Tendinitis is called inflammatory disease arising in the tendon apparatus of the joints. The disease can affect almost any joint, including such small ones as the temporal (temporal tendonitis), the wrist joint, as well as worsen the quality of life in case of damage to large joints - this is post-tibial tendonitis, inflammation of the knee, pelvis. Dangerous tendonitis of the knee hip joint, since a person cannot walk normally, naturally, working capacity decreases. With pathology, the connective tissue is damaged, which make up the muscles and ligaments. Deterioration of joint mobility and a feeling of pain is due to the fact that the transmission of motor impulses from the ligaments (muscles) to the joint, arising at the time of muscle contraction, is impaired. Consider common forms of the disease such as hip tendonitis, symptoms, diagnosis, and treatment.
Both types of surgeries are performed on an outpatient basis, so an overnight hospital stay is usually not required. Early research suggests that arthroscopic bursa excision is quite effective, but this is still being studied. While poor bursitis cannot always be prevented, there are things you can do to prevent inflammation from getting worse.
- Avoid repetitive activities that stress the hips.
- Lose weight if you need to.
- Get the correct fitting shoe insert for leg length difference.
- Maintain strength and flexibility in your hip muscles.
It is worth noting that acute and chronic types of the disease are distinguished, and the latter develops if the initial stage of tendonitis is not treated. For treatment, anti-inflammatory therapy is prescribed, while the load is limited, for recovery it is recommended to undergo a course of massage, exercise exercise therapy. In general, the disease more often affects men, moreover, between the ages of 30 and 50. The risk group includes athletes and people of physical labor, since overload and injury are the basis of pathology. Let us examine what leads to inflammation of the tendon apparatus of the joints, consisting of muscles and ligaments.
We present a clinical review intended as a guide for general practitioners to help identify these patients through targeted history and evaluation. We will lay out a guide to primary health care and advise on when to apply.
Our understanding of the causes of hip pain in young people has increased significantly over the past decade. This is important because it is now possible to identify and treat young people with pre-arthritis symptoms. There is a wide range of possible reasons hip pain in a young adult. The specific diagnosis of the cause of the pain is important for guidance. It is now understood that subtle abnormalities in the hip joint, called femeroacetal lesions, can cause soft tissue damage and can initiate osteoarthritis. 1, 2 This understanding increases the likelihood of identifying and treating young people with pre-arthritis symptoms.
Causes
Since a huge load falls on the hip joint, therefore, it is affected more often than others. No exception is inflammation of the tendon of the joint, which is why tendonitis occurs. The disease is more associated with other pathological processes occurring in the joint and surrounding tissues. Most often, tendon tendonitis is part of the degenerative-inflammatory process of the joint itself.
Patients are usually present when hip pain impairs activities such as work, physical exercise or sports. Symptoms suggestive of a hip joint disorder include localized symptoms, symptoms associated with being active or walking up and down stairs, or symptoms associated with prolonged sitting or standing.
History helps localize the hip as a source of pain rather than making a specific diagnosis, as there is significant overlap in symptoms originating from different structures in and around the hip area. The goal of a targeted hip examination is to confirm the hip as a source of symptoms and to rule out alternative diagnoses such as pain in the hospital rather than making a definitive diagnosis. It has been shown that clinical examination has a high sensitivity in the localization of intra-articular pathology of the hip joint, but poorly corresponds to an accurate definition of its nature. 6.
In the first place in terms of the frequency of occurrence of inflammation, excessive loads on the joints of the legs are emitted. In particular, athletes are exposed to them, especially football players, athletes, dancers often get sick, which is associated with constant stress on muscles and ligaments, plus the chance of getting sick increases due to possible injuries.
Common causes of the disease include injury to the joint or soft tissue in the pelvic region. In addition to athletes, people whose work is associated with physical activity also suffer from the inflammatory process in muscle tissue. Loaders, representatives of blue-collar workers, are amazed, especially when vibrations fall on the body. Such people often have a disease not only of the ligamentous apparatus of the pelvic joints, but also tendonitis. own bundle patella, ankle.
Inspection of the patient's standing posture and gait will reveal any apparent asymmetry in muscle or alignment. Antalgic gait reflects pain when carrying weight and may indicate a painful joint. Trendelenberg's gait reflects the integrity of the abductor muscles of the hip joint on the side of the standing leg. The patient can also indicate the location of the symptoms.
The patient may have one of clinical signs indicating intra-articular pathology of the thigh. It is important to note that these features are usually reported anecdotally rather than based on evidence, and their sensitivity to the detection of intra-articular hip disease is unknown.
Leads to the pathology of arthritis, which is associated with inflammation directly in the tissues of the joint. In turn, arthritis can cause systemic diseases such as gout, rheumatism, infectious processes (tuberculosis, syphilis, gonorrhea). By the way, both with the bloodstream and with injuries or surgical interventions, an infection can be introduced into the tendon apparatus, which leads to inflammation.
Palpation can reproduce symptoms from anatomical landmarks indicative of extra-articular pain. Pain expressed by palpation over the greater trochanter suggests vertebral bursitis or numbness. Gluteal tenderness for palpation suggests muscle abnormalities and tenderness in the lumbar tendon, suggestive of psozoindognitis.
An active range of motion will test the integrity of the muscles. Further assessment of individual muscle groups should be performed where weakness or pain is identified. Therefore, these tests are not diagnostic, but help to identify the intra-articular pathology of the hips.
Since the ligaments and muscles are predominantly composed of connective tissue, then its diseases lead to inflammation, as is the case with collagenoses. Among the more rare reasons are the following:
- metabolic and glandular disorders (diabetes, thyroid pathology);
- hormonal disruptions with estrogen deficiency, as happens with menopause;
- congenital malformations of the hip joints (dysplasia).
Thigh conditions in young people
Testing the anterior hip joint. The hip is located in flexion, adduction, and internal rotation. There are a number of conditions that can occur with hip pain. Thromic bursitis is usually tender compared to the greater trochanter. These pathologies can be grouped as the larger lumpy pain syndrome in the recognition that symptoms often overlap and are sometimes related. 3 Patients usually experience pain and tenderness compared to the greater trochanter, buttock, or lateral thighs.
Well, diseases such as tendonitis of the foot, knee and hip joint are associated with age-related changes, that is, older people are exposed to them. Based on the above reasons, two forms of the disease can be distinguished:
- Infectious tendinitis, which appears due to the influence of microorganisms, which lead to inflammation.
- Aseptic tendonitis, not associated with infections, but arising under the influence of trauma, stress, age-related changes and diseases of the joints.
Consider how the disease manifests itself and how much a person suffers when muscle tissue is damaged.
Neuropathies that cause symptoms around the hip joint include irritation sciatic nerve, obturator nerve and lateral femoral cutaneous nerve of the thigh. Symptoms include shooting pains, stinging or numbness, and neuropathic pain in the distribution of nerves.
Damaging surfaces can irritate and damage the soft tissues of the hip joint, of which the abrasive membrane and adjacent acetabular cartilage are most at risk. Deformities of the hip joint are subdivided into three types: 15. Cam type - asphericity of the femoral head; expansion of the femoral neck. The term comes from cams on engine cams that open and close valves by attacking the corresponding surface as they rotate the tick-type type over the covering of the anterior wall of the acetabulum; deep connector. Similar to the tips of the mixed tweezers - a combination of cam and tick deformations. Damage to stones is more common in young men and dumplings in middle-aged women.
Symptoms
Hip tendonitis develops gradually, with signs of tenderness. An attack of pain occurs during active movements, and its intensification occurs in the place where it is located inflammatory process... If a person is at rest and there is no load on the pelvic joint, then the pain disappears. Symptoms of pain are aggravated by pressing on the affected area.
There are other types associated with the orientation of the acetabulum and femoral neck. A prospective study of American college football players found that 95% of the 134 asymptomatic hips had at least one radiologic sign of a cam or mite shape, 18 and in a retrospective review of elite soccer players, radiographic hip anomaly was present in 72% of men and 50% of women. 19 Patients with hip pain have an even higher prevalence of shape abnormalities.
Why do some people get symptoms and others don't?
It is not yet clear why some people develop symptoms and others do not. The mechanism is likely due to a combination of factors: an anomaly in the shape of the hip joint together with the level and type of activity that provokes the lesion. Many of the conditions described in this review require a specialist diagnosis. Many of these conditions respond to a course of non-surgical care, especially physical therapy, and there is no evidence that such treatment is harmful. Therefore, for young people with persistent hip pain, it would be wise to begin physical therapy while awaiting diagnosis.
Over time, in addition to pain, tendonitis is manifested by a change in the color of the skin, while they become hyperemic. A local increase in temperature in the affected area is diagnosed. The inflammatory process of the tendon apparatus leads to swelling and swelling of the tissues. During the movement of the joints, signs of crepitus are heard, that is, a crunch associated with the tendons. With mild inflammation, only a doctor will be able to hear them by conducting a study using a phonendoscope. But with severe inflammation, the crunch is heard even at a distance.
In many cases, the specialist will continue to treat non-arthritic hip pain with physical therapy, as failure to respond to this can then be used as an indication to expedite surgery. 22. Patients who visit a specialist will reevaluate their symptoms and clinical examination. They may also be asked to complete an approved Hip Assessment Questionnaire to quantify their symptoms and monitor changes over time and response to treatment.
When the diagnosis is unclear or when multiple pathologies are suspected, a diagnostic intra-articular injection may be used. local anesthetic... Surgical treatment may be considered for extra- and intra-articular hip pathologies, where patients do not improve with non-operative care, and where symptoms are severe enough to justify the risks of surgery.
Symptoms are somewhat different depending on the localization of the process. So, with damage to the tendons, the long adductor muscle, pain appears, which intensifies during the abduction of the leg. In addition, there are signs of stiffness during leg movements, with a load on the heel area.
Competing interests: John O'Donnell received Board membership fees from Smith and Nephew. The patient's consent was obtained to publish the photographs in this review. The morphology of the hip affects the pattern of damage to the acetabular cartilage: femoral-abacular lesion as a cause of early osteoarthritis of the hip joint. Clinical presentation of patients with symptomatic lesions of the anterior hip joint. Pain in the hip joint - focusing on the athletic population. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography and intra-articular injection in patients with hip arthroscopy. Hip Assessment: History and Physical Examination. Diagnosis of femoral-abacular lesion and labral hip pathology: a systematic review of the accuracy and reliability of physical tests. The radiographic prevalence of femoracetabular lesions in the young population with hip complaints is high. Major Adverse Event Syndrome: An Overview of Anatomy, Diagnosis, and Treatment. Acetabular labral tears: diagnosis, repair and reconstruction of labra. Arthroscopic labration repair of the hip joint: surgical technique and literature review. Ligament teres of the adult thigh. Modern and new approaches to the treatment of chondral lesions. Femoraculatory lesion: the cause of osteoarthritis of the hip joint. Prevalence of cam-type femetracular aberration morphology in asymptomatic volunteers. Prevalence of radiographic hip anomalies among elite footballers. Genetic influences in the etiology of femetraculature lesions: a brother and sister study. Non-operative management of femtoral lesions: a systematic literature review. Joint surgery methods. Conservative treatment of soft femoral sac lesions. Analysis of clinical results of conservative and surgical treatment patients with clinical indications of pre-iliac, intra-articular hip disorders. Arthroscopic anatomy and surgical techniques for peritechanical spatial disorders of the hip joint. Comparison of fluoroscopically targeted and blind corticosteroid injections for a patient with trochanter pain syndrome: a multicenter randomized controlled trial. Introduction to Hip Arthroscopy. Part two: indications, results and complications. Arthroscopic femro-acetabular surgery for hip syndrome.
- Shrapnel abnormalities and early osteoarthritis: the role of the hip joint.
- Greater roughness syndrome.
With inflammation of the tendon located in the lumbar-iliac region, symptoms of pain and discomfort occur when walking or standing for a long time. The pain radiates to the thigh, lower abdomen. Abducens tendinitis is characterized by tenderness in the outer thigh.
By the way, the intensity and duration of pain in tendinitis depends on the neglect of the pathology and on the presence of concomitant diseases. A serious disease occurs after injuries, with arthritis and infectious processes. In an advanced form, pain syndrome can appear at night or during a rest period, which is why a person becomes irritable.
Diagnostics
Since the symptoms of tendonitis pain are similar to other joint diseases, it is important to get the correct diagnosis so that treatment can be started later. The examination must be passed by a doctor - an orthopedist and a neuropathologist, and if the cause of pain is trauma, then a traumatologist. To rule out joint disease, the patient will have to take an x-ray. For rent general analysis blood, blood for biochemistry. With the help of these studies, rheumatism, gout, or severe inflammation in the body can be suspected.
For correct setting diagnosis, the patient is assigned modern methods studies that study the condition of joints, muscles, ligaments. These methods include MRI and CT. Ultrasonography of the joint may be needed if necessary.
Treatment
In principle, the treatment of tendinitis is similar to each other, regardless of what it is: tendonitis of the foot or joint of the pelvis, knee. Of course, the inflammatory process of the tendon apparatus of the hands is easier to treat than the lower extremities, especially when tendonitis of the patella, ankle, and pelvic ligaments develops, since it is necessary to provide peace to the joint. Well, if you can put on a knee pad on the knee, and an orthosis on the ankle, then with the hip joint it is even more difficult. Therefore, the patient is advised to reduce the load on the leg, for which it will be necessary to use a cane or crutch when walking. In advanced cases, bed rest is shown.
Drug treatment
The therapy is based on the appointment of medications to eliminate inflammation and physiotherapy. To reduce inflammation, drugs of the NSAID group are prescribed. The appointment of Meloxicam, Ibuprofen, Diclofenac is effective. In addition to taking NSAIDs inside, with inflammation of the ligaments, ointments help - Voltaren, Diklak-gel, Fastum-gel. With severe pain associated with damage to the ligaments and joints, a blockade with hormonal agents, glucocorticosteroids may be required. Diprospan or its analogue Kenalog in solution with Lidocaine is injected intra-articularly.
If the cause of pain is gout or rheumatism, then hormone therapy may be required. To prevent the destruction of connective tissue, agents of the chondroprotective group are prescribed - Chondroxide, Glucosamine maximum, Teraflex. Since these drugs are quite expensive, you can replenish collagen reserves using recipes traditional medicine... It is recommended to eat jellies, jellies, broths from chicken paws every day.
Other treatments
For any form of tendonitis, whether it is knee or pelvis, physical therapy is prescribed. There are limitations when small joints are involved in the process (temporal tendonitis), then not all devices are suitable for treatment. In order to relieve inflammation, the doctor prescribes procedures for electrophoresis, shock wave therapy, paraffin therapy and laser therapy.
You can supplement physiotherapy procedures and taking medications with a massage course. Massage is indicated not from the first days, but when the acute period of the disease passes. Massage is recommended to be done in conjunction with remedial gymnastics... Since the pain syndrome immobilizes the affected area, the patient may be at risk of muscle atrophy. Therefore, a course of exercise therapy is prescribed to restore mobility. Exercise therapy is rarely recommended if the diagnosis is "temporal tendonitis" and there is inflammation of other ligaments of the joints with minimal mobility.
There are situations when conservative treatment Does not help. In such cases, an operation is prescribed. Do not be intimidated by the operation, as modern medicine uses minimally invasive methods. For tendinitis, arthroscopy is most often indicated. If the condition is neglected, an operation to force the rupture of the synovial capsule may be required. After its implementation, the patient is shown rehabilitation, including massage, exercise therapy, physiotherapy.
We can conclude: if a person is worried about pain in the hip joint, it is impossible to delay the visit to the doctor, because the initial stages are treated without surgery.
Prophylaxis
Methods for the prevention of tendonitis include the correct distribution of loads on the joints of the arms and legs. When doing physical work, breaks should be taken to rest the muscles. Athletes are advised to warm up before starting training or competition. Since injuries are often caused by playing sports, you need to wear comfortable shoes to reduce the chance of falling to the ground, stretching your muscles and ligaments. All injuries, including sprains, sprains, fractures, must be healed to the end. And also it is necessary to perform gymnastics, strengthen muscles.
Elderly people should not forget about the prevention of joint diseases, which also applies to athletes, women with hormonal disruptions. To do this, you need to take chondroprotectors 1-2 times a year. Supplementing with calcium and vitamin D has a beneficial effect on bones.
Tendinosis, also called "tendonitis", is a fairly common disease that most often occurs in people whose activities are associated with hard physical labor. The disease is diagnosed mainly in professional athletes. Tendinosis can affect any of the joints in the body (shoulders, elbows, feet, wrists), but the knee and hip joints are most susceptible to the disease. Disorders in the functioning of the joint cause severe pain and interfere with the normal movement of a person, reducing the level of his performance.
The inflammatory process occurs in the muscle ligaments and spreads to adjacent tissues. In most cases, the focus of inflammation is concentrated in the area of the joint between the ligament and the bone. Cases are identified, and they are not isolated, when pathology damages the entire tendon.
If there is a factor of frequent injury (especially in athletes), then tendonitis can become chronic.
Who is at risk?
As mentioned above, tendinosis is a disease that affects athletes. With the same frequency, pathology is found in people over 40 years of age. This is due to physiological age-related changes and the weakening of the ligamentous apparatus, which becomes vulnerable and can be easily damaged. The disease may also be present in the history of younger patients and even adolescents. The risk of developing the disease directly depends on the presence of provoking circumstances.
Causes of tendinosis
Pathology can begin to develop due to the impact of such unfavorable factors:
- frequent loads of the same type on the hip joint;
- infectious diseases occurring in the tissues surrounding the compound;
- inflammatory orthopedic diseases of a chronic nature (arthritis, arthrosis);
- injury;
- disturbances in calcium metabolism;
- changes in muscle fibers, tendons and joints against the background of aging.
Types of disease
Tendinosis of the hip joint is divided into two types, based on the influencing factor-pathogen. If an infectious agent is the cause, it is infectious tendonitis. If the stressors are age-related changes, mechanical damage and other disorders in the joints, then we are talking about aseptic tendonitis (non-infectious).
In addition, several types of pathology are distinguished, taking into account the affected area: 
- Tendonitis of the tendons of the long adductor muscle. This muscle attaches to the pelvic bones, which causes the proximal localization of pain. The main symptom is severe discomfort at the time of trying to move the leg to the side. Limb movements are very constrained.
- Iliopsoas tendonitis. It is difficult to diagnose and is manifested by the following symptoms: discomfort when walking and leaning on a limb, pain impulses in the lower abdomen and inner thigh.
- Abductor tendon tendonitis. A very common occurrence, which is characterized by the following symptoms: pain on the outer part of the thigh, concentrated in the region of the apex of the greater trochanter.
Symptoms of pathology
Tendinosis, regardless of the place of localization, is manifested by the same symptoms:
- sensation of pain when moving a limb that has been affected;
- arising sharp pain during palpation;
- the occurrence of crackling and crunching (crepitus) during movement;
- redness skin in the area of the focus of inflammation;
- an increase in body temperature in the area of the affected joint;
- limiting the mobility of the inflamed joint.
With this disease of the tendons, the pain syndrome develops on an increasing basis, that is, with each stage of the progression of tendinosis, the pain becomes stronger. Its intensity can increase and decrease at different times of the day. Most of the deterioration occurs during wakefulness and physical activity, but often the situation worsens at night, depriving the patient of peace and sleep.
Diagnostics
To identify tendinosis of the hip joint, specialists prescribe the patient an X-ray, ultrasound and magnetic resonance imaging. Based on the patient's complaints and the results of the diagnosis, the doctor makes an appropriate diagnosis.
Treatment of ailment
To eliminate tendonitis, doctors use several techniques. The composition of the complex and the intensity of therapy depend on the stage of development of the pathology and the zone of its localization. In the treatment of tendinosis, the following measures take place:
- limiting joint movement;
- applying cold to the affected area;
- taking pain relievers and anti-inflammatory drugs;
- performing exercise therapy exercises;
- the use of physiotherapy - ultrasound, magnetic waves, laser radiation;
- the use of mineral baths;
- applying mud applications.
Baths and mud therapy are possible only in conditions of sanatorium therapy, in institutions that specialize in diseases of the musculoskeletal system. Alternative medicine can be used at home. There are several effective folk methods treatment of tendinosis. Here are some of them:
- Infusion of walnut membranes. Method of preparation: separate partitions, in the amount of 1 glass, rinse and dry. Take 0.5 liters of vodka or alcohol and pour in a glass container with membranes. Close tightly and infuse the product for 3 weeks, in a dark and cool place. Drinking the medicine should be 3 times a day for 1 tbsp. l.
- A decoction of the fruit of bird cherry. Cooking method: take 3 tbsp. l. combine fresh fruits with 1 tbsp. l. dried and pour over 1 tbsp. boiling water and stand on a steam bath. Drink the broth in small quantities after meals.
- Curcumin. It is added to the diet as a seasoning. Up to 0.5 g of the product must be consumed per day.
In extreme cases, when conservative therapy does not have a positive result, doctors prescribe surgery that helps to eliminate the problem.