Pain in the hip joint

Gait with pain in the hip joint

Persons with unstable or painful hip joint use a stick placing it on the side opposite to the affected leg (the opposite situation occurs with pathology of the knee joint).

With pain in the hip joint, it is necessary to inquire about the condition of other joints. Tenderness in the hip may be associated with pathology in the lumbar spine, in the sacroiliac joints, in the abdominal cavity or pelvic cavity.

Measurement of the length of the lower limbs

The apparent inequality of the length of the legs (when the lower extremities lie parallel and on the same line with the trunk), also called an obvious shortening (for example, due to the pelvic incline or fixed deformation with reduction, which gives an obvious shortening on the affected side) or an explicit elongation legs (for example, due to fixed hip abduction) are said when in fact there is not really a true leg length inequality that is established by measuring the distance from the top of the iliac bone to the medial malleolus each side (the pelvis is thus kept parallel to the lower limbs, which in turn are in equal lead or lead).

Fixed deformation

In this case, the joint or muscle contracture prevents the position of the legs in the neutral position. With a fixed deformation of the reduction, the angle between the limb and the transverse pelvic axis (the line between both upper iliac spines) is usually less than 90 °, and for a fixed deformation of the lead it is more than 90 °.

Fixed deformation of flexion is established by means of Thomas's reception.

Reception of Thomas

On the side where you assume the presence of a fixed flexion deformation, feel the lumbar lordosis. If you succeed, maximally bend the healthy side. In this case, lordosis disappears, and a fixed flexural deformation becomes quite obvious on the side of the lesion. The angle to which you can raise the hip, and there is the actual angle of fixed bending.

Coxa vara (or curved inside the thigh)

This term denotes a hip joint in which the angle between the femoral neck and the bone (thigh) diaphysis is less than the normal angle of 125 °. Causes: congenital condition, slipped upper epiphysis of hip, fracture (vertex with wrong fusion); softening of bones (rickets, osteomalacia, Paget's disease). The consequences are a true shortening of the limb. "Trendelenburg's attack" during walking makes the patient limp.

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Examination of the hip joint

When examining the hip joint, the following movements should be checked: flexion (the patient lies on the back, grasp the combs of the ileal bones to exclude the rotation of the pelvis), normally it is 120 °; lead - normally 30-40 ° (while holding hands on the upper iliac bones to exclude the pelvic inclinations); withdrawal at simultaneous bending - at a norm of 70 ° and reduction - in the norm of 30 ° (it is investigated by movement with crossing of stops). Normally, lateral and medial rotation are 30 °.

[4], [5], [6], [7], [8], [9]

Trendelenburg Test

With the help of this test, the stability of the hip joint is clarified and the ability to maintain the pelvis in a standing position on one leg. In this position, the pelvis normally rises on the side of the raised leg. This test is considered positive when the pelvis is lowered on the side of the raised leg. The reasons for this are as follows.

1. Paralysis of the abducent muscle of the thigh (middle and small gluteus muscles).
2. Displacement to the top of a large trochanter (pronounced coxa vara or dislocation of the hip joint).
3. Absence of a stable point of support (for example, fragments were not connected at fracture of a neck of a femur).