarthritis, AVN = avascular necrosis, DDH = developmental dysplasia of the hip.
      *Not covered in this review

      Assessment

      Patients typically present when their hip pain impairs activities such as work, exercise or sport. Symptoms suggestive of hip pathology include localised symptoms (such as catching sensations), symptoms related to activity or when going up and down stairs, or symptoms related to prolonged sitting or standing.

      History helps to localise the hip as the source of pain rather than make a specific diagnosis as there is significant overlap in symptoms originating from different structures in and around the hip. For example, pain and tenderness over the greater trochanter, buttock or lateral thigh can suggest trochanteric bursitis, a tear of the gluteus medius muscle or a snapping hip.3 Patients with FAI most commonly report groin (88%), lateral hip (67%) and anterior thigh (35%) pain but may also complain of buttock (29%), knee (27%) and lower back (23%) pain.4 Other conditions that present predominantly with groin pain (eg. osteitis pubis, incipient inguinal hernia, adductor tendinopathies) have been the focus of a previous review articleandare not addressed here.

      Hip examination

      The aim of a focused hip examination is to confirm the hip as the source of symptoms and to exclude alternative diagnoses such as referred pain rather than make a definitive diagnosis. Clinical examination has been shown to have a high sensitivity (98%) in localising intra-articular hip pathology but is poor in exactly defining its nature.6

      Look

      Inspection of the patient’s standing posture and gait will reveal any obvious asymmetry in the musculature or alignment. An antalgic gait (short stance phase relative to swing phase) reflects pain on weight bearing and may indicate a painful joint. The Trendelenberg gait reflects the integrity of the hip abductor muscles on the side of the standing leg. The patient can also indicate the site of symptoms.

      The patient may have one of the clinical signs suggestive of intra-articular hip pathology (Figure 1). Cupping of the greater trochanter in the trochanteric C-sign7 (Figure 1A), pointing with two fingers towards the hip joint in the triangulation sign (Figure 1B) or pointing deep within the groin crease in the deep pointer sign (Figure 1C. It is important to note that these signs are commonly reported anecdotally rather than being evidence-based and their sensitivity for detecting intra-articular hip pathology is not known.

      Figure 1. Clinical signs often performed by patients with FAI syndrome A) trochanteric C-sign, B) triangulation sign, C) deep pointer sign

      Feel

      Palpation may reproduce symptoms over anatomical landmarks suggestive of extra-articular pain. Pain reproduced by palpation over the greater trochanter is suggestive of trochanteric bursitis or a snapping hip (iliotibial band irritation over the greater trochanter). Buttock tenderness to palpation suggests muscular pathology (such as gluteus medius tear) and tenderness over the psoas tendon (located lateral to the femoral nerve just below the inguinal ligament) is suggestive of psoas tendonitis.

      Move

      Active range of movement (ROM) will test muscle integrity. Further assessment of specific muscle groups should be made where weakness or pain is identified. Passive ROM assesses the integrity of the joint and surrounding soft tissues, a reduction in which suggests FAI or labral/chondral injury in this patient group.

      Special tests

      Special tests are indicated where intra-articular hip pathology is suspected after exclusion of acute conditions that require emergency department referral (eg. septic arthritis, fracture, slipped upper femoral epiphysis (SUFE), dislocation). The anterior impingement test (flexion, adduction and internal rotation; Figure 2) and the FABER test (flexion, abduction and external rotation; Figure 3) have the highest sensitivities and specificities of the special tests available (>0.9) for detecting intra-articular hip pathology.8 A reproduction of symptoms, pain and a decreased ROM relative to the unaffected side represent a positive test result. Although >90% of patients with FAI will have a positive anterior impingement and FABER test, a positive test can indicate intra-articular hip pathology unrelated to FAI (eg. traumatic labral tears). These tests are therefore not diagnostic but aid in identifying intra-articular hip pathology.

      Figure 2. The anterior hip impingement test. The hip is positioned in flexion, adduction and internal rotation

      Figure 3. The FABER test (flexion, abduction and external rotation)

      Basic imaging

      An anterior–posterior (AP) radiograph of the pelvis is an essential initial investigation to exclude fractures, developmental dysplasia of the hip, avascular necrosis, OA, malignancy and a missed childhood SUFE. However, for most conditions described in this review, the radiograph may be normal or show only subtle abnormalities that are easily overlooked.9Figure 4 shows an AP pelvis in a patient with cam-type FAI. We suggest that additional views such as a Dunn view or frog leg lateral, and CT and MRI are best conducted by a specialist.

      Figure 4. AP pelvis radiograph showing cam-type hip shape in FAI (left hip, red arrow)

      Hip conditions in young adults

      There are a number of conditions that may present with hip pain. Trochanteric bursitis typically presents with tenderness over the greater trochanter. The snapping hip originates from either the iliopsoas tendon or the iliotibial band (ITB). Snapping from the iliopsoas tendon is often audible and recreated when the hip is passively moved from flexion, abduction and external rotation to a position of extension with internal rotation.7 Snapping from the ITB is more visible than it is audible and patients often refer to the sensation of subluxation or dislocation as the tensor fascia lata ‘snaps’ back and forth across the greater trochanter.7 Gluteus muscle tears typically present with buttock pain, which is reproduced by palpation, but symptoms may also include pain over the greater trochanter and later hip pain. These pathologies can be grouped as the greater trochanteric pain syndrome in recognition that symptoms often overlap and are sometimes linked (eg. trochanteric bursitis due to a snapping hip).3 Patients typically present with pain and tenderness over the greater trochanter, buttock or lateral thigh. The prevalence is 1.8 per 1000 in the general population10 and although the incidence is thought to be low among young adults, this diagnosis should be considered where the symptoms are activity-related or follow injury.

      Neuropathies causing symptoms around the hip joint include irritation of the sciatic nerve, obturator nerve and lateral femoral cutaneous nerve (LFCN) of the thigh. Symptoms include shooting pains, stinging or numbness, and neuropathic pain in the nerve distribution. They typically arise from nerve entrapment, such as piriformis syndrome and inguinal ligament strain, causing entrapment of the LFCN of the thigh.

      The acetabular labrum is a cartilaginous ring surrounding the acetabulum and its function is to increase hip joint stability.11 Labral tears can arise from FAI, trauma, dysplasia, capsular laxity and degeneration.12 The ligamentum teres arises from the transverse ligament of the acetabulum and inserts into the fovea capitis of the femoral head. It is thought to provide stability, vascularity, proprioception, and nociception to the hip joint and ligamentum teres injury is recognised as a source of pain from the hip.13 Chondral defects refer to damage of the mature articular cartilage, which causes pain and may initiate the degenerative process of OA.14

      FAI

      The term FAI describes subtle deformities in hip shape that cause impingement between the femoral neck and anterior rim of the acetabulum during the normal range of functional hip movement, particularly in flexion adduction and internal rotation. The impinging surfaces can irritate and damage the soft tissues of the hip joint of which most at risk are the acetabular labrum and the adjacent acetabular cartilage. Hip shape deformities are classified into three types:15

      1. cam type – asphericity of the femoral head; widening of the femoral neck. The term comes from the cam-lobes on engine cam-shafts, which open and close valves by impinging on the appropriate surface as they rotate
      2. pincer type – over coverage of the anterosuperior acetabular wall; a deep socket. Similar to the tips of pincer forceps
      3. mixed type – a combination of cam and pincer deformities.

      Cam impingement is more common in young men, and pincer in middle-aged women. Other types exist and are related to the orientation of the acetabulum and femoral neck. We use the term FAI syndrome to refer to patients with hip shape abnormalities and symptoms suggestive of impingement.

      What is the prevalence of hip shape abnormality and FAI syndrome?

      Hip shape abnormalities characteristic of FAI are quite common in the young adult population.16 In a prospective study of 200 asymptomatic volunteers aged 21–50 years, the prevalence of cam-type hip shape was found to be 14%.17 The prevalence of hip shape abnormality is reported to be higher in asymptomatic athletes than in the general population and the reasons for this remain unclear. A prospective study of American college football players (average age 21 years) found that 95% of the 134 asymptomatic hips had at least one radiological sign of cam or pincer shape18 and in a retrospective review of elite soccer players, radiographic hip abnormality was present in 72% of men and 50% of women.19 In patients with hip pain the prevalence of shape abnormality is even higher. A retrospective review of the pelvic radiographs of 157 patients aged 18–50 years revealed that 87% were found to have a hip shape abnormality.9

      Why do some people get symptoms and others do not?

      It is not yet understood why some people develop symptoms (FAI syndrome) and others do not. It is likely that the mechanism involves a combination of factors: a hip shape abnormality together with a level and type of activity that provokes impingement. There may also be a genetic predisposition to shape abnormality and/or soft tissue damage in these patients.20 The natural history of FAI and long-term progression to OA remain topics of much debate and ongoing research.

      Management in primary care

      Many conditions described in this review require diagnosis by a specialist. Many of these conditions respond to a course of non-operative care, particularly physical therapy, and there is no evidence that such treatment is harmful.21 Therefore, for young adults with persistent hip pain it would be reasonable to commence a course of physical therapy pending a diagnosis. In many cases the specialist will continue to treat non-arthritic hip pain with physical therapy, as failure to respond to this may well then be used as an indication to expedite surgery.22

      For non-operative care, exercise-based physical therapy probably has the most evidence for effect but it is also reasonable to consider a short course of non steroidal anti-inflammatory drugs (NSAIDs), activity modification, education and advice, although limited evidence exists for this.21,23 Although non-arthritic hip pain is not a life- or limb-threatening condition, some causes, particularly FAI, are associated with an increased risk of OA. Therefore, it is advisable to obtain a specialist referral/diagnosis in a timely manner and within 3–6 months if symptoms do not improve with conservative management.

      Early specialist referral may be indicated in athletes where the prevalence of hip shape abnormality has been shown to be substantially higher than in the general population.18,19 At present there is no evidence that patients with asymptomatic incidental findings of FAI benefit from any intervention, but patient education regarding presenting early if symptoms develop is advised.

      Specialist assessment

      Patients who attend a specialist will have a reassessment of their symptoms and clinical examination. They may also be asked to complete a validated hip score questionnaire to quantify their symptoms and monitor changes over time and treatment response. The specialist may use more detailed imaging techniques, such as magnetic resonance arthrography (MRA) and 3-dimensional CT, to diagnose soft tissue and bony pathology and to plan treatment.

      When the diagnosis remains unclear or when multiple pathologies are suspected, a diagnostic intra-articular injection of local anaesthetic may be used. This has been shown to be an indicator of intra-articular pathology with an accuracy of 90%.6 Three-dimensional surface reconstructed CT provides the best impression of all aspects of hip shape and is particularly useful in pre-operative planning for FAI surgery (Figure 5).24

      Figure 5. 3-Dimensional reconstructed CT images of cam-type deformity (red arrows)

      Treatments often involve targeted physiotherapy, which has shown good short-term outcomes in pain and function for patients with mild FAI, although there is limited experimental data.21,25 The therapeutic aims are to increase the pain-free passive range of movement, improve the precision of hip motion, avoid hip hyperextension and femoroacetabular rotation under load, and to optimise the balance of muscle strength and length at the pelvis.25

      Surgical management may be considered for extra- and intra-articular hip pathologies when patients do not improve with non-operative care and where the symptoms are judged severe enough to justify the risks of surgery. Trochanteric bursitis, the snapping hip, and focal isolated gluteus medius and minimis tendon tears can be treated effectively with arthroscopic surgery.26,27

      Shape-corrective surgery for the treatment of FAI, as well as soft tissue repairs (eg. labral repair/reconstruction, microfracture and repair of ligamentum teres injuries) can be also be carried out arthroscopically.12,14,28 A growing body of literature now exists showing favourable short-to-mid-term outcomes of arthroscopic surgery for FAI in young adult and adolescent populations, although long-term data are still awaited and guidelines suggest that such surgery should only be carried out by specialists with expertise in arthroscopic hip surgery.29

      Key points

      • Persistent hip pain in young adults should not be ignored.
      • Clinical examination and basic imaging are important to exclude conditions such as childhood hip disorders, OA, septic arthritis and fractures.
      • Commence conservative management (NSAIDs, activity modification and physiotherapy) and follow up within 3 months.
      • Refer patients with persistent hip pain of 3–6 months duration for specialist review and further investigation.

      Competing interests: John O’Donnell has received payment for Board membership from Smith and Nephew. He has also received payment for consultancy from Arthrocare and Medacta, has grants pending from Arthrocare and has received royalties from Medacta.
      Provenance and peer review: Not commissioned; externally peer reviewed.

      Acknowledgements

      The authors would like to thank the Medical Photography and Illustration Department at University Hospitals Coventry and Warwickshire NHS Trust for the production of images included in this review.

      Patient consent was obtained for the publication of photographs in this review.

      References

      1. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 2005;87:1012–18.
      2. Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res 2004;429:170–77.
      3. Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc 2010;18:113–19.
      4. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res 2009;467:638–44.
      5. Braun PP, Jensen SS. Hip pain – a focus on the sporting population. Aust Fam Physician 2007;36:406–03.
      6. Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 2004;32:1668–74.
      7. Byrd JWT. Evaluation of the hip: history and physical examination. N Am J Sports Phys Ther 2007;2:231–40.
      8. Tijssen M, van Cingel R, Willemsen L, de Visser E. Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy 2012;28:860–71.
      9. Ochoa LM, Dawson L, Patzkowski JC, Hsu JR. Radiographic prevalence of femoroacetabular impingement in a young population with hip complaints is high. Clin Orthop Relat Res 2010;468:2710–14.
      10. Williams BS, Cohen SP. Greater Trochanteric Pain Syndrome: A Review of Anatomy, Diagnosis and Treatment. Anesth Analg 2009;108:1662–70.
      11. Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears: diagnosis, repair, and a method for labral reconstruction. Clin Sports Med 2011;30:317–29.
      12. Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy 2005;21:1496–504.
      13. Bardakos NV, Villar R-N. The ligamentum teres of the adult hip. J Bone Joint Surg Br 2009;91:8–15.
      14. Wright TM, Maher SA. Current and novel approaches to treating chondral lesions. J Bone Joint Surg Am 2009;91(Suppl 1):120–25.
      15. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003;417:112–20.
      16. Laborie LB, Lehmann TG, Engesaeter IO, Eastwood DM, Engesaeter LB, Rosendahl K. Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 2081 healthy young adults. Radiol 2011;260:494–502.
      17. Hack K, Di Primio G, Rakhra K, Beaulé PE. Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 2010;92:2436–44.
      18. Kapron AL, Anderson AE, Aoki SK, et al. Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS Exhibit Selection. ibid. 2011;93:e111.
      19. Gerhardt MB, Romero AA, Silvers HJ, Harris DJ, Watanabe D, Mandelbaum BR. The prevalence of radiographic hip abnormalities in elite soccer players. Am J Sports Med 2012;40:584–88.
      20. Pollard TCB, Villar R-N, Norton MR, et al. Genetic influences in the aetiology of femoroacetabular impingement: a sibling study. J Bone Joint Surg Br 2010;92:209–16.
      21. Wall PD, Fernandez M, Griffin D, Foster N. Nonoperative Treatment for Femoroacetabular Impingement: A Systematic Review of the Literature. PM R 2013;5:418–26.
      22. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res 2004;418:61–66.
      23. Emara K, Samir W, Motasem EH, Ghafar KAE. Conservative treatment for mild femoroacetabular impingement. J Orthop Surg (Hong Kong) 2011;19:41–45.
      24. Heyworth BE, Dolan MM, Nguyen JT, Chen NC, Kelly BT. Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy. Clin Orthop Relat Res 2012;470:1950-57.
      25. Hunt D, Prather H, Hayes MH, Clohisy JC. Clinical Outcomes Analysis of Conservative and Surgical Treatment of Patients With Clinical Indications of Prearthritic, Intra-articular Hip Disorders. PM R 2012;4:479–87.
      26. Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy 2007;23:1246.e1–5.
      27. Cohen SP, Strassels SA, Foster L, et al. Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trial. BMJ 2009;338:b1088.
      28. Wall PD, Brown JS, Karthikeyan S, Griffin D. An introduction to hip arthroscopy. Part two: indications, outcomes and complications. Orthop Trauma 2012;26:38–43.
      29. NICE. Arthroscopic femoro-acetabular surgery for hip impingement syndrome. National Institute for Health and Clinical Excellence; 2011 Sep. Report No.: 408. Available at www.nice.org.uk/ nicemedia/live/11328/56416/ 56416.pdf [Accessed 13 September 2013].

      Correspondence [email protected]

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      90,000 Treatment of pain in the hip joint

      Pain in the hip joint is a reason to see a doctor, traumatologist-orthopedist or rheumatologist. It can be difficult for patients to deal with the nature of pain on their own, because the reasons can be completely different, or there may be several of them.

      Let’s first turn to the pain syndrome associated with the hip joint itself.

      Osteoarthritis of the hip joint (or, as it is also called, coxarthrosis) is a serious disease that, if untreated, leads to disability.It develops over several years and begins with overload or inflammation in the joint. Patients notice the discomfort, but do not pay much attention to it until it develops into pain. As a result, the volume of fluid in the hip joint decreases, which “lubricates” the joint and nourishes the hyaline cartilage. Gradually, the cartilage becomes thinner and damaged, which causes pain and limited range of motion in the joint. The bones themselves that form the joint are also deformed, bone outgrowths – osteophytes appear.Often, injuries become the root cause of arthrosis of the hip joint, and then we are talking about post-traumatic coxarthrosis.

      Dysplasia of the hip joints is a congenital underdevelopment of the acetabulum. Fortunately, now there are fewer and fewer patients with this diagnosis, due to the introduction of ultrasound screenings in childhood. This made it possible to identify patients earlier, and therefore help them at the very beginning of the disease. Dysplasia can cause dislocations and arthrosis, even in elderly patients.In this case, they speak of dysplastic coxarthrosis.

      Aseptic or avascular necrosis of the femoral head occurs when blockage (thrombosis) or compression of the vascular bundle that supplies the femoral head with blood. As a result of exsanguination, the head of the femur begins to gradually lose calcium, cavities (cysts) are formed. Over time, this leads to severe pain and immobilization of patients. Naturally, it is better not to bring it up to this and consult a traumatologist-orthopedist at the slightest suspicion.

      Fracture of the femoral neck is common in conditions such as osteoporosis (bone loss of calcium). The femoral neck – has a special bone structure – it allows you to withstand serious loads at a young age, and with the development of osteoporosis, one of the first becomes the target of the disease. It would seem that a fracture … Logically, it occurs after an injury, but what is typical for hip fractures in older people, the injury can be completely insignificant. For example, a fall from your own height or a bruise on a doorframe.A fracture can be suspected if a sharp pain appears, movements in the joint are disturbed, the leg is shortened and lies in an unnatural position. If the diagnosis is confirmed by an X-ray examination, then the fracture must be operated on, unless there are serious contraindications from the cardiac or respiratory systems.

      Inflammation of the hip joint (coxitis, coxoarthritis) – another cause of problems in the hip joint. Inflammation can be accompanied by an increase in temperature, a change in the general condition of the body for the worse.This type of joint damage occurs in quite serious rheumatic diseases such as ankylosing spondylitis, gouty arthritis, psoriasis with joint damage, rheumatoid arthritis, and Systemic lupus erythematosus.

      Now a few words should be said about the causes of pain in the hip joint, which do not directly relate to it. They can be combined into 2 large groups:

      1. “Causes from above” are disorders in structures that are adjacent to the hip joint, but are located above it.For example, diseases such as intervertebral hernia of the lumbar spine, sacroiliitis (inflammation of the sacroiliac joint), injuries and lesions of the coccyx and sacrum. All of these conditions can manifest as pain in the hip joint.
      2. “Reasons from below” . The neighbor from below, which is manifested by pain in the hip, is the knee joint, or rather its arthrosis (gonarthrosis). It is fair to say that the hip joint often “reciprocates”. That is, with pain in the knees, examining patients, they find changes in the hip joints.

      It is because of such a variety of reasons that it is not always easy for even experienced doctors to deal with hip pain. The clinic “Artus” will help not only to understand “Why the hip joint hurts”, but also to quickly and effectively cope with this nuisance.

      Pelvic torsion | Kinesio (Kharkiv)

      I want to start publishing articles on pelvic instability. From my point of view, this is a very interesting and not very well covered topic in Russian-language literature.

      Here is a translation of an article by a well-known German chiropractor – Robert’a Schleip’a, devoted to pelvic instability. If, while reading the original, my translation seems inaccurate or incorrect, write to me about it (not very rudely :-), I will definitely correct it.

      Pelvic torsion and gravity alignment

      ( http : // www . somatics . de / Torsion . html )

      Pelvic Torsion and Structural Alignment in the Gravitational Field

      by Robert Schleip

      Published in ROLF LINES, May 1996

      While I am usually very skeptical of any kind of “structural logic” in our work and instead prefer an approach in terms of nonlinear systems dynamics in the interweaving of the intricacies of human motor organization, there are few exeptions that I have come across to agree to a linear mechanical relationship.Most of them deal with the force of gravity and its long-term effect on the human structure. The following article, taken from a recent class handout of mine, is one example.

      In the practice of manual therapy, the following problem can often be observed: the chiropractor detects a torsion of the patient’s pelvis. After successful correction (usually with direct or indirect techniques), the pelvis appears smoother on the table in the horizontal position of the patient. But when the patient stands up, the axis of the pelvis and spine again acquire unevenness, sometimes even more noticeable than before.The question arises: did the therapist do something wrong or is the structure broken? Or is it a necessary part of therapy – the so-called. “Treatment crisis”? The purpose of this article is to clarify these issues.

      Pelvic torsion is usually defined as an intrasegmental pelvic pattern (model) in which one wing of the ilium is tilted more anteriorly than the other. Based on a number of studies, isolated displacement of the right side of the pelvis forward, and the left side backward, is more common. The presence of such a pattern in these studies is not explained.Displacement (torsion) of the wing of the ilium anteriorly leads to tilt (rotation) on this side of the anterior superior iliac spine anteriorly and downward (rotation forward). The sciatic tubercle deviates posteriorly and upward (usually combined with its lateral displacement – ??? ) On the contralateral side, the opposite picture is noted.

      Now let’s look at the relationship between the acetabulum and the sacroiliac joint. The distance between these anatomical structures is constant.But what will change when the pelvis rotates is the so-called “vertical distance” between them.

      Fig. 1.

      As you can see in Figure 1. anterior rotation of the iliac wing leads to an increase in the vertical distance between the sacroiliac joint and the femoral head. While the rotation of the wing posteriorly leads to a decrease in this distance.

      Imagine a healthy person standing upright on two legs with one femoral head taller than the other.There can be several reasons for the change in the height of the femoral heads: a unilateral increase in the cervico-shaft angle or a difference in the length of the femur or tibia (congenital asymmetry or fracture). In this case, the pelvis and sacrum will tilt to the side of the lower position of the support – the femoral head. In this position, the support of the human body will be unstable. Correcting this imbalance is to lower the sacroiliac joint slightly lower on the higher acetabular side and raise the sacrum higher on the other side to reduce the lateral slope of the sacrum.It is known from biomechanical studies that most of the body weight load is transferred through the sacroiliac joints. Therefore, corrective rotation (in the original text – torsion) of these joints helps to distribute more or less evenly the load on the legs. The body weight will rotate this sacroiliac joint (on the side of the elevated femoral head) downward. Considering the first figure (Fig. 1), we understand that this “correction” shifts the wing of the ilium anteriorly on one side and posteriorly on the other, while maintaining the horizontalization of the trunk (pelvis) as much as possible.

      Therefore, the following is true: if a person does not complain of pain in the sacroiliac joint and if we continue our work to align symmetry (in the original text – alignment with gravity), then we should look at the position of the sacrum in a standing position upright before we Let’s start derotation of the pelvic torsion. If, in a standing position, the patient has the edge of the sacrum higher on the side where the wing is rotated anteriorly, then it is probably more correct for us to work on eliminating the torsion of the pelvis (rotation of the iliac wings – approx.translator).

      If the sacrum is lower on the side of the anteriorly rotated iliac wing, then it is probably a good idea to leave the torsion as it is, starting with gravity, since the doctor has already done a better job than we would have been (Figure 3).

      Fig. 2. Fig.3.

      Gravity as the therapist at work! Leave the torsional alone.

      I have observed similar cases several times, even with fairly experienced colleagues whom I know well as sensible osteopaths and chiropractors: a doctor (in the original – a practitioner * – a practitioner) detects a torsion of the pelvis in a patient lying on the table and works to eliminate this torsion.As a result of the work, the pelvis looks smoother. The patient is still on the table. But when the patient stands up, the upper torso becomes less balanced than before. Sometimes in this case, doctors (practitioners *) begin to work with the spine to correct the tilt, sometimes they call it a “recovery crisis”, or even worse, “beautiful unwinding.” In fact, they simply forget to relate the torsion of the pelvis to gravity (weight loading) before attempting to correct the torsion by biomechanically separating the body into its constituents.Fortunately, in these cases, the force of gravity will successfully compensate for the “efforts” of the therapist and the torsion of the pelvis will return again after a few minutes when walking or descending steps. Thus, it seems to me that the therapist will not aggravate the patient’s situation and will not cause him much harm, just wasting time.

      So what is the best way to diagnose pelvic torsion and determine the position of the sacrum? Place one finger on the anterior superior spine and the other on the posterior superior spine of the right iliac bone and compare their height in the patient’s upright position (standing).(Note: to palpate the posterior superior iliac spine, apply moderate finger pressure for more accurate localization). After that, do the same with the other ilium (on the other side). This simple diagnostic manipulation is a reliable indicator of the pelvic torsion pattern. After that, define on the patient’s back the so-called “sacral fossa” on the skin, corresponding to the apexes of the sacroiliac joints (lateral apices of the Michaelis diamond – approx.transl.) and compare their height and horizontal level (in the original text – the height from the floor). Their horizontal position is a fairly reliable reference point for determining the position (position) of the sacrum. You can also determine the inclination of the lumbar spine (in the frontal plane – approx. Transl.) (If there is such an inclination), this will complement the “picture” of your patient.

      After completing the above steps, you will see that the “rationality” of our body, expressed in the torsion of the pelvis, where the sacroiliac joint is deliberately lowered to the side where the head of the femur is located below.And, of course, there are such cases when torsion of the pelvis (which occurs often by actual external events) leads to an elevation of the sacrum on the same side (i.e. on the side of the anterior inclination of the iliac crest – approx. Transl.), Which reduces the compensatory balance and violates the vertical axis of the body.

      To summarize: except for cases where pain in the sacroiliac joint is severely manifested and bothers the patient more than compensation for the vertical axis of the body as a whole or in those rare cases when the symmetry of the superior spinal column is significantly disturbed, follow these simple rules of thumb:

      When the rim of the sacrum is raised on the side where the ilium is rotated anteriorly, work on the derotation of the pelvis.

      Otherwise (the edge of the sacrum is raised on the side opposite to the wing of the ilium rotated anteriorly): leave the torsion in this state.

      “When you eliminate local bias and convert a curve to a line, you are just moving the stress.

      This is what chiropractors call chronic damage.

      The patient experiences back or hip pain / discomfort and goes to a chiropractor who performs the correction.

      The patient is satisfied, he says: “Oh, this is great!”

      Gravity is the only tool we use. I think my experience supports this rather broad assumption.

      Gravity is the only tool that deals with chronic situations in the body. ”

      – I.P. Rolf

      Used literature :

      1) Details for this drawing taken from: Ackermann, Die gezielte Diagnose, Stockholm, 1983

      2) “In all other cases ” means: If either the sacral base appears to be horizontal OR if the sacral base is more inferior on the side of the anterior rotated ilium.

      Orthopedic traumatologist answers frequently asked questions

      Young parents always have many questions about their child’s development. We asked the most frequently asked questions to the traumatologist-orthopedist of EuroMed Clinic Dmitry Olegovich Sagdeev.

      – It is recommended to see a small child quite often to an orthopedist: a month, at three months, at six months, a year … What is the reason for this, what exactly does the orthopedist evaluate?

      – The orthopedist looks at how the child’s musculoskeletal system develops during periods of active development in order to notice possible deviations in its development in time and correct them.At an early stage – a month – we do ultrasound of the hip joints so as not to miss any congenital pathology. At three to four months, we repeat the ultrasound scan for control in order to see the dynamics of joint development.

      Based on the results of an ultrasound examination, the doctor may suspect violations of the formation and dynamics of the development of the hip joint.

      The doctor of ultrasound diagnostics assesses the formation of the joint on a special scale (Graf’s scale), and then the orthopedist determines whether correction is required by therapeutic exercises, whether any physiotherapy is needed, etc.etc.

      The sooner deviations in the development of the child are identified, the more effective the treatment will be.

      At about six months, the child begins to sit down, then he will get up, walk, and it is important to know how his hip joint is formed and, if there are violations, to have time to correct them before that moment.

      Dysplasia of the hip joint is a violation of the formation of the hip joint, which in severe forms leads to the formation of subluxation or dislocation of the femoral head.

      – When dysplasia of the hip joint is detected, the wearing of orthopedic structures is usually prescribed: Frejk’s pillows, Vilensky’s splints, etc. They look quite frightening, and the parents are afraid that the child will be uncomfortable in them.

      – The child will not experience discomfort. He still does not have a stable understanding in what position his lower limbs should be, therefore, the construction will not interfere with him.

      At the same time, thanks to the effect of these structures, the child’s legs are located at a certain angle, and in this position the head of the femur is centered in the cavity, it is in the correct position, any deforming load is removed from it, which allows the joint to develop correctly.If this is not done, then a constant deforming load will be exerted on the head of the femur, which ultimately will entail subluxation and dislocation of the hip. This will already be a severe degree of hip dysplasia.

      – In addition to dysplasia, ultrasound always looks at the formation of ossification nuclei in the hip joint. Why is their correct development so important to us?

      – The femoral head is composed of cartilage tissue. The ossification nucleus is located inside the femoral head and, gradually increasing, it reinforces it from the inside and gives the structure stability under axial load.In the absence of an ossification nucleus, any axial load on the thigh leads to its deformation, as a result of which subluxation may develop and further – dislocation of the thigh. Accordingly, if the core of ossification does not develop or develops with a delay, any axial loads are strictly prohibited: you cannot stand, and even more so, you cannot walk.

      – Can I sit?

      – Sitting is not prohibited with a slowed rate of ossification (ossification, bone formation), provided that the roof of the acetabulum is normally formed, the head of the femur is centered.This is determined by ultrasound.

      – What influences the formation of ossification nuclei, how can their development be stimulated?

      – First of all, activity. Therefore, we recommend that you engage in therapeutic exercises with your child right from birth. Mom needs to do gymnastics with the child every day. Moreover, it is important that this should be a normal load, the so-called static one – when the child lies down and the mother spreads his arms and legs. I categorically do not recommend “dynamic gymnastics”, which is gaining popularity now – a set of exercises in which the child is twisted, twisted, swayed, twisted by the arms and legs, etc.Such exercises contribute to overstrain of the developing musculo-ligamentous apparatus of the child, and create a high risk of injury: from sprains to dislocation with rupture of the ligaments of the joint.

      From 2.5 months, a child can and even needs to visit the pool. Individual lessons with a trainer in water are very useful for the development of the musculoskeletal system, cardiovascular and respiratory systems, muscle training, and strengthening of immunity.

      Massage is useful as an auxiliary procedure.

      Vitamin D is also needed, it stimulates the development of bone tissue. Vitamin D is recommended to be given to almost all children under two years of age, and some even later. This issue is resolved jointly by a pediatrician and an orthopedist, doctors select the dosage of the drug and the duration of its administration. In our region, there is little sunlight, which provokes a vitamin D deficiency in almost all children, which leads to rickets. In Siberia, the majority of children who do not take vitamin D have rickets to one degree or another.

      If indicated, the doctor may prescribe physiotherapy: magnetotherapy, electrophoresis, applications with polymineral mud wipes. These are time-tested effective techniques.

      – Doctors say that a child should not be seated before he sits himself, put, stimulate to an early standing, walking. What is the reason for this?

      – This is due to the fact that in a small child, the musculoskeletal system is still immature, and she and the central nervous system are not ready for active axial loads.If we begin to actively verticalize the child, to stimulate him to sit, stand, this can lead to deformation of the spine, disruption of the formation of joints. At the start, they should develop without axial loads, as nature has laid down. Systems, and, first of all, the central nervous system, must mature so that the signal from the brain from, so to speak, the “central computer” reaches the periphery without distortion and the response, from the periphery to the center, is also adequate. There is no need to rush.When these structures are ready, the child will sit down and crawl and get up on his own.

      – What are the age norms when a child sits down, gets up?

      – Indeed, there are certain norms, but one should not focus too much on them. Each child develops according to his own individual program, there is no need to adjust everyone to the same standard. To assess its development, you need to take into account many different circumstances, ranging from the characteristics of the course of pregnancy and childbirth.Timing and norms are needed, I think, more by doctors in order to adequately assess whether the child is developing correctly or not, and if there is a delay, to see it in time and help the baby.

      Children begin to sit down at about six months, crawl at 7-8 months. Classical development: the child first sat down, then crawled, then begins to get up, move with support. Then, when he felt that he was ready, he detached himself from the support and took the first independent steps. This happens when the musculoskeletal system has matured, the central nervous system and the vestibular apparatus have adapted.And all these systems have learned to work together correctly.

      Some children begin to crawl before they sit down, some will get up before they crawl. It happens that the child does not crawl at all, but immediately got up and went. All these are features of individual development.

      – What is wrong with such devices as a walker, allowing the child to “go” much earlier, entertaining him?

      – Walkers knock down the “program” of the correct interaction between the central nervous system, the vestibular apparatus and the musculoskeletal system.In the walker, the child takes an unnatural position, he does not take a full step in them, but simply hangs, pushes off with his toes and moves in space. His brain and muscles remember this incorrect program of vertical position and movement, and subsequently, when the child tries to start walking without a walker, these incorrect settings are triggered, the wrong muscle groups that should keep him upright are turned on, and the child falls down. After the walker, it is very difficult for a child to maintain balance on his own, later it is quite difficult to correct this.

      – Another problem associated with the fact that the child began to be placed before he was ready is flat feet. Right?

      – Flat feet are congenital and functional (acquired).

      If a child is positioned too early, they may develop incorrect positioning of the foot. And often as a result, doctors diagnose planovalgus deformity of the feet. This flat-valgus placement of the feet is usually not pathological. On examination, the doctor determines whether the foot is mobile or rigid (inactive), and if the foot is mobile, it is easily brought into the correction position, then we are not talking about deformation, this is just an incorrect setting, which is corrected by therapeutic exercises, the correct distribution of loads.

      All these attitudes that mothers complain about: raking in socks, seeming curvature of the limbs, is a consequence of the child’s transition from a horizontal position to a vertical one and his adaptation to upright posture. During the prenatal period of development, the fetus is tightly “packed” inside the uterus: the arms are pressed to the body, and the legs are folded in a rather unnatural way for a person – the feet are turned inward, the bones of the lower leg and thighs are also twisted inward, and the hips in the hip joints, on the contrary, turn outward as much as possible …When the baby is just learning to stand, the wrong position of the feet is imperceptible, since the turn of his legs in the hip joints and the twisting of the bones of the thighs and shins happened in opposite directions – that is, they compensated each other, and the feet stand as if straight. Then the ratio in the hip joint begins to change – the head of the femur is centered, and this happens a little faster than the change in the rotation of the shin bones. And during this period, parents notice clubfoot and begin to worry.But in fact, in most cases, this is an absolutely normal stage of development, and there is no need to panic that the child is somehow walking unevenly, putting his foot in the wrong way. Nature is smart, she has provided for the entire mechanism for the development of the lower extremities, and you should not interfere with this process. Of course, if this bothers you, then it makes sense to consult a doctor to determine whether these changes are physiological or pathological. If pathology – we treat, if physiology – there is no need to treat.

      To prevent improper installation of the foot, passive therapeutic exercises, the choice of the correct orthopedic regimen are necessary.

      A small child cannot yet actively fulfill the direct wishes of his parents and do gymnastics himself, therefore at this stage a passive influence is recommended: walking barefoot on uneven surfaces, on grass, on sand, on pebbles (of course, we make sure that the child is not injured so that the surfaces are safe). As the child grows up (after about three years), we move on to active physical therapy in a playful way. For example, we run on our heels to wash, eat breakfast on our toes, go to the bedroom like a penguin, watch cartoons like a bear.Try to make it interesting for the child to do this, and then he will get used to it and will be happy to do the exercises himself.

      Important for the correct fit of the foot and the selection of shoes. Shoes should be lightweight, with an elastic sole, an instep support – a lined arch. If the arch is laid out on the sole, no additional insoles are needed (unless the doctor has prescribed). The height of the shoe is up to the ankle (you don’t need to buy high ankle boots), so that the ankle works freely, and the short muscles of the lower leg can develop correctly – the very ones that hold the transverse and longitudinal arch of the foot.

      For a child starting to walk, it is optimal that the heel and toe are closed in the shoes – this is how the toes are protected from possible injuries if the child hesitates.

      – Real flat feet are treated differently?

      – Yes, “real” flat feet cannot be cured by gymnastics. If this is congenital flat feet, then it is treated quite difficult and in many stages. There are many surgical techniques that the doctor selects depending on the severity of the case and its characteristics.Treatment begins with staged plaster casts. There are minimally invasive surgical aids on the tendon-ligamentous apparatus with the subsequent use of special devices – braces. There are also various surgical aids related to the intervention on the joints of the foot, aimed at correcting the ratio of the bones of the foot and eliminating planovalgus deformity.

      – Why should flat feet and clubfoot be treated?

      – Because these violations lead to the deformation of the entire skeleton.From the bottom up, like a snowball, there are violations. Improper support leads to improper placement of the hip, changes in the position of the pelvis, knee joints suffer, receiving an altered load. To even out the load on the knee joint, the hip begins to rotate, trying to bring out some kind of support position. The thigh unfolded, began to dislocate from the hip joint. To prevent him from dislocating, the pelvis tilted. The pelvis tilted – the angle of inclination of the spine changed. Accordingly, the spine was bent to leave the head straight.As a result: gross violations of the gait and the entire musculoskeletal system, scoliotic deformities from the spine. These conditions do not pose a threat to life, but the quality of life of a person with orthopedic problems suffers greatly.

      – Another very common diagnosis that newborn babies are diagnosed with is torticollis. How serious is this pathology?

      – Many children are diagnosed with neurogenic functional torticollis, often with subluxation of the first cervical vertebra (C1).Most often, this is a functional disorder that goes away on its own with our minimal intervention, and it does not pose any threat to the health of the child.

      Children with functional torticollis are observed jointly by a neurologist and an orthopedist, usually corrective styling, an orthopedic pillow and a soft fixing collar are enough for this situation to be resolved without any complications.

      It is important to separate functional torticollis from congenital muscle torticollis.If the latter is suspected, an ultrasound of the sternocleidomastoid muscles of the neck is performed at two months, which allows us to make the correct diagnosis with a high dose of probability. If an ultrasound examination reveals any changes in the sternocleidomastoid muscle, then we begin to carry out complex treatment aimed at eliminating torticollis and restoring the functional ability of the sternocleidomastoid muscle. The treatment includes fixing the head with an orthopedic collar, physiotherapy courses are prescribed, aimed at improving muscle nutrition and restoring their structure.With unsuccessful conservative treatment, if the deformity grows, then after a year, surgical treatment of congenital muscle torticollis is performed.

      If you have any doubts, questions, worries, do not be afraid to consult a doctor. Children’s orthopedist, neurologist, pediatrician – these are specialists who are always ready to answer your questions and help your baby grow up healthy.

      Optional

      Subluxation of the elbow joint

      A very common trauma in children is the subluxation of the radial head in the elbow joint.In the elbow joint, three bones are connected: the humerus, the ulnar and the radius. Ligaments exist to hold these bones together. In young children, the ligaments are very elastic, loose and can easily slip over the bone. With age, the ligaments become stronger, and sub-ligaments no longer happen so easily.

      This injury happens when the child is abruptly pulled by the hand: the dad twisted it, just sharply lifted the child by the wrists (the child must be lifted, supporting by the armpits), or it even happens that the parent leads the child by the hand, the baby slips, hangs on the arm – and a subluxation occurs …

      At the moment of injury, you can hear the click of the joint. Usually, with an injury, the child experiences short-term sharp pain, which goes away almost immediately. The main sign of injury is that the child stops bending the arm at the elbow – children keep the injured arm fully extended.

      As soon as possible after an injury, the child should be shown to a traumatologist who will correct the subluxation and return the ligament to its place.

      When should I see a traumatologist?

      Children often fall, hit, and get injured in one way or another.How to determine when you can get by with a patch and iodine, and when you need to go to the emergency room?

      • Any cut, puncture wound should be shown to the doctor. Do not fill the wound with brilliant green or iodine! This will add chemical burns to the cut. There is no need to apply cotton wool to an open wound – its fibers are then extremely difficult to remove from the wound. If the injury site is heavily contaminated, rinse with clean water. Then cover the wound with a clean cloth (sterile bandage, handkerchief, etc.), apply a pressure bandage and, as soon as possible, go to the emergency room.The doctor will conduct the initial surgical treatment of the wound, thoroughly clean it (you are unlikely to be able to do it so well on your own), restore the integrity of all structures and apply a bandage.
      • If noticeable swelling appears at the injury site. This may indicate that this is not just a bruise, but also a fracture, dislocation or rupture of the ligaments.
      • If the child has lost consciousness, even for a short time. This may indicate a traumatic brain injury, which can have serious consequences.
      • If a child has vomited after an injury. Vomiting, nausea, and pallor also indicate the possibility of traumatic brain injury.
      • If the child hits his head. The consequences of a head blow may not be immediately noticeable, and at the same time have very serious consequences.
      • If the child has hit the belly. When struck by the stomach, damage to internal organs and internal bleeding is possible.
      • If a child falls from a height (from a chair, table, etc.), falls off a bicycle, etc.It happens that outwardly it does not manifest itself in any way, but the internal organs are damaged.
      • If the child is worried, behaves in an unusual way.

      In general, in case of any doubt, it is better to play it safe and see a doctor. Traumas in children – this is such a question when it is better, as they say, to overdo it than to miss it. Do not be ashamed, afraid that you distract emergency doctors or emergency room doctors over trifles. Your child’s health is the most important thing!

      Caution: trampoline!

      Trampoline is a very popular entertainment among modern children.Unfortunately, this fun can lead to serious problems. The most common injury that children and adolescents receive on trampolines is a compression fracture of the spine. Recently, there have been a lot of cases of compression fractures of the spines, including those who are professionally involved in trampoline sports.

      There is no safe way to be on trampolines. A child, even without falling, can break the spine, since during jumping, the spine receives very large axial loads.Especially, of course, this is dangerous for children with a weak muscle corset.

      Diseases of the musculoskeletal system

      The main symptoms arising from diseases of the musculoskeletal system are pain in the joints, muscles, spine, which can be aggravated by movement or “in the weather”.

      The main diseases of the musculoskeletal system are:

      • Arthritis
      • Osteoarthritis
      • Ankylosing spondylitis (chronic systemic disease of the joints and soft tissues around the spine)
      • Joint hygroma
      • Hip dysplasia (congenital, congenital, abnormal development of the acetabulum joints)
      • Coccygodynia (pain in the coccyx)
      • Osteoporosis of bones
      • Osteochondrosis of the spine
      • Flat feet
      • Gout
      • Rachitis
      • Sacroiliitis (inflammation of the sacroiliac joint)
      • 29 Synovolisis

        29 vertebra relative to the other)

      • Stenosis of the spinal canal
      • Tendovaginitis
      • Tuberculosis of bones
      • Calcaneal spur
      • Epicondylitis of the elbow joint

      Causes

      Until the end of the cause e quiet diseases have not been clarified.It is believed that the main factor causing the development of these diseases is genetic (the presence of these diseases in close relatives) and autoimmune disorders (the immune system produces antibodies to the cells and tissues of its body).

      From other factors provoking diseases of the musculoskeletal system, the following are distinguished:

      • endocrine disorders;
      • Disruption of normal metabolic processes;
      • Chronic joint microtrauma;
      • Hypersensitivity to certain foods and drugs.

      In addition, the infectious factor (transferred viral, bacterial, especially streptococcal, chlamydial infections) and the presence of chronic foci of infection (caries, tonsillitis, sinusitis), hypothermia are also important.

      Symptoms

      Everyone’s body is different and does not react in the same way to certain problems, so the symptoms of such pathologies are quite diverse. Most often, diseases of the bone and muscular systems are manifested by the following symptoms:

      • pain;
      • Stiffness in movement, especially after waking up;
      • increased pain when changing weather conditions;
      • pain on exertion;
      • muscle pain;
      • pallor of the skin of the fingers under the influence of cold, worries;
      • decrease in temperature sensitivity;
      • Numbness of certain parts of the body and “creeping creeps;
      • Swelling and redness around the affected area.

      The course of the disease provides a great influence on the symptomatology. There are diseases of the skeletal system, which proceed almost imperceptibly and progress rather slowly, which means that the symptoms will be mild. And the acute onset of the disease will immediately make itself felt with clear signs.

      Treatment

      Treatment of the musculoskeletal system is usually carried out in several directions:

      • drug therapy;
      • adequate physical activity;
      • physiotherapy procedures, especially SWT;
      • reflexology;
      • therapeutic massage;
      • traditional methods of treatment;
      • dietary adjustment.

      An important role in the treatment of diseases of the musculoskeletal system is played by the patient’s attitude to his health. If the patient relies only on medications and does not want to change the diet and his lifestyle, then effective treatment will not work.

      Coxarthrosis: description of the disease, causes, symptoms, cost of treatment in Moscow

      Deforming arthrosis of the hip joints is coxarthrosis. Various factors can provoke this disease.This happens with the abnormal development of the pelvic bones, the spine of the legs (the acetabulum decreases, congenital dislocation, subluxation, scoliosis, one leg is longer than the other). With secondary coxarthrosis, an unequal lesion of both joints occurs, or it is completely unilateral.

      According to medical research, the following data can be distinguished:

      • Unclear etiology of coxarthrosis occurs in 43 percent of all cases.

      • The appearance of secondary coxarthrosis occurs in 25% of cases.

      • The rest of the percentage is the result of injury, excessive physical or occupational stress.

      The mechanism of development of the disease

      The articulation of the nameless and femur occurs in the hip joint. The acetabulum is located in the anonymous bone.The head of the femur bone is placed in this cavity. The acetabulum is covered with cartilage. The lower and anterior part of the cartilaginous cover is thin, the upper posterior part is thick. Cartilage also covers the head of the femur. In the slit space that remains inside the joint, there is synovial fluid. It is a transparent viscous substance that resembles egg white. In addition, it is responsible for the metabolic function in the joint, and represents the immune defense.

      The hip joint is very powerful, it is subjected to great stress, so there are a lot of ligaments there.They contribute to the formation of the joint capsule. The cartilage lacks blood vessels and nerve fibers, and as a result, there are no sensitive nerve fields that signal excessive stress. Under the influence of such loads, there is a gradual loosening of the cartilaginous tissue, a change in the physicochemical properties of the extracellular matrix. As a result, the cartilage tissue loses its biochemical properties.

      The synovial fluid captures the smallest particles of exfoliated cartilaginous tissue.When these particles find themselves between surfaces that rub against each other, they begin to penetrate into the joint capsule. As a result, an inflammatory process begins in the synovial membrane, a large amount of fluid with poor quality is released. There is an increase in the destruction of the joints. Swelling begins in the joint, bone growths (osteophytes) appear, due to which a person feels pain during movement.

      Why does the disease appear, classification

      Coxarthrosis can be primary and secondary.The development of the primary form occurs in healthy from birth cartilage of the joint, when excessive loads become the cause of problems. The secondary form is characterized by degenerative processes in the cartilage, which has already been changed before.

      The secondary form includes:

      • The presence of dysplastic coxarthrosis (a manifestation of congenital underdevelopment of the joint).

      • Congenital anomaly (dislocation).

      • Presence of osteochondrosis dissecans of the hip joints.

      If we talk about the clinical forms of coxarthrosis, they are distinguished, given the localization of the pathology. The upper pole of the hip joint is affected due to a congenital defect. This type of disease begins early and is accompanied by pain. If the lower pole of the hip joint is affected, there may be no painful sensations, and the pathology is visible on an x-ray.If the central part of the hip is affected, it is called central arthrosis. There is a favorable course of this type of disease.

      Given the above, there are some reasons for the development of the disease, as well as its classification type:

      1. with involutive, a person notices the onset of manifestations when the age reaches 45 years. This disease is associated with age-related changes.

      2. with idiopathic, basically, do not determine the cause of development.In most cases, this type refers to the primary form of coxarthrosis.

      3. the disease can be congenital or dysplastic.

      4. the appearance of a post-traumatic appearance is associated with a previous trauma. This occurs when the pelvic bones or the head of the femur break. In some cases, coxarthrosis appears even when the patient has received adequate treatment.

      5. the emergence of post-infectious coxarthrosis is observed in the presence of rheumatoid arthritis or trauma caused by a trapped and untreated infection.

      6. the development of dyshormonal or metabolic coxarthrosis is associated with impaired metabolism, as well as if a person abuses certain drugs (hormones, corticosteroids).

      7. The most common causes of the development of the disease include impaired blood flow and outflow to the joints. This happens with varicose veins.

      8. at risk are those people who have been diagnosed with a disease of the spine. Scoliosis, lordosis, intervertebral hernia and other pathologies provoke a violation of the biomechanics of movements.In addition, there is an increase in the load on the hip joint. This is the adaptation of the body to the existing problem.

      9. Coxarthrosis can appear with insufficient physical activity.

      10. the main reasons include the hereditary factor. If close relatives have a weak skeleton, some structural features of cartilaginous tissues, metabolic diseases, there is a significant increase in the risk of getting coxarthrosis.

      Identify common causes of the disease:

      • congenital subluxation of the femoral head.

      • Fracture of the pelvis, hip.

      • Necrosis of the femoral head, when the cervico-diaphyseal angle changes.

      • Benign or malignant bone tumor.

      • Arthrosis.

      • Ankylosing spondylitis.

      • Rheumatoid arthritis.

      How to recognize coxarthrosis

      The main symptom of coxarthrosis is the appearance of painful sensations in the joint. Most of the pain occurs at the end of the day. And then, over time, the painful syndrome accompanies a person throughout the day, and in the evening it even interferes with normal sleep.

      The victim begins to atrophy of the muscles, thighs, buttocks. Walking becomes problematic, then the affected limb becomes shorter, resulting in lameness.After a certain period of time, the joint itself is affected, various changes occur in it, and normal functioning disappears. The early stage of the disease is characterized by limitation of joint movement, and then the person may become completely immobilized.

      Disease degree

      There are three degrees of coxarthrosis. At the first degree, slight aching pains appear, the localization of which is the area of ​​the joint. The painful syndrome manifests itself after significant exertion.However, there is no violation of the biomechanics of movements, and the painful sensations quickly disappear.

      When the second degree begins, the person notices that the pain increases, the mobility of the joints is impaired. Soreness can be felt in the groin, knee, popliteal ligament. Such pain is associated with pathologies that are located in the spine or knee joint, therefore, it can be misdiagnosed. Aching pain appears even in a calm state. This is due to the development of an inflammatory process.And also, there is a violation of biomechanics, a decrease in functional abilities. A person notices that during movement a characteristic sound appears in the joint. In addition, the victim begins to specifically limp, and due to the fact that the pelvis is distorted, the limb visually appears shorter. The X-ray shows that osteophytes have grown significantly, the femoral head is deformed, and the contour is changed. The joint space narrows, the head of the hip bone is displaced.

      If the 3rd degree of the disease has begun, there is a strong atrophy of the muscles, a violation of the biomechanics of the joints, painful sensations become constant and make it difficult to perform various movements.Also, the affected limb becomes shorter due to the increased skewing of the pelvis, a duck gait appears. An X-ray examination reveals a significant deformation of the head of the bone and the presence of a large number of osteophytes. The third degree of coxarthrosis is characterized by an increased risk of a person’s disability. In most cases, the patient needs a cane to move.

      What awaits a person, given the localization of the disease

      If the central part is affected, this means that the disease will proceed calmly and for a long time.The pain syndrome will be of moderate severity. There will be a narrowing of the joint space in the center of the acetabulum. Such localization makes it possible to carry out supportive conservative therapy for a long time, and not to use surgical intervention.

      If the lower pole is affected, the pain will not be strong. There will be more irregularities on the internal rotation than on the external one. And also, the endplate is sclerosed. This type of disease has been going on for many years without aggressive symptoms.

      A complex and severe form of the disease when the upper pole is affected. Such localization can be found in congenital joint anomalies. Painful sensations differ in their intensity, and appear in adolescence. If the disease is started, subluxation of the joint may occur. There is a large violation of the external rotation. In addition, necrosis of the upper part of the head of the bone is observed. This type of disease is characterized by a poor prognosis. Such a patient is prescribed an operation.

      How to diagnose disease

      The diagnosis of coxarthrosis should be carried out by a qualified doctor. Often there are cases when an orthopedic doctor prescribes treatment for the spine, but at the same time, an x-ray examination of the hip joint is not performed. In such a situation, the patient’s time is wasted.

      There are modern methods with which you can accurately diagnose. This refers to the conduct of:

      • Radiography.The picture shows how large the joint space is, determines whether osteophytes are present or absent, as well as the state of the femoral head.

      • Ultrasound research. On the ultrasound, the degree of the disease is determined, localization is visible, as well as how many osteophytes have formed, in what state the acetabulum and whether there are changes in the ligamentous apparatus.

      • Computed tomography.The essence of this research method is similar to X-ray, however, thanks to computed tomography, a more voluminous and detailed image is obtained.

      • Magnetic resonance imaging. This belongs to the most complete and truthful diagnostic method. During MRI, a layer-by-layer scan of the joint takes place, fixing the slightest changes in the bone and cartilaginous structure.

      Also
      can prescribe additional laboratory tests, using
      which reveals the degree of the inflammatory process in the joints.Medical examination
      an orthopedist is an integral part of diagnostic measures. When summing
      of all the data obtained, the doctor makes an accurate and truthful diagnosis, and also,
      indicates the extent to which the disease is located.

      Coxarthrosis of the hip joint – treatment, surgery, price in St. Petersburg

      Coxarthrosis is a degenerative disease that leads to the destruction of the hip joint and has a chronic course. More common in older age groups.Women are more likely to get sick than men.

      The onset of the disease is gradual, develops slowly. May affect one joint or both. It is the most common type of arthrosis.

      Why does the disease develop?

      Coxarthrosis in some patients accompanies the natural aging process of the body and is a dystrophy of the tissues of the hip joint. Its occurrence is influenced by the following factors:

      • reduced tissue nutrition;
      • congenital malformation of the hip joint, in particular dysplasia;
      • postponed trauma to the pelvic region;
      • post-infectious coxarthrosis;
      • aseptic necrosis of the head of the hip joint;
      • Perthes disease (osteochondropathy).

      Unfortunately, it is not always possible to determine the cause of the disease, and the pathology of the hip joint is called idiopathic coxarthrosis – that is, the cause of which has not been established. This is a stimulus for constant research of the problem. Scientific work is underway in this area and doctors have come to the conclusion that a higher risk of coxarthrosis is observed in the following patients:

      • Hereditary tendency to pathology. Patients whose parents suffered from diseases of cartilage and bone tissue, in most cases, will also have similar problems;
      • Overweight. Significant body weight is a stress on joints, which are already regularly subjected to mechanical work;
      • Metabolic disorders, diabetes mellitus. This leads to poor-quality supply of oxygen and nutrients to the tissues of the joint, due to which they lose their properties.

      Knowing the main risk factors for the disease, you can plan preventive measures to prevent it.

      How to recognize abnormalities of the hip joint?

      The symptomatology of coxarthrosis depends on the anatomical features of the musculoskeletal system, the causes of the pathology and the stage of the process.Let’s consider the main clinical manifestations:

      • joint pain;
      • Irradiation of pain to the knee, hip, groin area;
      • stiffness of movement;
      • limited mobility;
      • 90,029 walking disorders, lameness;

      • decrease in the mass of the muscles of the thigh;
      • shortening of the injured limb.

      The clinical picture corresponds to internal changes in the tissues of the joint.Symptoms increase gradually and in the early stages the patient does not pay enough attention to them. This is dangerous, because it is at the beginning of the process that the treatment has a greater effect.

      Clinical and radiological degrees of coxarthrosis

      The following are the symptoms of the disease that are characteristic for each degree.

      • 1st stage. The patient experiences periodic pain and discomfort. Unpleasant sensations disturb after physical exertion, prolonged position in a static position.Soreness is localized in the joint area and disappears after rest. At this stage of the process, the gait is not disturbed and there is no shortening of the leg. Changes are noticeable on the roentgenogram – the joint space narrows, osteophytes (bone growths) appear.
      • 2nd stage. The intensity of pain increases, it can appear during rest and radiate to adjacent parts of the body. Lameness appears after a person has walked for a long time or overexerted. The range of motion in the joint is limited.In parallel, changes in the X-ray picture develop: the inter-articular gap is significantly narrowed, the head of the femur is displaced, osteophytes grow on the inner and outer edges of the acetabulum.
      • Stage 3. Soreness becomes permanent, appears during the day and night. The gait significantly deteriorates, there is a constant limp. The motor function sharply decreases, the muscles of the leg atrophy. the change in muscle tissue leads to the fact that the leg is “pulled up” a little and becomes shorter.This leads to deformation of posture and curvature of the body. X-ray at this stage of the process: total narrowing of the gap between the surfaces of the joint, deformation of the femoral head, significant growth of osteophytes.

      Diagnostic program for disease

      The main diagnostic method is X-ray. With its help, you can determine the presence of the disease and its stage. On radiography, the structure of the joint is analyzed for narrowing of the joint space, osteophytes, destruction of the head of the hip bone.

      If there is a need to study the state of soft tissues, magnetic resonance imaging is performed. It allows you to examine in detail the condition of the cartilaginous areas of the joint, as well as the muscles of the hip region.

      Modern methods and directions of treatment of coxarthrosis of the hip joint

      Coxarthrosis treatment can be conservative and surgical. Coxarthrosis treatment is aimed at achieving the following goals:

      • reduction of pain manifestations;
      • restoration of motor activity;
      • rehabilitation and restoration of working capacity;
      • prevention of complications;
      • improvement of the patient’s quality of life.

      The initiation of treatment consists of modifying risk factors. For this, the doctor recommends the following measures:

      • normalization of body weight;
      • giving up bad habits;
      • good nutrition;
      • normalization of physical activity;
      • balanced drinking regime;
      • healthy sleep.

      Conservative treatment is distinguished: medication and non-medication.Drug treatment includes non-steroidal anti-inflammatory drugs, analgesics, chondroprotectors. They reduce inflammation in the tissues of the joint, eliminate swelling and soreness, restore range of motion and improve the condition of the cartilage tissue.

      Non-drug treatment includes, but is not limited to, massage the affected area. This stimulates the work of muscles, resists their dystrophy and is the prevention of limb shortening. A full and professional massage stimulates blood flow in the joint area, and this, in turn, leads to the normalization of tissue metabolism.Please note that massage is not always useful for coxarthrosis – it is carried out only between exacerbations and at some stages of the process. The attending physician can prescribe it, recommend massage techniques, the frequency of the procedure and the duration of the course.

      A prerequisite for treatment is physiotherapy exercises. This is the prevention of contractures and disease progression. Exercises should be done daily, only then will they have an effect. Gymnastics is selected on an individual basis and is prescribed by a rehabilitation therapist.Exercise improves overall well-being, reduces the risk of emotional disorders, and strengthens the body’s strength.

      Physiotherapy is another method that is used for coxarthrosis. It can be mud therapy, therapeutic baths and showers, magnetotherapy. Electro- and phonophoresis with medicinal substances is used.

      If the listed methods of treatment did not bring an effect or were applied out of time, surgical treatment is required.

      Surgery for coxarthrosis

      Surgical treatment is used when conservative methods are ineffective.This is especially true with late diagnosis. Modern surgical techniques and high-quality equipment of the operating room allow restoring the structure and function of the joint, restoring the person’s range of motion and a normal quality of life. The most effective method of surgical treatment is joint arthroplasty.

      The indications for surgery are:

      • coxarthrosis 2-3 degrees;
      • no effect of therapy;
      • total restriction of movement, walking.

      Contraindications that do not allow the operation to be performed:

      • decompensated state of the kidneys, heart, liver;
      • mental illness;
      • acute stage of the inflammatory process in the body.

      This is why preoperative diagnostics are performed. However, if it is possible to correct the condition, the patient prepares for the operation and after that the intervention is performed.

      The operation consists in removing the affected tissue and installing a prosthesis. There are various models of endoprostheses. The methods of their attachment to the bone differ – cement and cementless, the material from which the endoprosthesis is made. You can get information about all the features of the endoprosthesis and the intricacies of surgical intervention in consultation with your doctor.

      Recovery period after surgical treatment

      From the first day after the operation, rehabilitation is carried out under the supervision of a doctor.First, it consists in performing passive movements, then the loads gradually increase. Walking at first is allowed only with crutches, sitting and squatting are allowed.

      Naturally, in the first time after the operation, there are restrictions on the loads. You should not be afraid of this – after all, without the operation, these restrictions would have survived until the end of life. Reducing physical activity after surgical treatment is necessary to strengthen the position of the endoprosthesis, restore bone integrity, and heal wounds.Within 2 months, sports activities, physical activity on the joint, long walking and some types of exercises should be excluded. After complete recovery, a person returns to a full life, can go in for sports and active recreation.

      Endoprosthesis service life: most companies indicate a survival rate of about 90% for follow-up periods of up to 15 years.

      Personal site – pelvic pain

      Pelvis (lat.pelvis) – a part of the human skeleton located at the base of the spine, which provides attachment of the lower extremities to the body, and is also a support and bone container for a number of vital organs.
      The base of the pelvis is formed by two pelvic bones, the sacrum and the coccyx, connected by the joints of the girdle of the lower extremities into a bony ring, inside which a cavity is formed that encloses the internal organs. Until the age of 16-18, the bones (ilium, pubic and sciatic) are connected by cartilage. Subsequently, ossification occurs and these bones grow together to form the pelvic bone.

      Paired pelvic bones in front are connected by means of the pubic symphysis, and behind they are attached by ear-shaped surfaces to the formation of the sacrum of the same name, forming paired sacroiliac joints. Each of the pelvic bones, in turn, is formed by three components: the ilium, the ischium and the pubic bone, whose bodies on the outer surface form the acetabulum – the glenoid fossa for the femoral head.

      The causes of pelvic pain are varied.They include trauma, inflammatory diseases of the hip joint and tendons, can manifest as local manifestations of systemic diseases, as well as infectious processes affecting the joint itself or periarticular anatomical formations.

      Articular pain in the hip joint of a non-traumatic nature is caused by the development of diseases such as osteoarthritis, osteoarthritis, infectious arthritis, impaired blood supply to the bones that form the joint. Complications of these diseases are caused by degenerative changes in the articular surfaces (cartilage damage, pathological changes in the synovial membrane of the joint, damage to the periarticular structures, a decrease in the amount of articular fluid), which leads to the development of severe pain syndrome and dysfunction of the joint.

      In what diseases does pelvic pain occur:

      Characteristics of pelvic pain in diseases of the hip joint.

      When the hip joint is worn out, thinning of the cartilage and cartilage fragments floating around the joint can cause inflammation of the inner surface of the joint, which also causes pain. With the complete absence of cartilage, the exposed bone of the femoral head rubs against the bone of the pelvic cavity and causes even more severe pain.
      Pain associated with damage to the hip joint does not always bother in the area of ​​the joint, it can spread throughout the thigh, descend to the lower leg. Conversely, pain in the hip joint can be associated with damage not to the joint, but, for example, to the lumbar spine.
      In addition to pain, patients are often worried about a decrease in joint mobility (stiffness) – flexion of the hip is impaired, its lateral movements suffer. This is due to the cross innervation of the thigh and knee.
      Significant hip disease can also lead to lameness and one leg appears shorter than the other. As the disease progresses, the hip joint may become stiff and less mobile. Moving after long periods of sitting can be particularly painful.
      The distance you can walk gradually decreases along with the decrease in other basic movements.
      Pelvic pain can be associated with damage to its various structures or adjacent tissues (bones, cartilage, tendons, muscles, fascia, etc.).

      Possible causes of pelvic pain:
      1. Fractures of the pelvic bones.
      – Fracture of the ilium.
      – Fracture of the acetabulum.
      – Fracture of the pubic bone.
      – Multiple fractures of the lumbosacral spine and pelvic bones.
      – Fractures of other and unspecified parts of the lumbosacral spine and pelvic bones.
      In case of pelvic injuries, you should immediately consult a specialist doctor for timely diagnosis and treatment of the problem.

      2. Aseptic necrosis of the femoral head is death and destruction of the articular part of the femur, which occurs due to the cessation of its blood supply. This condition can be a complication when taking glucocorticoid (hormonal) drugs, with antiphospholipid thrombosis and some other diseases.

      3. Tumors of the pelvic bones and soft tissues surrounding the pelvic ring.

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