Collateral circulation in the hip joint. Collaterals of the hip joint

Arthrosis is a degenerative-dystrophic process that affects the tissues of the joint. Simply put, this is the slow destruction of the joint, leading to the loss of its functions. Any joint can be affected by arthritis. But among all the joints, the hip joint is most often affected. It is here that arthrosis of the hip joint develops. This disease is also called coxarthrosis.

Causes and pathogenesis

Before finding out what are the causes (etiology) and what is the sequence of negative changes (pathogenesis) in arthrosis of the hip joint, we should briefly dwell on some features of the anatomy and physiology of this joint. The hip joint is formed by two bones - the ischium (its acetabulum) and the femur (its head).

The configuration of the hip joint approaches the spherical. The head of the femur, like a billiard ball, is located in the pocket of the acetabulum. To facilitate friction, the articular surfaces are covered with cartilage. The continuation of the cartilaginous surface of the acetabulum is the cartilaginous lip, designed to increase the area of ​​contact between the acetabulum and the femoral head. All these structures are surrounded by a joint capsule, additionally strengthened by ligaments, femoral and gluteal muscles.

The hip joint is the largest. Here, hip movements are carried out in all three planes. Indispensable conditions for ensuring all these movements are:

• Normal tone of nearby muscles;
• Integrity of articular structures;
• Their complete blood supply;
• Elasticity of articular cartilage;
• Optimal volume and composition of intraarticular fluid.

In the absence of these conditions, dystrophic changes are formed in the articular cartilage, which are irreversible. At the initial stage, the nutrition of the articular cartilage worsens, which leads to its thinning. Due to further trophic disorders, the subchondral (located under the cartilage) bone undergoes negative changes. Pathological cavities (cysts) form inside the femoral head, and bone growths (osteophytes) form on its surface. As a result, the congruence (anatomical correspondence) of the articular surfaces is lost, which cannot but lead to movement disorders.

The causes of arthrosis of the hip joint are diverse, and among them:

• Congenital anomalies - dysplasia. Hip dysplasia in children can be either a consequence of genetic abnormalities or occur during childbirth (congenital dislocation of the hip). In these conditions, the anatomical axis of the joint changes, and articular surfaces that have not yet formed are affected.
• Elderly age. It is not for nothing that the age of most patients suffering from arthrosis of the hip joint exceeds 40 years. As we age, the recovery processes in various tissues slow down. And this cannot but affect the articular hip cartilage, which experiences the maximum load.
• Overweight. The greater the body weight, the greater the static load on the joint, and the faster the articular cartilage wears out.
• Accompanying illnesses. Diabetes mellitus, thyroid disease, atherosclerosis and other metabolic disorders are accompanied by insufficient blood supply to the hip joints. In the articular structures, a deficiency of oxygen and nutrients is formed, instead of which toxins accumulate.
• Physical exercise. Systematic hard work, playing sports can also lead to wear of the cartilaginous articular surfaces.
• Sedentary lifestyle. On the one hand, it is often accompanied by obesity. On the other hand, it leads to a decrease in the tone of the muscles that stabilize the hip joint.
• Injuries. Here, mechanical damage to the articular structures is combined with a decrease in the tone of nearby muscles.
• Coxarthritis. Inflammation of the hip joint (infectious, rheumatic or any other) is accompanied by a change in the quality of the joint fluid and malnutrition of the articular cartilage. In addition, the inflammatory process can lead to direct damage - aseptic necrosis (non-infectious necrosis) of the femoral head.
• Damage to other parts of the musculoskeletal system. Lateral curvature of the spine (scoliosis), flat feet, diseases and injuries of the knee joint - all this increases the load on the hip joint and leads to arthrosis.

In some cases, despite extensive clinical and laboratory studies, it is not possible to establish the cause of arthrosis. Then they talk about idiopathic arthrosis of the hip joint.

Symptoms

The main symptoms of arthrosis of the hip joint are as follows:

• Pain. It is the main complaint of patients suffering from this disease. At an early stage of the disease, pain is mild or may be absent altogether. With the progression of degenerative changes in the hip joint, pain literally "drives" the patient to the doctor.
• Reduced range of motion. Partly due to pain, but mostly due to a violation of the congruence of the articular structures due to the appearance of osteophytes, thinning of the articular cartilage and destruction of the femoral head. At first, motor disorders are accompanied by mild lameness, and at a later stage, the patient practically cannot move at all.
• Violation of muscle tone. A decrease in muscle tone is not only a cause, but also a consequence of hip arthrosis. Subsequently, it leads to irreversible atrophic changes in the muscles of the thigh and buttocks.
• Scoliosis. Also both cause and effect of hip arthrosis. With unilateral hip arthrosis, the patient spares the affected joint. In this case, the load on a healthy limb increases. This misalignment eventually leads to a lateral curvature of the spine.
• Shortening of the limb. With a far advanced process, the lower limb on the side of arthrosis is shortened. Among the reasons - the destruction of the joint, muscle atrophy and the forced position of the patient.

All these external changes are formed against the background of corresponding structural disturbances. In the affected joint, in addition to the aforementioned osteophytes and cysts, there is a thickening of the joint capsule, narrowing of the joint space, thinning of the cartilaginous lip of the acetabulum. All these structural disorders lead to displacement of the functional axis of the hip joint. With the destruction of the articular structures, the cervical-diaphyseal angle between the femoral neck and the vertical axis of the femur changes. These disorders are well detected during radiography and computed tomography of the hip joint.

Degrees of arthrosis

All these changes are not equally pronounced and may depend on the prescription of arthrosis of the hip joint. In this regard, there are three degrees of arthrosis of the hip joint:

1. Arthrosis 1 degree. The pain is mild, occurs during physical exertion and completely stops at rest. There are no restrictions on movements, a decrease in muscle tone yet. X-rays show narrowing of the joint space.
2. Arthrosis 2 degrees. Pain occurs even at rest, increases with physical exertion and may be accompanied by lameness. It does not go away on its own, it is removed only with analgesics. Limitation of range of motion and decreased muscle tone. Structural changes in the form of thinning of the articular cartilage, the appearance of osteophytes and cysts of the femoral head, and its displacement relative to the articular cavity.
3. Arthrosis 3 degrees. The pain is constant, disturbing even at night. It is practically not removed by analgesics. Severe muscle atrophy, movements in the hip joint are reduced or completely absent. The limb is shortened. As a result, the patient is forced to walk with a cane. Osteophytes are clearly visible on the acetabulum. Absence of cartilage on the femoral head, its partial or complete destruction.

The transition of hip arthrosis from one degree to another occurs gradually, over several years.

Treatment

Treatment for osteoarthritis of the hip joint depends on its degree. In order to relieve pain and relieve concomitant inflammation, anti-inflammatory drugs (Diclofenac, Indomethacin, Voltaren) are prescribed in the form of locally applied ointments, lotions and compresses. To improve the nutrition of cartilage tissue, chondroprotectors are used - Chondroitin complex, Chondroxide. And intravenous drip Trental and Pentoxifylline improve local blood supply, and at the same time the delivery of oxygen to the tissues of the hip joint.

Physical procedures (UHF, magnetotherapy, inductothermy) enhance the effect of drugs. And physical therapy strengthens the pelvic and femoral muscles, and to some extent contributes to the stabilization of the hip joint. A set of exercises is developed by an exercise therapy specialist individually for each patient. In any case, the exercises performed should be smooth, without sudden movements and pain. For such patients, classes in the swimming pool are recommended.

All these activities justify themselves only with coxarthrosis of 1-2 degrees. 3 degree comes with the destruction of bone and cartilage structures. Simply put, there is nothing to treat and restore. The only way out is arthroplasty, an operation to replace a worn joint with a synthetic endoprosthesis.

The diet for coxarthrosis should be aimed at correcting weight and removing toxins from the body. In this regard, it is undesirable to take flour and pasta, potatoes and other products that lead to obesity. You should also limit salt, strong tea, coffee and alcohol. Although, in fairness, it is worth noting that the diet for hip arthrosis is not strict and is advisory in nature. A complete diet for such patients should be low-calorie and include vegetables, fruits, and lean meats.

Comments

Guest - 29.11.2016 - 13:18

• answer

Add a comment

My spina.ru © 2012-2018. Copying materials is possible only with a link to this site.
ATTENTION! All information on this website is for informational purposes only. Diagnosis and prescription of medications require knowledge of the medical history and examination by a doctor. Therefore, we strongly recommend that you consult a doctor for treatment and diagnosis, and not self-medicate. User agreementAdvertisers

Arthritis of the hip joint in children: symptoms and treatment of the disease.

Diseases of a rheumatological nature in children are not so rare. And if earlier in the structure in the first place was juvenile rheumatoid arthritis, then at present there is a tendency to increase the number of reactive arthritis (RA). The most common inflammation of large joints - knee, hip, ankle. Arthritis of the hip joint in children is called coxitis. Preschool children account for about sixty percent of cases and about forty percent are seen in adolescence.

Structural features

The hip joint (HJ) is spherical and has an increased blood supply and innervation. It is the largest in the human body. Until the age of six, the formation of the femoral head and articular surfaces occurs, and an increase in ossification and growth of the neck also occurs in adolescence. In earlier stages, the acetabulum is flattened, and the head is soft, cartilaginous, and elliptical in shape. It is held by ligaments, which in children are more elastic and tend to stretch.
Therefore, dysplasia, dislocations and injuries of the hip joint are so frequent in babies. In addition, the immune system is still imperfect and does not always cope with an infectious agent that has entered the body.

Etiology

The group of arthropathies associated with HJ is extensive, so there are many reasons for the occurrence of hip arthritis.

Provoke the development of coxitis can:

• hypothermia;
• vaccinations;
• the use of certain medicines;
• excessive physical activity (sports).

Classification

Arthritis of the hip joint is divided into two large groups, based on the causes:

• Infectious nature: reactive, rheumatic, tuberculous, etc.
• Non-infectious: juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, etc.

Infectious arthritis, in turn, is sometimes conditionally divided into septic (purulent), which developed with direct contact of the pathogen inside the joint, and aseptic (reactive), arising after an infection of a different localization. But at present, with the improvement of diagnostic methods, such a division is controversial, since in reactive arthritis it is possible to detect a pathogen in the synovial fluid.

According to the duration, acute, subacute, chronic and recurrent are distinguished. According to the degree of activity:

1. Remission
2. Low
3. Medium
4. High

When classifying arthritis, it is customary to talk about the degree of dysfunction: the first is preserved, the second is impaired, the third is completely lost.

Clinical manifestations

Since arthritis of the hip joint in children can be caused by different pathogens and have different etiologies, the symptoms that accompany each form are different. The onset of the disease can be acute and begin with general intoxication, hyperthermia (with septic arthritis), or it can be gradual, subtle. Common to all species will be the presence of inflammation, accompanied by swelling, swelling, pain, impaired blood supply, inability to step on the foot. The kid becomes capricious, cries, refuses the usual games, spares the limb. Since the most common form is reactive arthritis of the hip joint in children, all symptoms occur some time after a viral or bacterial infection, more often urogenital or intestinal.

Septic hip arthritis is very dangerous - a disease that develops rapidly, acutely, with high fever, severe pain, significant hyperemia and fever in the affected area. Due to the good blood supply and insufficient protective function of the immune system in children, the pathogen and its toxins can be carried through the bloodstream throughout the body, which can lead to a serious condition - sepsis.
A special course of the disease is characterized by arthritis of the hip joint with tuberculosis in children. This is a fairly common complication of the pulmonary form of the disease. Runs chronically. It starts slowly, gradually. Slight subfebrile condition, irritability, sweating, weakness are characteristic. There is pain in the joint, lameness, muscle atrophy increases, edema is pale, fistulas with curdled contents may form.

In addition to the main characteristic signs, arthritis of the hip joint can be accompanied by both general symptoms of intoxication (weakness, drowsiness, weight loss) and various extra-articular symptoms: damage to the skin, mucous membranes of the eyes, kidneys, and the cardiovascular system.

Treatment

The assistance provided depends on the form of arthritis, its course and comorbidities. Therapy should be comprehensive, aimed at both the cause, the elimination of symptoms, and the prevention of complications and restoration of function. There are conservative (drug) treatment and surgical.
When drug therapy is used:

• Etiotropic treatment: elimination of the pathogen, allergen, etc.
• Pathogenetic: destruction of the mechanisms of pathological reactions.
• Symptomatic: elimination of manifestations and improvement of the general condition.

The first group of drugs includes antibiotics, antiseptics, antiviral and anti-tuberculosis drugs.

In the case of septic coxitis, the drugs of choice are penicillin antibiotics and cephalosporins (ceftriaxone, cefuroxime), administered intravenously. Synovial fluid culture is mandatory to determine the pathogen and its sensitivity. Based on the results of this analysis, therapy is adjusted. A combination of intravenous and intra-articular administration is effective.

Tuberculosis is treated with specific drugs (ftivazid, isoniazid). It is most effective in the early period. When treating reactive arthritis of the hip with antibiotics, the type of pathogen is also taken into account, since the choice of drugs in children is limited. Used in adults, fluoroquinolones (ciprolet), tetracyclines and macrolides (azithromycin) have a wide range of contraindications in childhood.

If hip arthritis is caused by an autoimmune or metabolic disorder, then therapy is carried out with pathogenetic drugs that can slow down or stop the process - cytostatics or immunosuppressants.

Symptomatic drugs include drugs that can relieve pain and reduce inflammation and swelling. This is a group of non-steroidal anti-inflammatory drugs (NSAIDs). Due to the irritant effect on the mucosa of the gastrointestinal tract, the list of these drugs used in childhood, especially in preschoolers, is very limited. Apply nemisulide in the form of a suspension, nurofen, ibuklin. They reduce fever, relieve swelling, affecting the general symptoms of intoxication, and improve well-being. In cases of their low efficiency, a combination with hormonal drugs (dexamethasone, prednisone) is acceptable.

In the acute period, the load on the affected joint is reduced: bed rest, immobilization with a plaster cast, splinting, etc. The expansion of motor activity is carried out gradually. Prolonged immobilization with gypsum is indicated for tuberculous coxitis.

After the removal of acute manifestations, physiotherapy, massage, physiotherapy exercises, vitamin therapy are prescribed. Shown sanatorium treatment.

In some cases, with the ineffectiveness of conservative therapy, surgical intervention is resorted to. Small forms: opening and drainage of the hip joint, the introduction of drugs inside.

When the deformation is significant, ankylosis and contractures are formed, reconstructive operations are performed to restore mobility. In case of tuberculous arthritis, the foci of destruction in the bones are surgically removed, and the hip joint is resected.

Prevention

The prognosis depends on the type of disease. As a rule, most arthritis, with timely treatment, achieve complete recovery or stable long-term remission.

There are no specific methods to permanently prevent the development of arthritis. However, a healthy lifestyle, personal hygiene, regular exercise, and proper nutrition should not be neglected. Include vitamin-mineral complexes rich in calcium and vitamin D in your child’s diet. To avoid infection, you should consult a doctor in time, sanitize foci of chronic infection, avoid viral diseases “on your feet” and be attentive to the health of your children.

Bilateral coxarthrosis leads to deformation of the surface of the joint and bones. There is a risk of development not only in 1 joint, but also immediately in 2. In this case, the disease will be bilateral. The disease is typical for people over 40 years old, although the development of the disease is not excluded earlier.

Symptoms of this disease can be divided into several groups. The division is based on the degree of illness, since the signs of coxarthrosis in each case have some differences. During the 1st degree of the disease in the pelvic region, minor pains occur. They can appear after physical exertion, standing for a long time or walking. By the end of the day, the discomfort subsides, which provides little relief to the patient. There may be pain in the knee or hip area, but this phenomenon occurs in rare cases.

If any of the symptoms occur, you should immediately seek help from a specialist. This will allow you to deal with the problem in a timely manner, quickly eliminate it and prevent the development of complications and the transition of the disease to the next stage of development.

With grade 2, pain intensifies. They can occur not only in the pelvis, but also in the hips, knee, groin. Unpleasant pain occurs even with simple movements and a slight load. This is observed even during sleep, when muscle tension does not disappear. This leads to poor quality sleep. As a result, the patient has slight changes in gait, lameness appears, some movements are limited.

For the 3rd degree, very strong pains are characteristic, which radically change the patient: his gait, position in lying, standing and sitting positions, and much more. Unpleasant sensations persist constantly, they increase during walking or other actions. The joint no longer works, muscle dystrophy occurs in the thigh and buttocks. This complicates the basic actions of the patient, it is even difficult for him to stand without assistance. There is no need to talk about walking in such conditions.

During this stage, there is a constant contraction and tension of the muscles of the legs, which creates a feeling of shortening of the legs. Treatment in conditions of the 3rd degree is difficult. A large number of drugs used may not help the patient, then resort to the use of a surgical method.

In addition to the presented degrees, primary and secondary coxarthrosis of the hip joint are distinguished. In the 1st case, the cause of the development of the disease may not be clarified, which indicates the presence of other processes that could lead to the disease. The second case implies that a certain disease is at the heart of the development of coxarthrosis of the hip joint.

Bilateral type of arthrosis develops due to an already existing disease on 1 joint. Due to certain conditions, the disease can go to another joint. Various reasons can lead to this, ranging from lifestyle to impaired metabolism. Modern scientists in the course of laboratory studies have come to the conclusion that arthrosis of the hip joint is not inherited, however, a predisposition to metabolic disorders can be genetically transmitted, which leads to the occurrence of this disease.

Often the disease appears with a large load on the joints. Therefore, athletes and overweight people are in the 1st position in the risk group. This should also include people who have a very active daily routine and who need to perform heavy loads.

But do not assume that the lack of exercise will protect you from this disease. A sedentary and sedentary lifestyle also causes the disease. At risk are patients who have osteoporosis, arthritis, diabetes, or an underdeveloped joint. In addition to the age category over 40 years, the disease also appears in young people. In their case, the cause of the development of coxarthrosis is associated with a congenital type of hip dislocation, the presence of injuries or bruises.

A significant place is occupied by the emotional state of a person, so stressful situations and often developing depression can contribute to the appearance of the disease. This is due to the fact that during prolonged stressful conditions, the production of corticosteroid hormones occurs, which have a negative effect on the production of hyaluronic acid. The last component is responsible for lubricating the joints, therefore, in the absence of lubrication, the cartilage begins to dry out, and the structure of the joint changes. In addition, stress disrupts the blood supply to tissues, resulting in bilateral coxarthrosis.

The method of treating the disease depends on the specific stage that has developed in the patient.

It must be pointed out that it is possible to completely eliminate the disease in the presence of the 1st stage of arthrosis, in other cases the process is irreversible, which can only be stopped and prevented from worsening the situation.

At grade 1, treatment is not difficult if you contact a specialist. Your doctor may prescribe a home type of hip treatment. Anti-inflammatory and vasodilators, analgesics and other medicines are used. As additional measures, gymnastics and physiotherapy exercises can be used.

In gymnastics and physical education, it is important to exclude sudden movements, axial loads are completely excluded from the program. Classes must be held regularly and without gaps. Before class, you need to stretch the joint a little, do a massage.

Grade 2 is characterized by more complex treatment. The previously named analgesics and anti-inflammatory drugs are used, but electrophoresis, ultrasound, laser and magnetic therapy are beginning to be used. Do not forget about massage and physical education of the therapeutic type. The patient needs to undergo a maintenance course, which is performed every 6 months.

At the 3rd stage, prosthetics and surgery can become a way out of the situation. In the case of the development of a bilateral type of arthrosis, the patient automatically becomes disabled. A contraindication to surgical intervention may be the presence of problems with the heart and blood vessels, age and the drugs used for treatment are taken into account. If the patient is disturbed by pains of a strong nature, then blockades of the intra-articular type are used. And, although such actions will not lead to the recovery of the patient, it is possible to ensure that the patient is unhindered in a lying or sitting position.

The anatomy of the human hip joint (HJ) is interesting because of its significant modification over the course of evolution, which can be seen when compared with mammals that are not upright. Maintaining body weight in a vertical position required special mechanics of this joint, which cast a shadow on the structure of the joint.

The hip joint is the link between the trunk and lower limbs. It is a strong and spherical joint. Its structure is aimed at maintaining stability and performing a large number of movements in it.

Important! The hip joint is the second most mobile in the human body.

Bone anatomy - what connects and how

The head of the femur has the shape of a sphere located on the "leg" - its neck. Its entire surface is covered with articular cartilage, thickening in places of increased impact of body weight on the lower limb. An exception is the place of attachment of the own ligament of the femoral head, namely its fossa (English, fovea for the ligament of the femoral head).

The acetabulum (English, acetabulum), in turn - the second main component of the joint, is a hemisphere, covered for most of its length with cartilaginous tissue. This reduces the friction of the head on the pelvic bone.

In the photo - intra-articular surfaces - head and cavity (fossa)

The cavity is a consequence of the connection of the three bones of the pelvis - the ilium, ischium and pubis. It consists of a crescent-shaped rim, protruding somewhat upward, covered with cartilage, and being the articular part of the joint, as well as the surface of the acetabulum, which has the same shape.

Attached to the rim is an acetabular "lip" (English, acetabular labrum), which looks like a lip, due to which it got its name. By means of it, the surface area of ​​this cavity is increased by about 10%. The part of the acetabulum that is not involved in the formation of the joint is called the fossa, and is made entirely of the ischium.

Due to the presence of a full-fledged connection between the femoral head and the pelvic bones, the structure of the hip joint allows it to remain one of the most stable joints. The congruence of the articular surfaces is most complete in the position of flexion in the joint at 90°, abduction of the lower limb by 5°, and external rotation by 10°. It is in this position that the axis of the pelvis coincides with the axis of the femoral head and forms a straight line.

Joint capsule and its ligamentous apparatus

The stability of the hip joint is further strengthened by closing this joint along its entire length with two layers of the capsule - a loose outer fibrous layer and an inner synovial membrane.

Hip ligaments are compacted parts of the fibrous layer of the capsule, which are spirally stretched between the bones of the pelvis and thigh, thereby strengthening this connection.

The structure of the human hip joint, especially its ligamentous apparatus, causes the head to completely enter the acetabulum when it is extended by rewinding the spiral ligaments that tighten the fibrous capsule, problems in this place can. Thus, the congruence of the joint during its extension is produced by passive movements of its articular surfaces.

Tensioned ligaments of the fibrous capsule limit excessive extension, which results in a lack of 10-20° to a full vertical position, however, it is this slight difference in angle that increases the stability of this joint.

The structure of the TBS includes three internal ligaments:

1. Iliofemoral ligament. It is located in front and somewhat upward, stretching between the lower anterior iliac spine (English, anterior inferior iliac spine) and the intertrochanteric line of the thigh distally.
   It is believed that this ligament is the strongest in the body. Her job is to limit hyperextension of the hip joint in a standing position.
2. pubofemoral ligament(English, pubofemoral ligament). It extends from the obturator crest, heading down and laterally to the connection with the fibrous capsule. Intertwined with the medial part of the iliofemoral ligament, it also participates in limiting excessive extension of the joint, but to a greater extent prevents hip hyperabduction (too much abduction).
3. Ischiofemoral ligament. Localized on the back surface of the joint. It is the weakest of all three ligaments. Spiral around the neck of the femur, attaching to the base of the greater trochanter.

An important role in gait is played by the hip joint, the structure of which is maintained precisely thanks to the above-described ligaments and the muscular skeleton, which ensure its structural integrity. Their work is interconnected, where the lack of some elements is covered by the advantage of others. Learn more about this in the video in this article.

Thus, the work of the ligamentous and muscular apparatus is balanced. The medial hip flexors, located anteriorly, are weaker than its medial rotators, but their function is enhanced by the anterior internal thigh ligaments (pubofemoral and iliofemoral), which are much stronger and denser than the posterior ligament of the joint.

The only ligament that performs almost no function in relation to strengthening the joint is the ligament of the femoral head. Its weak fibers are directed from the fossa, located in the center of the femoral head, to the acetabular notch. Her job is mostly to protect the vessel (artery of the femoral head) that runs between her fibers.

The fatty tissue that fills the fossa of the acetabulum, together with the ligament, is covered with a synovial membrane. This adipose tissue compensates for the lack of congruence of the articular surfaces by changing its shape during movements.

Movements in the joint

This:

• flexion and extension;
• abduction and adduction;
• medial and lateral rotation;
• rotation.

All of the above movements are extremely important, as they provide such daily human activities as getting out of bed, keeping the body upright, sitting, if you have problems with the implementation of these simple actions, check out.

The anatomy of the hip joint is rich in muscles that allow the implementation of the above-described functions of the hip joint.

These include:

• iliopsoas muscle (eng., iliopsoas muscle) - the strongest flexor of the lower limb;
• the large adductor muscle is its synergist;
• simultaneous flexion and adduction of the limb is provided by the piriformis and gracilis muscles;
• the small and middle gluteal muscles serve simultaneously as abductor and medal rotators;
• the gluteus maximus plays the role of the main extensor, participating in the transition of the body from a bent position in the hip joint to an extended one (standing up).

blood supply

The head and neck of the femur are supplied by branches of the medial and lateral circumflex arteries, the deep femoral artery, and the own artery of the femoral head. In adulthood, the medial circumflex femoral artery is considered the most important source of blood supply to the femoral head and proximal part of its neck.

Attention! In old age, the blood supply to the head and proximal part of the femoral neck decreases, which leads to a high incidence of trauma in this area and difficulty in healing fractures, which often requires a complete or partial replacement of the joint to restore its mobility.

Among other things, recovery after a hip fracture is lengthy and requires patience and the desire of the patient, but more importantly, the full implementation of all the techniques that the instructions developed by the rehabilitation doctor offer. The lesson plan is developed individually and requires the efforts of the patient.

Important! Only a doctor can diagnose problems in TBS and prescribe the appropriate treatment. If symptoms appear that indicate a violation of full-fledged movements in this joint, contact an orthopedist-traumatologist.

The hip joint is the largest articulation in the human musculoskeletal system, connecting the lower limbs to the body. Takes an active part in the movement and maintaining balance in the vertical position of the body. Despite its strength, the hip joint is one of the most vulnerable parts of the human skeleton, as it experiences daily stress when walking, running and exercising.

Human hip anatomy

The hip joint is a large spherical joint with several axes of rotation, formed by the articular surface of the femoral head and the acetabulum of the ilium of the pelvis. The structure of the hip joints in women and men has no fundamental differences.

In fact, the hip joint consists of a neck and a head covered with cartilaginous tissue, a femoral bone, an acetabulum and an acetabular lip deepening it, located inside the capsule. The articular capsule of the hip joint is a hollow formation that limits its internal cavity. The walls of the capsule consist of three layers:

• external - dense fibrous tissue;
• median - connective tissue fibers;
• internal - synovial membrane.

The synovial membrane lining the joint capsule from the inside produces a serous secretion that acts as a lubricant for the articular surfaces during movement, reducing their friction against each other.

Articular ligaments

The ligamentous apparatus of the hip joint provides rotation, supination, as well as mobility of the lower extremities in the longitudinal and transverse directions; It is formed by several structures:

• The iliofemoral ligament is the largest and strongest of all that holds and provides mobility to the hip joint. It originates near the anterior lower spine of the pelvic bone, and then fan-shaped, attaching in bundles in the femur along the intertrochanteric line. It is included in the group of muscles and ligaments responsible for balance and keeping the torso in an upright position. Another function of the ligament is to inhibit hip extension.
• Ischio-femoral - one end is attached to the ischium; passing inside the trochanteric fossa, the other end is woven into the articular capsule. Inhibits adductor movements of the hip.
• Pubic-femoral - originates on the anterior surface of the pubic bone and is woven into the joint capsule. Responsible for the inhibition of hip movements performed in a direction transverse to the axis of the body.
• The circular ligament is located inside the articular capsule, originates from the anterior edge of the ilium and loops around the head of the femur.
• Ligament of the femoral head - located inside the joint capsule, protecting the blood vessels of the femoral head.

Muscles of the hip joint

The hip joint has several axes of rotation:

• frontal (transverse),
• sagittal (anterior-posterior),
• longitudinal (vertical).

Joint movements along the frontal axis provide flexion and extension movements of the hip. The following muscles are responsible for hip flexion:

• straight,
• comb,
• ilio-lumbar,
• tailor,
• wide.

Hip extension is provided by antagonist muscles:

• two-headed
• semitendinosus,
• semimembranous,
• big buttock.

Along the sagittal axis, adducting and abducting movements of the thigh are performed. Responsible for hip abduction:

• pear-shaped
• twin,
• internal obturator muscle.

Bringing is carried out:

• big adductor,
• comb,
• thin,
• short and long adductor muscles.

The longitudinal axis of rotation is necessary for rotation of the hip, as well as for pronation and supination of the joint. These functions are:

• square,
• big buttock,
• ilio-lumbar,
• pear-shaped
• twin,
• tailor,
• external and internal obturator muscles.

Blood supply of TBS

The blood supply of the hip joint is carried out;

• ascending branch of the lateral femoral artery
• round ligament artery,
• acetabular branch of the obturator artery,
• branches of the inferior and superior gluteal arteries,
• deep branch of the medial femoral artery
• branches of the external iliac artery
• branches of the inferior hypogastric artery.

The importance of these arteries for providing blood supply to the hip joint is not the same. The main food is provided by the deep branch of the medial femoral artery. The outflow of blood from the joint and surrounding tissues is provided by the branches of the femoral, hypogastric and iliac veins.

Innervation and lymphatic drainage of the hip joint

The hip joint is innervated by branches of the femoral, obturator, sciatic, lower gluteal, and genital nerve trunks.

Also, periarticular neurovascular formations and nerve roots of the periosteum take part in the innervation.

The lymphatic drainage of the joint passes through deep lymphatic vessels leading to the pelvic lymph nodes and internal sinuses.

Functions of the hip joint

One of the main functions of the hip joint is to connect the lower limbs to the body. In addition, the joint plays an important role in ensuring their movement, performing the following functions:

• supports,
• bending,
• extension,
• rotation,
• pronation,
• supination,
• leads,
• leg adduction.

Possible causes of hip pain

Daily stress, trauma, age-related changes, inflammatory and infectious processes in the tissues of the joint and its surroundings can cause pain.

Injuries

Trauma is one of the most common causes of pain in the hip area. The severity of symptoms is directly related to the severity of the injuries.

The most mild joint injury is a bruise resulting from a blow or a fall on its side. Symptoms of a bruise are pain in the thigh area, swelling and redness, temporary lameness.

A more severe injury to the hip joint is a dislocation, which can be the result of a strong blow, for example, in a traffic accident, a fall from a height, a sharp jerk, excessive movement. Dislocation symptoms are:

• sharp pain, aggravated by attempts to move the leg or lean on it;
• swelling and redness of tissues in the area of ​​the damaged joint;
• the formation of an extensive hematoma in the thigh area;
• visually distinguishable deformities, protrusion on the thigh at the site of ligament rupture;
• forced rotational position of the limb;
• loss of functionality of the affected leg.

The most severe injury is considered to be a fracture of the femoral neck. In young and middle-aged people, such injuries are relatively rare, and occur as a result of severe blows received in a car accident or falling from a height. The vast majority of hip fractures occur in older people.

The bone tissue of the elderly loses its strength as a result of hormonal and age-related changes that accelerate the processes of calcium leaching. A fracture can occur with little physical impact or even spontaneously, in the absence of any external causes.

Symptoms of a hip fracture:

• pain in the groin;
• loss of functions of the injured limb, inability to lean on it;
• forced rotational position of the leg outward;
• visually distinguishable in the prone position shortening of the injured limb relative to the healthy one;
• sticky heel syndrome - the inability to raise a leg straightened at the knee from a supine position;
• swelling and redness of tissues.

Inflammatory and degenerative diseases

One of the most common causes of pain in the hip joint are inflammatory processes in the tissues.

Arthritis- inflammation of the tissues of the joint caused by autoimmune reactions, chronic damage, bacterial or viral infections. The disease can affect both one and both joints, manifesting itself as pain that worsens after exertion and with a long stay in a motionless position, limited mobility, swelling, redness of the tissues, and local fever.

arthrosis of the hip joint, or coxarthrosis, is a chronic, steadily progressive disease, accompanied by degenerative-dystrophic changes in tissues. The causes of development can be trauma, genetic predisposition, endocrine disorders. In the early stages, pain in the articular area is the only symptom, progressing, the disease leads to dysfunction of the joint and, ultimately, its complete destruction.

Bursitis- an inflammatory process that develops in the synovial cavity of the trochanteric bag of the joint. The causes of development can be chronic injuries, as well as complications of inflammatory diseases of the joint. A characteristic symptom of the pathology is pain in the subgluteal region and on the back of the thigh, aggravated by running or walking.

Tendinitis- inflammation of the ligaments that stabilize the joint. In most cases, the cause of the development of the disease is inadequately high loads and regular microtraumas of the connective tissue. As a result of the formation of micro-tears in the fibers, scars are formed, and when pathogenic microorganisms enter them, an inflammatory process develops.

Systemic connective tissue diseases

Systemic connective tissue diseases mostly develop as a result of pathological autoimmune reactions or genetic disorders; in this case, several joints are involved in the pathological process at once.

Gout- pathological accumulation of uric acid salts in organs and tissues, causing inflammation of the joints and the formation of tophi - specific bumps in the affected joints.

ankylosing spondylitis, or ankylosing spondylitis, - a genetically determined disease, in the early stages manifested by pain and a decrease in the amplitude of movements, and in the later stages - leading to ankylosis - a complete loss of mobility - of the affected joints.

epiphyseolysis- a disease based on the mechanisms of development of which are endocrine disorders, presumably of a hereditary nature. The main symptom of the pathology is the displacement and slippage of the femoral head from the acetabulum, accompanied by forced outward rotation of the limb, changes in gait, lameness and chronic pain in the hip joint.

Diagnostics

Treatment of diseases of the hip joint is impossible without making an accurate diagnosis, since there are many reasons for the development of pain syndrome and impaired mobility, and each pathology involves its own tactics and choice of treatment methods. At the initial stage of diagnosis, the specialist conducts an examination and history taking, and also prescribes a number of instrumental and laboratory tests to clarify the clinical picture:

• radiography allows you to identify the integrity of bone structures, the presence of foci of tissue changes;
• ultrasound detects changes in soft and cartilaginous tissues;
• MRI and CT help to obtain the most accurate picture of the affected area for layer-by-layer study;
• arthroscopy and examination of effusion - pathological fluid that accumulates in the synovial capsule.

Prevention of diseases and injuries of the hip joint

Injuries and diseases of the hip joint are the most common orthopedic pathologies that can be encountered by both professional athletes and people who are as far from sports as possible. To minimize the risk of complications will allow the observance of a number of preventive measures.

Arthrosis of the hip joint, the largest joint in the human body, is a chronic disease of a long course. Due to the enormous load acting on the femur and ilium, this important joint in many people becomes unusable and gradually collapses. The interaction of two rubbing surfaces occurs due to the small size of the joint space, which makes them vulnerable to many factors and excessive load.

• The structure of the joint
• Changes in the joint with coxarthrosis
• Characteristic signs of coxarthrosis of the second degree
• Treatment of moderate coxarthrosis
• Methods for the treatment of coxarthrosis
  • The use of nonsteroidal anti-inflammatory drugs
  • Treatment with chondroprotectors
  • Muscle relaxants in the treatment of coxarthrosis
  • Application of ointments and creams
  • The use of intra-articular injections
• Drinking regimen with destructive coxarthrosis of the second degree

The structure of the joint

In order to have a clear idea of ​​​​how to treat grade 2 coxarthrosis of the hip joint, you should study the structure of the joint. The hip joint consists of the ilium of the pelvis, in which the acetabulum is present and the head on the femur. The convex part enters the cavity and forms a kind of hinge that allows you to make a variety of leg movements with a large amplitude. Outside, the joint is surrounded by an articular bag and strengthened by muscles and ligaments.

On the inner plane of the hip joint capsule is a synovial membrane that produces fluid for lubrication and smooth movement in the joint. In the plane of the joint space is cartilaginous hyaline tissue, both elastic and pliable consistency. Cartilage helps bones move smoothly relative to each other and cushions when running and walking, preventing bone breakdown.

For the proper functioning of the hip joint, blood supply to tissues, metabolism and the degree of absorption of substances play an important role. With age or due to changes in the body, the cartilage gradually ceases to hold water, dries out, and a network of cracks appears on the surface. These manifestations are attributed to the first signs of arthrosis, the cartilage lining loses elasticity, becomes brittle.

Changes in the joint with coxarthrosis

Further progress of the disease leads to deformations of the cartilage body, its erasure and destruction, exfoliated particles of cartilage fall into the gap between the bones and cause various inflammatory processes, not of bacterial origin. Along the edges of the cavity, inside and outside, bone tissue grows, with which the body tries to compensate for the missing lining. These growths that exacerbate inflammation and cause pain are called osteophytes. Inflammation spreads to the bone, causing necrosis of the surrounding space.

The advanced stage of arthrosis is characterized by the necrosis of not only bone endings, but also nearby soft muscles, nerves, blood vessels, and ligaments around the hip joint. The final end of the disease, the treatment of which was ignored, is the destruction of the joint and, as a result, complete immobility.

Characteristic signs of coxarthrosis of the second degree

Coxarthrosis is a progressive disease, and it is completely impossible to cure it. The main indicators of the transition of arthrosis of the hip joint to the second degree are:

• pain symptoms are expressed more clearly, they are felt not only in the joint, but also give to the buttocks, groin, knee;
• with prolonged walking or running, lameness appears;
• if you try to take the thigh to the side, then the amplitude of rotation becomes limited;
• x-ray shows that the joint space has narrowed twice from the norm;
• massive growths on the edges of the acetabulum;
• the head of the femur increases, its deformation, characteristic protrusions and uneven edges can be traced;
• the muscles on the side of the affected hip joint dry up, and the proportions of the two thighs seem to be unequal.

Treatment of moderate coxarthrosis

It is not completely possible to cure the disease of hip arthrosis in the second stage. In addition to cartilage damage, the onset of bone tissue deformation is laid and the disease progresses. It is almost impossible to restore the original state of damaged bones. Treatment at this stage is aimed at improving the joint as a whole, strengthening the nutrition of the cartilage, increasing the blood supply to nearby tissues and expanding the interosseous gap.

It will no longer be possible to return the wounded joint to its initial state, as well as to make the rotation of the head in the acetabulum ideal, but a timely course of treatment will help make the patient feel much better. This is achieved by a decrease in piercing pain and an increase in joint mobility and its amplitude when the hip is rotated. If the operation cannot be completely avoided, then there is a real possibility to postpone it indefinitely. This becomes possible only if the patient is determined to conduct complex treatment.

Methods for the treatment of coxarthrosis

The use of nonsteroidal anti-inflammatory drugs

Fixed assets from this group: piroxicam, diclofenac, indomethacin, butadione, ketoprofen, movalis, arcoxia, nimulide, zeolebrex and derivatives of these drugs. Non-hormonal, that is, non-steroidal drugs actively act to remove pain in the damaged hip joint, thigh, groove, gluteal region. Any visit to the doctor begins with the appointment of NVPS.

This is justified by the fact that for some procedures, for example, gymnastics, massage, articular traction, removal from pain is required. Therefore, with the help of non-steroidal drugs, pain is removed, and then they proceed to the prescribed procedures. It should be remembered that non-steroids only remove inflammation and pain symptoms, but they have nothing to do with curing coxarthrosis.

After the end of taking the drugs, the pain returns. Temporary relief is still dangerous because the disease continues to develop during treatment with nonsteroidal drugs. Recent scientific studies confirm the fact that long-term use of non-steroidal drugs affects the formation of proteglycans (molecules responsible for retaining fluid in cartilage tissue).

This suggests that if the patient takes the pills for more than a year, then the pain and inflammatory symptoms will disappear, but nonsteroidal drugs, to some extent, contribute to the destruction of cartilage. Long-term use is fraught with the appearance of side effects of another plan that violate general health.

Treatment with chondroprotectors

Modern varieties of the group include:

• chondroitin sulfate;
• glucosamine.

These drugs are substances that deliver nutrition to the pads and restore the damaged structure. These drugs are among the most effective in the treatment of coxarthrosis. Unlike nonsteroidal drugs, they not only eliminate the symptoms of the disease, but also help restore the cartilage of the femoral joint, increase the production of fluid for lubricating surfaces and normalize its performance.

The multifaceted effect on the joint with coxarthrosis makes them indispensable for treating the disease in the initial stage. To cure coxarthrosis of the second degree, these drugs are well suited. But if the disease goes into the third degree, then chondroprotectors do not produce the desired effect if the cartilage tissue is completely destroyed.

In the first two stages of coxarthrosis, the drug acts slowly, sometimes it takes several courses to get the desired result, although advertising claims an immediate cure. It sometimes takes six months to one and a half years to pass the initial application period.

Of all the drugs used in the treatment of deforming coxarthrosis, chondroprotectors are the most useful for treating the disease, and not just for relieving the main symptoms. Medicines have almost no side effects and contraindications. To get the maximum result, the drug is taken in courses for a long time, the regularity of intake plays an important role. It is absolutely pointless to take the medicine in single doses, from time to time.

Muscle relaxants in the treatment of coxarthrosis

These medicines are used to reduce muscle spasms. Arthrosis is most often treated with drugs:

• sirdalud;
• mydocalm.

They are prescribed to relieve pain and reduce spasm of smooth muscle muscles. They are able to improve blood circulation in neighboring tissues. The use of muscle relaxants requires caution, since sometimes the body's response to saving a joint is precisely a spasm. If it is removed, but the joint is not protected from excessive stress, then this will lead to accelerated destruction. Muscle relaxants are prescribed in combination with chondroprotectors and joint traction procedure.

Application of ointments and creams

Often, advertising promotes these drugs as a wonderful remedy for getting rid of coxarthrosis of the femoral joint. But in fact, doctors are forced to admit that these drugs are used as a distraction, not a single case of curing arthrosis has been identified. But the use of ointments and creams gives a warming effect, which works very well on a sore joint.

The irritating effect of the ointment gevkamen, menovazin, finalgon, espol leads to the production of painkillers in the body, due to which pain is relieved to a small extent. Warming the periarticular tissues leads to an increase in blood circulation in them and, accordingly, nutrition of the cartilage.

The use of intra-articular injections

Such injections into the joint have been used quite often recently, since this is an effective method. But the only limitation to the use of intra-articular injections is the experience of the doctor. According to statistics, about 30% of specialists miss and do not fall into the joint space, where the cartilage is located. This is further complicated by the fact that with coxarthrosis, the size of the opening of the slit is approximately halved, which makes it difficult to administer the drug.

Some doctors inject the drug not into the gap between the femur and ilium, but into the periarticular space. So there is less risk of damaging the nerve and vascular trunks. Such injections are designed to eliminate the developing exacerbation of pain. Therefore, there is little point in prescribing corticosteroid injections of diprosan, hydrocortisone, kenalog, and flosterone if there is mild pain in the joint with coxarthrosis of the second degree.

The introduction of chondroprotectors into the periarticular space will bring much more benefit: chondrolon, alflutop. These drugs are prescribed in courses of 7-15 injections per year for 3 courses. Like all chondroprotectors, these drugs are used to restore cartilage and improve metabolic processes in the periarticular muscles. Unlike corticosteroids, chondroprotectors treat the disease, but do not eliminate the visible symptoms of the disease. In addition, they act slowly, and it makes sense to introduce them into the interosseous gap, and not into the periarticular space.

As intra-articular injections, hyaluronic acid is used, which helps the joints work as a lubricant. The following names are used:

• ostenil;
• fermatron;
• duralan;
• synvisc;
• hyastat.

These drugs to treat coxarthrosis are injected into the hip joint itself. Injections have an irreplaceable effect, but injections require increased control and a lot of experience. Many doctors prefer to give intra-articular injections only under the control of an X-ray machine or a tomograph.

Drinking regimen with destructive coxarthrosis of the second degree

It is known that with arthrosis of the hip joint, cartilage loses moisture and dries up. Therefore, people suffering from coxarthrosis should drink more fluids. At the same time, attention is paid to the predisposition of the body to the manifestation of swelling in the lower or other parts of the body. But often the appearance of edema is the result of poor functioning of the kidneys, liver or blood vessels.

By increasing fluid intake, care should be taken to remove water from the body as soon as possible, for example, drink diuretics or use herbal preparations. You should only drink water, plain, not carbonated, you can boil it. You can not increase the amount of moisture in the body due to the increased consumption of coffee, juices or strong tea. These drinks will not be able to freely, like water, circulate inside the body, penetrate into the vessels and be excreted outside the body.

In conclusion, it should be noted that at the first signs of discomfort in the joints, you should immediately undergo an examination by a specialist, in which case the disease may stop and not develop further. The second stage, which was written about in the article, is already a serious disease and requires more serious treatment.

Hip Exercises

The largest and most complex joint in the human body is the hip joint. It consists of the head of the femur, connected to the pelvis with articular cartilage, numerous ligaments and muscle tissue. Depreciation of the hip joint is provided by the presence of synovial fluid in the cartilage tissues. In inflammatory processes, as well as as a result of injury, there may be a violation of the functionality of the joint, which, along with drug therapy, will help to cope with special exercises for the hip joint.

Conditions for doing gymnastics

The main direction of all therapeutic exercises is the correct distribution of loads on the hip joint, as well as the possibility of eliminating pain symptoms not only in the joint, but also in the connective tissues.

When performing exercises, certain conditions must be observed:

• all movements should be done quite actively, but at the same time there should be no unpleasant or painful sensations;
• daily gymnastics enhances the elasticity and blood supply of the joint;
• with arthrosis and arthritis of the hip joint, the patient should take the most comfortable position in order to reduce the load on the joint;
• An important role in performing gymnastics is the correct nasal breathing. After each exercise, a deep breath is taken and exhaled, which allows you to relieve tension;
• movements should be smooth and unhurried, as sharp jerks can lead to microtrauma of the joint. With moderate exercise, a certain movement of blood is created, progressively washing the surface of the joint, nourishing it with the necessary elements while removing toxins from the body.

Important! Even with a properly performed set of exercises, the first improvement can occur no earlier than 2 weeks, which requires patience and a certain psychological attitude on the part of the patient.

General exercises

Gymnastics increases the stability of the hip joint while relaxing the muscles surrounding it.

General exercises include:

• the patient lies on his back and bends his knees, pressing his feet firmly to the floor. Then the knees are brought together and divorced with a gradual acceleration of the pace and the complication of movements (the legs alternately rise and swing to the left and right side);
• lying on your back, legs alternately rise and fall (5 times for each limb). Then the legs are bent at the knee and pulled up (alternately) with the help of the hands to the chest;
• in a sitting position, the patient leans as much as possible, trying to touch his toes with his hands, and then returns to his original position;
• the patient needs to stand up and lean his hands on the wall, after which the left leg is lifted and retracted to the side and back (5-7 times), then a similar exercise is performed with the right leg.

It is important to control that physical exercises are not accompanied by discomfort and pain. If this happens, stop exercising and consult a doctor.

With osteoarthritis

With the defeat of deforming osteoarthritis, gymnastics includes the following set of exercises:

• lying on the back, the straight leg rises with a delay of 5 seconds, and slowly lowers. This action is then performed with the second leg;
• both legs are bent at the knee, after which the left and then the right leg alternately rises. The purpose of this exercise for the hip joints is to stabilize muscle functionality and blood supply;
• bending the legs at the knee joint, they should be slightly moved apart, resting their feet on the gymnastic wall, after which the palms of the hands are also placed on the floor, and then the pelvis slowly rises to the highest possible height for the patient and lowers to its original position (3-5 times);
• lying on its side, one leg is bent at the knee, and the other is straightened. Next, the leg that is on top slowly rises to 45 degrees, lingers in this position for a few seconds and lowers. Then this exercise is performed on the other side;
• in the sitting position, the patient takes the ends of the towel in both hands, forming a kind of loop, and leans forward, trying to throw it over his toes. In osteoarthritis, this exercise is aimed only at the muscles of the legs, excluding tension in other departments.

With osteoporosis

In this disease, there is a decrease in bone density with a violation of metabolic processes. The main reasons for the development of the disease are eating disorders, the age of the patient and bad habits.

A characteristic difference between osteoporosis and other pathologies of the musculoskeletal system is bone fragility, which greatly complicates treatment, including concomitant diseases. Complex therapy, in addition to drug treatment, includes dosed loads to accelerate the recovery of bone and muscle tissue.

With osteoporosis, the gymnastics complex is aimed at developing muscles and maintaining bone thickness:

• in a standing position, the patient several times steps over the rope, located on the floor in the form of a straight line;
• lying on the stomach, hands are removed behind the head, and the legs are slightly raised up (at least 3 times);
• the patient stands, holding on to the wall, crouches 3-4 times, first on the right, and then on the left leg;
• sitting on a flat surface, a person pinches a ball between his knees (no more than 18 cm in diameter), which he squeezes with his knees and unclenches for 5 minutes.

In advanced cases, therapeutic exercises are performed only under the supervision of a doctor. The effectiveness of exercise is much higher at the initial stage of the development of the disease.

For arthritis

The main reason for the development of arthritis is an inflammatory process that can develop latently (slowly) or, conversely, rapidly. Treatment of arthritis with the help of special exercises, first of all, allows you to stop pain symptoms and includes:

• in a horizontal position, both legs are bent at the knee joints and pulled very slowly to the chest, and then slowly return to their original position;
• the patient sits down on a low chair, then slowly rises to his feet and slowly sits down again;
• in the prone position, the pelvis is raised, and several rotations are performed;
• lying on your back, legs rise and cross, forming "scissors";
• lying on its side, the leg bent at the knee is placed on a small roller or pillow, and then the leg rises parallel to the surface and lowers onto the roller;
• for the development and warm-up of the joints, calm walking on the spot for 10 minutes is useful.

The total number of approaches when performing gymnastics should not exceed 5 times. In addition, with arthritis, any exercise with a power load, aerobics and jumping are excluded.

With arthrosis

Arthrosis is characterized by deformities and destruction of cartilaginous tissue, accompanied by pain in the hip joint. In this case, the most sparing physical culture complex is selected.

The main goal of gymnastics is to improve blood circulation in the joint. Physical education is aimed at maintaining joint mobility and is performed without sudden and vigorous movements:

• in a horizontal position, the patient performs the exercise "bicycle";
• legs alternately rise and slowly fall;
• lying on the back, legs stretched out turn inward with toes, and then with heels;
• holding on to the back of the chair, the patient makes smooth swings to the sides, first with the right and then with the left foot.

For severe forms

In the case when a complicated form of arthrosis is diagnosed in a person, gymnastics is performed in a special mode. To strengthen muscle tissue and the hip joint, the following complex is recommended:

• near a stable support, you need to put a small elevation (chair, brick, etc.) and stand on it with one foot. The other remains in a free state and sways with a small amplitude, which should be increased as pain symptoms are relieved. Then the legs change;
• sitting on a chair, the patient spreads his knees shoulder-width apart, after which he brings them together, holding in this position for 5 seconds, and then relaxing his legs;
• lying on his back and placing a low pillow under his lower back, the patient stretches his legs, spreads them apart and reconnects. Then the same exercise is repeated, but with small turns of the feet (in and out).

At the initial stage, the total duration of the exercises should not exceed 10 minutes, but within 1 month it is recommended to increase the duration to 25 minutes. The presence of pain is an indication for the abolition of classes, followed by medical coordination of loads.

With dysplasia

Gymnastics and massage for congenital dysplasia in children are included in the general complex of therapy and rehabilitation measures aimed at avoiding surgery. Massage is performed by a specialist, while parents can do gymnastics on their own, which is a definite advantage.

First, parents should calm the baby, stroke him, so that all muscle tissue relaxes as much as possible. Then the child is placed on his back, the legs are slightly bent and unbent in the hip joint, without exerting any physical effort. Next, the legs are bent at the knee and parted to the sides, forming a “frog” pose. This position is fixed for 10 seconds and returns to its original position. Such techniques are aimed at developing the muscular development of the hip joint.

Putting the child on the back, one leg of the baby is bent at the knee and hip, after which the adult fixes the thigh with one hand, and with the other holds the knee and performs circular rotations, first to the left side, and then to the right. If the baby is worried during the exercise, the impact should be weakened or the gymnastics should be stopped altogether.

Important! It is necessary to count the efforts on the part of an adult. Absolutely excluded pressure and jerks when performing gymnastics.

The complex starts from 3-5 minutes and is gradually brought to 15-20 (daily). For greater efficiency, it is recommended to combine gymnastics with massage.

Contraindications for exercise therapy

Despite the fact that gymnastics prescribed for diseases of the hip joint is one of the effective ways to deal with various pathologies, there are a number of contraindications to its implementation.

• arterial hypertension;
• blood diseases;
• hernias and acute period of the disease;
• severe disorders in the work of the cardiovascular system;
• infectious diseases accompanied by fever;
• exacerbation of chronic diseases.

You should know that gymnastics for the hip joint is one of the therapeutic methods, therefore, before starting the exercises, it is recommended to consult a doctor. If necessary, he will prescribe a number of diagnostic measures, select a special exercise therapy complex and control the correctness of its implementation. Self-medication can provoke various complications, which in the future can lead to disability of the patient.

In the process of evolution, the human hip joint becomes the main supporting element of the skeleton, combining strength and mobility at the same time. The transition to walking on two limbs required from the body a gradual restructuring of the bones and soft tissues of the articulation. Adaptation to new loads occurred gradually, but inevitably, so modern man has acquired a joint that is unique in structure.

First of all, the changes affected the soft tissues - ligaments and muscles, which previously provided the necessary strength and mobility to the legs. The need for stable support made the muscles and tendons extremely strong and resistant to stretching. At the same time, they have not lost their flexibility at all, allowing you to perform almost the full range of motion in the hip joint. This feature ensured the survival of man in nature, giving him an advantage over natural enemies.

The change in the structure of soft tissues over time ensured a complete restructuring of the bones, which made it possible to stably hold the human torso in an upright position. Despite such transformations, the hip joint practically did not lose mobility. The largest joint of the skeleton in terms of range of motion is second only to the shoulder joint, providing almost complete rotation of the leg. Although earlier there was much in common between these two joints, evolution has provided them with different purposes for humans.

Bones

The less the mechanism forms active elements, the more reliable it is. According to this principle, the anatomy of the hip joint is arranged, which provides a strong and flexible support for the entire human skeleton. The special structure of the bones that form the connection allows you to perform movements in it in all axes:

• In normal walking, thousands of imperceptible flexions and extensions are performed daily, allowing you to raise and lower your leg. Also, such movements are necessary for a person for daily activities - they soften any jumps and falls, allow you to quickly pick up the necessary item from the floor. The largest muscle groups in the human body are responsible for their implementation - the anterior and posterior muscles of the thigh.
• Unlike the shoulder joint, the structure of the hip joint does not allow full abduction and adduction. Therefore, these movements play an auxiliary role, allowing a person to move sharply to the side when running. For example, they allow you to change direction to dodge objects moving towards you.
• The inward and outward rotation of the leg also plays a supporting role, allowing people the freedom to work or play. It allows you to set your feet at a convenient level for any occasion to allow people to climb and cling to various ledges and surfaces.

The listed range of movements is created by only two anatomical formations - these are the largest bones in the human skeleton.

Pelvic

The fixed part of the joint is formed by the pelvic bones, which form the acetabulum in the region of the outer surface. It is a deep rounded bowl, the center of which is directed obliquely and upwards. This feature provides a reliable support for the body, since the center of gravity in this position is distributed evenly over the entire upper part of the pelvic bones.

This part of the joint is securely hidden under the thickness of soft tissues, so its structure can only be studied with the help of books or special diagnostic methods. The following features deserve attention:

1. The acetabulum is formed simultaneously by three pelvic bones - the pubic, ischial and ilium. Surprisingly, their bone sutures divide the anatomical formation into equal thirds.
2. Despite the diverse composition, the articular cavity is a very strong and integral formation. It is least stable in childhood, when its main part is formed from cartilaginous tissue.
3. The edge of the cavity is represented by a thickened bone roller (in contrast to the shoulder joint), and covers the head of the femur along the entire circumference. This allows you to create a reliable support for the leg, preventing the development of injuries.
4. The upper half of the glenoid fossa is much more massive than the lower, which is due to its supporting function. The largest pelvic bone - the ilium - forms the arch of the acetabulum, which takes on the entire load of body weight.
5. In the center of the formation there is a special hole in which the ligament is attached, going to a similar recess on the head of the femur. This tendon provides not only additional strengthening of the joint, but also contains in its thickness the vessels necessary for the blood supply of the connection.

The “health” of the articulation completely depends on the state of the acetabulum, since many diseases of the hip joint begin precisely with its defeat.

femoral

The movable part of the connection is formed by the head and neck of the femur, as well as the large and small trochanters - bone protrusions, which are the site of attachment of muscles. They are also quite densely surrounded by soft tissues, so they are inaccessible for direct examination - palpation. Outwardly, only the structure of the greater trochanter can be assessed, which is defined as a dense protrusion on the lateral surface of the upper third of the thigh.

The anatomy of the largest bone in the human skeleton is of interest, despite the small number of external formations. Therefore, within the framework of the hip joint, only the features of its upper part can be described:

1. The head has a regular rounded shape, which fully corresponds to the internal structure of the acetabulum. And for a complete match, it is completely covered with dense cartilage, hiding any roughness. If there were no such accuracy in the device, then with every movement a person would feel slight jolts and a crunch associated with the friction of irregularities.
2. In the center of the head there is a hole from which a strong ligament emerges - together with a similar recess on the acetabulum, it forms an additional support.
3. The neck does not come out of the head at a right angle - this would create an excessive load on all elements of the joint. An angle of about 130 degrees is obtuse - it provides an almost vertical transmission of gravity to the limbs. At the same time, mobility in the joint is not lost at all, which could be lost with the vertical arrangement of the bones.
4. The skewers are the anatomical completion of the joint - a connection capsule is attached at their base. Also, the tendons of almost all the muscles that carry out movements in the joint are fixed on them.

In the mobile part of the joint, the weakest point is the femoral neck - as a result of various injuries, its fractures are often observed.

Internal organization

To fully match the articular surfaces, there are anatomical devices - a capsule and cartilage. They provide softening of movements, making them more accurate and invisible to the body:

• Shell - capsule, is a source of synovial fluid, which provides natural lubrication of the articular surfaces. It also has special folds that, when stretched, do not interfere with movements in various directions.
• The cartilage in the hip joint also has its own characteristics: it covers the head completely, but the acetabulum - only in the form of a horseshoe open down. This is due to the function of the articulation - its lower part practically does not participate in the support, therefore it is devoid of a dense cartilaginous plate.

The normal supporting and motor function of the joint is completely dependent not only on the internal elements, but also on the surrounding soft tissues. Good muscle and ligament tone ensures good blood supply to the joint, supplying it with all the necessary substances.

Bundles

The tendons surrounding the hip joint from all sides form its soft corset. There are three main groups of ligaments that provide support for bony elements:

• The strongest tendons of the body surround the joint along the entire circumference, covering not only the cavity with the head, but also the neck of the femur. A powerful ligament departs from each pelvic bone, after which they go to the trochanters of the thigh. Their strength is such that they are able to withstand a voltage of about 600 kg.
• A powerful band strengthens the joint from the inside, providing a continuous connection between the femoral head and the acetabulum. The ligament was created by nature with a small margin of length, which in no way limits the range of motion in the joint.
• Ligaments also include a circular area around the joint space, which is formed by a soft plate of connective tissue. Despite the apparent unreliability, this ligament plays the role of a shock absorber, softening any shocks during movements.

It was the change in the structure of the ligaments that ensured during evolution a complete restructuring of the bones that formed the hip joint.

muscles

The remaining elements of the connection have only supporting qualities, and only the muscles allow you to create mobility in it. The following muscle groups are involved in the implementation of this function:

• On the thigh, all the muscles are involved in making any movement in the hip joint - even ordinary standing. Both everyday and special human activities - sports, professional - depend on their joint work.
• The muscles of the pelvis and lower back also play a supporting role in some movements, also further strengthening the joint from the outside. Their role is most noticeable during hip flexion or internal rotation.
• The gluteal muscles play a huge role not only for movement, but also for the external protection of the joint. Short and powerful muscles serve as a real “pillow” that covers the joint from external shocks. They also create hip abduction and flexion.

The good development of the muscles surrounding the hip joint ensures the correct position of the bone formations during movements.

blood supply

The hip joint receives nutrition from several sources, allowing vessels to be brought to the connection cavity from the inside and outside. This structure of the circulatory system ensures an uninterrupted supply of nutrients and oxygen to all elements of the articulation:

1. All external elements of the joint receive blood from the arteries that envelop the femur. Their branches go in the opposite direction - from the bottom up, due to the location of their source - the deep arteries of the thigh. Therefore, the blood supply affects only the superficial parts of the joint - the capsule, ligaments, and surrounding muscles.
2. Also, part of the blood comes from the lower and upper gluteal arteries, which approach the hip joint from above.

The largest in the human body, the hip joint, is included in the so-called belt of the lower extremities. It must carry a huge load, providing motor activity, a person's ability to work, the ability to perform various types of activities. Without his health and full functionality, a person is severely limited in life, and getting a disability due to a disease of this joint can sufficiently reduce self-esteem and social adaptation in society.

The anatomy of a joint means its structure. All joints consist of two or more bones covered with cartilage and enclosed in a kind of bag. A cavity filled with fluid is formed, which is necessary for the free movement of the articular surfaces. Outside, this bag is braided with ligaments and tendons, which are attached at one end, for example, to the bone of the limb, and at the other to the muscle. An extensive system of blood vessels and nerve fibers ensures the delivery of oxygen to the tissues of the joint, the removal of metabolic products, communication with the brain centers and coordination of movements.

Bones and cartilage

The anatomy of the hip joint differs from other limb joints in that it involves the pelvic bone. Or rather, her acetabulum, curved in a special way and completely repeating the outlines of the spherical femoral head. They are completely congruent, that is, they match in size and shape.

Bones and cartilage of the joint

The joint belongs to the spherical type and is called nut-shaped, since the femoral head is closed by the acetabulum by two-thirds. The shape of the hip joint determines its multiaxiality, the possibility of movements in various planes. In the frontal plane, a person can bend and straighten the thigh, in the vertical plane - to pronate and supinate it (external and internal rotation of the thigh), in the sagittal plane - to abduct and adduct. It is also important that the movements in the joint can be rotational.

The surfaces of the head of the femur and the cavity are covered with hyaline cartilage. This is a smooth and durable substance, the functionality of the joint largely depends on its condition. The hip articular cartilage experiences a constant dynamic load. Under the action of mechanical force, it must compress and decompress, remaining elastic and smooth. This is possible due to its structure, its content of more than 50% collagen, especially in the upper layers. The rest is occupied by water and chondrocytes, the actual cartilage cells that ensure its restoration in case of damage.

Ligaments, tendons and muscles

The hip joint is surrounded and protected by a synovial sac or capsule. This formation consists of a strong connective tissue, resilient and elastic. In its upper part, the bag covers the acetabulum in a semicircle, and the lower edge is attached to the thigh below the neck, which is part of the joint. The surface of the bag on the inside is covered with a layer of synovial cells that produce fluid that fills the joint cavity. The normal operation of the joint largely depends on the properties of the synovial fluid, its quantity and viscosity.

Ligaments of the joint

The joint capsule contains several ligaments that perform not only a strengthening function. The intraarticular ligament of the femoral head provides adduction and pronation. Extra-articular ligaments on the outside create a fibrous layer of the capsule. In addition, the iliofemoral ligament prevents excessive extension and falling back.

The isiofemoral and pubic-femoral ligaments provide rotation and abduction. Ligaments of the "circular zone" additionally strengthen the femoral neck. Ligament strength is essential for static and safe movement and accounts for the small number of hip dislocations compared to shoulder dislocations.

Joint muscles

The muscles surrounding the hip joint provide all the variety of movements in it. The psoas major flexes the hip and tilts the torso forward with a fixed leg. The obturator internus, piriformis, and gemellius muscles rotate the thigh outward. The gluteus maximus muscle consists of several bundles of fibers that perform different functions. They extend and rotate, adduct and abduct the hip, and participate in knee extension.

Joint muscles

The gluteus medius and minimus abduct the thigh, rotate it inward and outward. The tensor fascia lata is involved in hip flexion. Its location allows this muscle to be used as a "bridge" for nutrition during hip plasty. The quadratus and obturator externus muscles participate in external rotation. The layer of muscles surrounding the joint also provides static torso and full range of motion.

Blood supply and innervation

To supply the joint with oxygen and energy, there is a whole network of blood vessels, represented by arteries and their branches. The vessels pass through the muscles, penetrate the ligaments and fascia, and enter the bone substance of the pelvic and femoral bones. From there, they penetrate into the joint cavity in the form of a system of capillaries, nourishing the intra-articular ligament, cartilage and synovial membrane.

Joint arteries

The main role in the blood supply of the joint is played by the medial and lateral arteries that go around the thigh. Less significant is the artery of the round ligament, iliac and gluteal arteries. The outflow of blood with the products of the metabolism of the joint is carried out through the veins that run in parallel with the arteries. Gathering together, they flow into the iliac, femoral and hypogastric veins.

Joint veins

Nerve fibers braid the joint from the outside and inside, ending in the joint cavity with receptors that respond to unwanted changes. Among them are pain, signaling injury or inflammation. The main innervation of the joint occurs due to large nerve conductors: femoral, obturator, sciatic, gluteal. Without them, the normal functioning of the muscular and vascular apparatus, a full-fledged tissue metabolism is impossible.

Nerves of the joint

All of its components are involved in the work of the hip joint. Each element performs its important function.