Don't take "big hip pain" seriously! It may be this disease at work

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Author: Mi Kun, Guangxi International Zhuang Medical Hospital

Doctor, my crotch always hurts after playing. Could it be femoral head necrosis?

Doctor, my hip hurts after walking for a long time, what’s wrong?

600″> due toim width “Osteonecrosis” is a disease, doctors are vigilant, and the general public is also aware of it. Therefore, once there is pain in the hip joint (the common people call it hip bone, big hip), they are all afraid of “femoral head necrosis”. Everyone goes to the hospital. However, it is not only the necrosis of the femoral head that causes hip pain, but also the lesser known “Hip Impingement Syndrome“. Today we will uncover its causes. The veil of mystery.

What is Hip Impingement Syndrome?

Hip impingement syndrome, also known as femoroacetabular impingement syndrome(femoro-acetabular impingement, FAI) , reported and formally proposed by Ganz et al. in 1999 and 2003, is a group of hip anatomical abnormalities resulting in impact between the proximal femur and the acetabular rim, which damages the glenoid of the acetabulum The lips and adjacent cartilages cause chronic pain in the hip joint, and the movement of the hip joint is limited, especially the limitation of flexion and internal rotation. If not controlled, it will eventually develop into hip osteoarthritis.

Hip impingement syndrome is medically divided into three categories:

Cam Shock

Most common in young men who exercise regularly, it is caused by the abnormal anatomy of the femoral head and neck. Insufficient depression, or even a gun handle-like deformity) collides with the acetabular rim, causing tearing of the anterior and superior labrum of the acetabulum and damage to the articular cartilage and subchondral bone. Quality protrusions.

Clamp-on impact

more commonathletic Middle-aged women, caused by the abnormal contact between the head and the acetabulum caused by the abnormal acetabular anatomy, the acetabulum is too deep and the anteversion is insufficient. Excessive coverage affects the range of motion of the femoral head, which impinges on the cartilage of the acetabulum in a narrow annular strip.

Mixed

The majority of hip impingements have abnormalities of the acetabulum and femoral head and neck. It is a mixed type.

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What are the symptoms of hip impingement syndrome?

Hip impingement syndrome has an insidious onset and no obvious history of trauma, and is more common in young adults. It is mainly manifested as irregular intermittent pain in the groin area (root of thigh), especially after exercise, standing up for a long time, and after long-distance walking. Hip flexion, adduction, and internal rotation are restricted.

As the disease progresses, pain may occur in the lower back, sacroiliac joints, buttocks, or the greater trochanter of the femur. The hip joint is accompanied by a snapping and unsteady feeling (sudden limitation of flexion and extension, like being stuck and unable to move with significant pain). The “dead leg sign” may also be present, where severe pain or locking of the hip joint occurs when changing positions (eg, sitting or turning around), but returns to normal after a short period of movement. Those with a longer medical history may also experience joint stiffness, weakness, and decreased range of motion.

Mobility

Hip flexion, external rotation, abduction limit.

Anterior impact test

The patient is in a supine position, and the examiner flexes the hip to 90° while adducting and internally rotating; or The affected hip is flexed to 90° while abducted and externally rotated. The above actions make the femoral head and neck come into contact with the anteromedial edge of the acetabulum, and the symptoms of pain or compression in the hip joint or groin area are positive.

Posterior impact test

Patients were placed in a supine position, with the affected limb hanging freely from the edge of the bed, and the hip joint should be extended and externally rotated as far as possible. The above actions make the femoral head and neck come into contact with the posterolateral border of the acetabulum, and pain in the hip joint or groin area is positive.

“4” test

nonspecific, but mostly positive.

Imaging:

DR and CT can detect abnormalities in the shape of the acetabulum and femoral head, such as too deep acetabulum, acetabular ossicles, femoral head neckpistol handle deformity, or small anterolateral protrusion , or dents, ossification, etc. MRI has high sensitivity and specificity for acetabular labrum and femoral head cartilage lacerationsHeterosexual, local edema and joint effusion can often be seen.

Note:

1. Many asymptomatic patients can also show signs of FAI on imaging;

2. Some FAI can appear completely normal on imaging. This is one of the important reasons why hip impingement is easily misdiagnosed.

How is hip impingement syndrome treated?

non-surgical treatment

It is mainly suitable for those whose hip pain does not have a significant impact on daily life and work. The main measures include: avoid physical labor, excessive exercise and long-distance walking; avoid hip joint movements that cause collision, such as try not to Excessive flexion of the hip, reduction of vigorous activity, etc.

Non-steroidal anti-inflammatory drugs, chondroprotective drugs, local shock wave therapy, etc. Scholars believe that non-surgical treatment does not really eliminate the cause of the disease, so it can only relieve the pain of the patient, and cannot fundamentally relieve the continued degeneration of the joint. Despite this, non-surgical treatment should still be the first choice for treatment, and surgery should be considered for ineffective patients.

Surgical treatment

Mainly suitable for those with unbearable hip pain or significant symptoms of strangulation.

For cam impingement, the surgery mainly includes femoral head plasty and femoral neck plasty. For pincer impingement, surgery is generally performed to remove the hyperplastic bone tissue surrounding the acetabulum, and partial resection of the torn or ossified acetabular labrum. If the acetabular anatomy is abnormal, surgery to change the shape of the acetabulum to the normal structure, such as acetabular osteotomy, may be performed. With the exception of acetabular osteotomy, other surgeries can be performed with minimally invasive hip arthroscopy.

Hip arthroscopy is an important part of hip impingement syndrome The method can remove the hyperplasia synovium, polish the protruding bone, straighten the degenerated cartilage, and even suture and repair the torn acetabular lip, so as to remove the cause, relieve the pain and restore the function.

In short, if there is hip pain, radiograph For avascular necrosis of the femoral head, one should consider the possibility of hip impingement syndrome and seek medical treatment in sports medicine and arthroscopic surgery as soon as possible. Blind delay will only aggravate the condition.

This article is reproduced with permission:This article is reproduced with permission: Property to original author.

The article is only for reference and learning and sharing, and everything depends on the patient’s own situation and the diagnosis and treatment of professional doctors.

About the author

Mi Kun, Director, Chief Physician, Professor, Department of Bone, Joint and Sports Medicine, Guangxi International Zhuang Medical Hospital ((International Zhuang Medical Hospital Affiliated to Guangxi University of Traditional Chinese Medicine).

Good at diagnosis and treatment of joint injuries and diseases, various complexTreatment of miscellaneous fractures and their complications, correction of deformities of limbs and joints, reconstruction of limb function, skin flap transplantation, and modern advanced artificial joint surgery, especially arthroscopic minimally invasive surgery, have innovated many surgical methods, and the treatment emphasizes function first and strives for excellence. Back to sports. In the past ten years, various arthroscopic surgeries have been carried out on the shoulder, elbow, wrist, hip, knee and ankle joints and small joints such as the acromioclavicular joint, subtalar joint, and metatarsophalangeal joint, which are in line with the international advanced level. Under arthroscopy, a series of minimally invasive release of peripheral nerve entrapment syndrome and the treatment of joint trauma such as tendon and bursa lesion resection have been performed. The number of arthroscopic operations has exceeded 10,000, and it has helped more than 160 hospitals across the country to carry out Arthroscopy and other high-tech and difficult orthopedic operations, and trained more than 150 arthroscopic surgeons.

He is currently a member of the Lower Limb Sports Traumatology Group of the Sports Medicine Branch of the Chinese Medical Association, a member of the Sports Medicine Working Committee of the Orthopedic Physician Branch of the Chinese Medical Doctor Association, and a member of the International Arthroscopy-Knee-Orthopedic Sports Medicine Chairman of the South China Region of the Chinese Committee of the Society (ISAKOS), member of the International Society of Orthopaedic and Traumatology (SICOT), member of the Sports Medicine Professional Committee of SICOT China, member of the Asia Pacific Knee-Knee Arthroscopy-Orthopaedic Sports Medicine Society (APKASS) Chinese member, national Member of the National Physician Periodic Assessment Expert Committee for Endoscopy and Minimally Invasive Medicine of the National Health Commission, Member of the Standing Committee of the Shoulder and Elbow Sports Medicine Professional Committee of the China Medical Education Association, Vice President of the Western China Sports Medicine and Arthroscopy Collaborative Alliance Committee, and Director of the Pan-Pearl River Delta Regional Sports Medicine Alliance Vice President of the Association, Member of the Standing Committee of the Sports Medicine Branch of the Chinese Association of Traditional Chinese Medicine, Executive Director of the Sports Injury Branch of the China Medical Rescue Association, Vice Chairman of the Western Union and Vice Chairman of the Joint Sports Injury Group, Member of the Orthopaedic Minimally Invasive Branch of the Chinese Association of Integrative Medicine, Member of Sports Medicine and Arthroscopic Surgery, Orthopedics Branch of Chinese Association of Integrative Medicine, Member of Health Science Popularization Professional Group of Sports Medicine Physician Branch of Chinese Medical Doctor Association, Joint Surgery Professional Committee of Chinese Academy of Research Medical Colleges – Partial Knee Replacement Research Group Member, member of the Sports Medicine Group of the Orthopaedic Professional College of the Chinese Physician Training College.

Won the 2nd Guangxi Excellent Physician Award in 2012, the National Best Lecturer of Orthopedic Sports Medicine in 2017, and the 3rd Most Influential Orthopaedic Department in China in 2018 Lecturer, for two consecutive years in 2018 and 2019, he has ranked among the top 20 most influential orthopedic physicians in the country, and is a well-known expert in orthopedic sports medicine and arthroscopic surgery in China.

Hospital address: No. 8, Qiuyue Road, Wuxiang New District, Nanning City, Guangxi.

Inpatient ward: Department of Orthopedics and Sports Medicine, 8th Floor, Inpatient Building, Guangxi International Zhuang Medical Hospital. Ward Tel: 0771-3376595, 3376596. Visit time: Wednesday all day, Friday morning. (No clinic during holidays)Visit location: Clinic Room of Bone, Joint and Sports Medicine, 3rd Floor, Outpatient Clinic of Guangxi International Zhuang Medicine Hospital.

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