Introduction
Pain above the hip can be caused by various diseases or injuries of the locomotor system. Some diseases are mentioned in this article by way of example and presented in more detail. During the physical examination of the spinal column and thorax, attention is paid to the curvature of the spinal column and the symmetries of the shoulder and pelvis position and the mobility of the spinal column is checked. In addition, the nervous system is examined for orientation.
Causes
The main causes of pain above the hip are listed below:
- Lumbar Syndrome
- Baastrup’s disease
- Slipped disc of the lumbar spine
- Spinal canal stenoses
- Vertebral Blocking
- Thoracic Syndrome
- Spondylolisthesis
- Rheumatic diseases
- Osteoporosis
- Vertebral and ligament disc infections
- Bone metastases and tumors
- Other injuries of the spine
Patients with a lumbar syndrome complain of pain in the lower back that can radiate into the legs but does not have to. In many cases, the patients have lifted a heavy object or otherwise been physically active. During the examination, the physician finds that the back extensor muscles are tensed and that forward mobility is restricted.
Apparative diagnostics are necessary after an accident, but should also be carried out for accompanying symptoms such as fever and weight loss as well as for tumor patients. If the pain persists over a longer period of time, diagnostic equipment should also be used. Therapy is started with a combination of heat application, painkillers, manual therapy and injections, although not all options need to be used.
The prognosis for low back pain is good, the pain usually decreases significantly within the next few days. However, there is the possibility of chronicity of back pain, which is mainly favored by psychological factors. Baastrup’s disease is more common in men who work hard.
A hollow back and large spinous processes cause painful contact with the spinous processes of the vertebral bodies in the area of the lumbar spine, which is clearly visible in the X-ray image. The pain becomes worse as the abdomen is stretched forward and the thorax put back. The treatment is carried out by physiotherapy, application of heat and injections of local anesthetics.
Surgery is only rarely performed. Due to the natural aging of the intervertebral disc, the outer part, the fibrous ring, is damaged and can tear in extreme cases. Through the tear in the fibrous ring, disc tissue can escape from the inside and irritate the nerve roots.
Patients with a slipped disc of the lumbar spine complain of sharp, stabbing pain radiating into the legs. In most cases, the symptoms are only present on one side of the body. The examiner can detect a malposition of the spine, which the patient takes to keep the pain as low as possible.
There are also sensory disturbances along a dermatome (supply area of a nerve root) and asymmetrically pronounced reflexes. The X-ray image cannot show the intervertebral disc itself, but provides important information and serves to exclude other diseases. A herniated disc of the lumbar spine can be best assessed by MRI of the lumbar spine of the lumbar spine.
Therapy is started conservatively with physiotherapy, pain medication and local anesthetics. In most cases, surgery achieves good results and is performed in cases of severe nerve disorders or if there is no improvement with conservative therapy. Nevertheless, the symptoms may return, as scarring in the area of the operation or a loss of stability due to the operation may cause similar symptoms.
Osteoarthritis of the spine results in bony restructuring of the vertebral bodies and joints and thickening of the ligamentous apparatus. These changes constrict the spinal canal and lead to claudication spinalis symptoms with low back pain when standing upright and numbness in the legs or genital region while walking upright. The symptoms improve when sitting.
The diagnosis is made by the typical clinic, by X-rays and the MRI of the lumbar spine. The conservative therapy is similar to the therapy for a herniated disc of the lumbar spine or the therapy for a herniated disc of the BWS.An operation is performed in the absence of improvement, in which the bony attachments are removed and the spinal canal is relieved. In general, an operation achieves good results.
In colloquial language, the term “blockage” refers to a reversible functional disorder of a joint. In the area of the spine, in addition to a vertebral segment, the overlying skin and soft tissues can also be affected. The patient complains of sudden discomfort in a certain area of the spine and of limited mobility.
The cause lies in jerky movements or long-lasting incorrect postures with little movement (e.g. working at the computer). Pre-existing conditions of the spinal column such as osteoarthritis can also lead to spinal blockages. The Kibler skinfold test is carried out for a clear diagnosis.
The examiner lifts a skin fold on the back and rolls it out over the entire back. In the area of the blockage, the skin and the underlying soft tissues are thickened and painful. Damage to the spinal cord must be excluded in the examination.
An X-ray is then taken. Blockages are treated with physiotherapeutic measures, which have very good results if the blockage is not caused by a serious illness of the spinal column. Manual therapy should not be used after an accident or in cases of severe osteoporosis.
If the rib-vertebral joints are disturbed in their function or degeneratively altered, the thoracic syndrome can be the result. Wear and tear of the intervertebral discs is also considered a possible cause. Typical symptoms of the thoracic syndrome are severe muscle tension in the spinal column and pressure pain in the thoracic spine.
People who work a lot on the computer are more often affected than others. The prognosis is good, as treatment with painkillers and physiotherapy responds well. In spondylolisthesis, the formation of a gap between two vertebrae causes the upper vertebra to first loosen and then slide in this mobile segment.
In extreme cases, the sliding vertebra can slip off and tip in front of the vertebral body below (spondyloptosis). Patients experience pain in the affected area, and the physician can detect a stepped spinal column with poor posture and muscle tension and assess the extent of spondylolisthesis by CT or MRI. In mild cases, physiotherapy is started, in more severe cases the spinal segment has to be surgically stiffened.
Typical for osteoporosis are collapses of vertebral bodies due to the decreasing bone mass. An acute vertebral body collapse causes severe pain in the affected area for 1-2 months, after which the fracture heals and the pain subsides. Many rheumatic systemic diseases such as ankylosing spondylitis or rheumatoid arthritis can affect the spine and cause pain above the hip.
Infections of the vertebral bodies and intervertebral discs usually affect older patients with risk factors such as alcoholism, diabetes or cortisone therapy. Patients complain of a local, very strong pressure pain (usually in the transition between the thoracic and lumbar spine) and at the same time have a fever and increased inflammation values in the blood. The occurrence of a so-called non-specific vertebral body infection is favored by germ transfer during surgical procedures, which, however, need not have been in the area of the spinal column.
Specific inflammations of the vertebral bodies are very rare and can occur in the case of tuberculosis, brucellosis or syphilis infection. Bursitis is an inflammation of a bursa. Bursae are located in various joints and improve the sliding ability of the joint partners.
In bursitis trochanterica, the bursa located in the hip joint is affected. This inflammation can occur after an accident, for example after a fall on the hip joint, overloading of the joint or due to systemic diseases such as rheumatoid arthritis. In addition to pain above and also in the hip, movement restrictions, swelling, redness and overheating can occur.
In case of bursitis trochanterica, the joint should be cooled. Therapy with anti-inflammatory painkillers – so-called NSAIDs – such as ibuprofen or diclofenac should also be carried out and the joint should also be protected. There are different types of bone tumors.The chondrosarcoma often affects the pelvis and the plasmocytoma often the vertebral bodies, but of course other localizations are also possible.
Approximately half of all bone metastases are located in the spinal column. Spinal column metastases are either discovered during staging examinations or are found during the examination due to back pain without the primary tumor being known. In any imaging diagnosis due to back pain, the doctor will rule out a metastasis before further treatment.
Spinal column injuries happen quasi only through accidents of any kind. The patient feels severe pain immediately after the event and may notice neurological deficits. Spinal column injuries are divided into three classes.
- Type A describes compression injuries following the application of axial force, including, for example, a compression fracture.
- Type B describes distraction injuries caused by excessive flexion or extension. Among other things, this includes a rupture of the posterior ligament structures.
- Type C summarizes all injuries due to rotations and combined injuries.
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