Diseases of the hip joint and their treatment
Structure of the pelvic joint
All organs of the human body are important and unique. Its frame is the musculoskeletal system. The hip joint is one of the largest and most mobile parts of this system, which largely determines the mobility of the whole body.
Motion is the symbol of life itself. The hip joint connects the upper part of the trunk and lower limbs, ensuring their movement. The joint itself is able to move in several directions and carries out various types of motion, so the damage or disease of it leads to serious consequences.
Hip Joint: General Anatomy
This joint connects the pelvic and femur. It is a cup-shaped joint, which is a kind of globular shape. With the help of numerous ligaments and cartilaginous joints, the joint articulates the acetabulum of the pelvic bone with the femoral head.
At the junction site, the surface of the femoral head is almost completely covered with hyaline cartilage, except for the fossa where the ligament is fixed. The cartilage covering of the pelvic bone is located only on the round portion of the acetabulum. The remaining bone surface in the joint region is covered with fiber in the form of loose joint tissue and synovial membrane( membrane).On the free edge of the acetabulum, the acetabular fibrous-cartilaginous lip is grown, having a height of up to 6 mm and formed by collagen fibers.
Lip provides full and dense coverage of the acetabulum of the femoral head. The volume under the transverse ligament formed by the acetabulum is filled with a loose articular tissue, through which blood vessels and nerve channels are laid.
Anatomy of the capsuleThe capsule of the hip joint is a strong formation. It is fixed on the hip bone in the back of the acetabulum;and on the femur is attached in two places: in front - on the intertwining line, behind - slightly away from the intertwining crest.
Fixing on the bones in this way, the articular bag is on the circumference of the acetabulum and encloses two thirds of the neck of the femur and the acetabulum.
In front of the surface of the articular capsule lie the fibers of the ilio-lumbar muscle. The thickness of the capsule in this zone decreases.
In some cases, this formation generates a synovial bag.
Bundles of the hip joint
The hip joint contains five main ligaments. In the anterior part, the ileal-femoral ligament is located on the surface of the joint, connecting the pelvic and femoral bones between the lower iliac region and the intervertebral line. This bundle fan of its fibers covers the hip joint. The ileum-femoral ligament is the most solid ligament of the entire human musculoskeletal system. The thickness of the bundle is due to the fact that it largely determines the vertical arrangement of the entire human body and must provide certain inhibition during extension.
The pubic-femoral ligament consists of fairly thin fibers assembled in a bundle, and placed in the lower part on the surface of the joint. The ligament begins from the pubic part of the hip bone, is directed downwards and is attached to the femur in the area of the small trochanter, right up to the vertex. Passing from the outside of the joint, part of the fibers of this ligament are weaved into the tissues of the joint capsule. The main function of the ligament is the inhibition of the transverse movement of the thigh.
Joint and its ligaments
The sciatic-femoral ligament is located behind the coxofemoral joint. The beginning of this ligament is fastened in front on the surface of the ischium of the pelvis. Fibers of the sciatic-femoral ligament encircle the femoral neck, some of them intertwine into the joint capsule. The remaining fibers are fixed on the femur in the zone of the large trochanter up to the pit. The main task of this ligament is the inhibition of the movement of the thigh in the inner direction.
The bundle of the head of the femur is a fairly loose structure of the tissue, covered with the synovial membrane. Inside the ligament are the vessels that are directed to the head of the femur. The beginning of the ligament is fixed in the pit of the acetabulum of the hip bone, and the end is fixed in the fossa of the head of the femur. A bundle of the femoral head is inside the capsule of the hip joint. The strength of the ligament is not very great, and it can easily stretch. When the joint moves inside, a space is formed that is filled with a bundle of the femoral head and synovial fluid, which ensures the lining between the surfaces of the bones and increases the strength. A bundle of the femoral head prevents excessive rotation of the thigh in the outer direction.
The circular zone of the ligaments is located inside the capsule of the hip joint. It has the appearance of a loop that runs around the femur in the middle part of the cervix. This zone is a mixture of different collagen fibers collected by thin beams. Ligaments are attached in the ileum.
Hip joint:motor functions The anatomy of the hip joint makes it possible to ensure its high freedom of movement in different planes and directions. The maximum amplitude of the movement of the joint is allowed relative to the frontal axis. This axis passes through the head of the femur. Such movements of the joint ensure flexion and extension of the person. Flexion is almost not limited to ligaments and can reach 122º( a restriction on flexion is made by the abdominal muscles).Extension is possible only at angles up to 13º.The inhibition of the joint to unbend is provided by the iliac-femoral ligament, as when this extension is stretched, this ligament is stretched. Further movement of the body backward is possible only due to the lumbar region.
The second type of motion is transverse movement of the thigh relative to the sagittal axis, i.e.removal and reduction of the thigh relative to the trunk. The travel angle is limited to 45 °.A large spit is inhibited by a large spit when it comes into contact with the ilium. If the thigh is in a bent state, then the large spit is pointed back and does not create obstacles for the hip.
The movement of the hip joint relative to the vertical axis provides external and internal rotation of the thigh. The amplitude of the rotation amplitude is 40-50º.Both femoral ligaments actively participate in inhibition of this type of movement.
Finally, the globular design of the joint allows for another movement - pelvic rotation relative to the lower extremities. The amplitude of such movements is determined by the size of the wings of the ilium and the large trochanter, and also by the magnitude of the angle between the vertical axis and the longitudinal axis of the femur. A noticeable effect is exerted by the angle of the neck of the femur, which changes in a person with age, which explains the changes in the amplitude of these movements and, accordingly, in the gait of a person with age.
For example, this angle for newborns is up to 150º, and for a 30-year-old man - up to 125º, for a woman - to 118º.
Features of the circulatory system in the hip joint
The circulatory system of the knee joint consists of a variety of blood vessels. The blood supply is provided by the external and internal arteries, enveloping the hip bone and departing from its deep artery, as well as branches of the acetabular artery and gluteal arteries. Blood flow is carried out through the veins, which are located on the surface and inside the hip joint. Through the venous system of the joint, blood enters the femoral vein, and bypassing the veins of the venous vessels, the outflow reaches the iliac vein. Below the outflow system is associated with the system of lower limbs, which originates from the finger veins entering the venous arch of the foot. In turn, the inner and outer marginal veins, which pass into the large and small saphenous veins of the leg, feed from the arc.
The lymphatic system includes lymph nodes and transfer vessels. Lymphatic drainage is performed in the lymph nodes that are located( outside and inside) around the iliac vessels. The nervous system of the hip joint is included in the general nervous system of the person through the femoral, sciatic, blocking and gluteal nerves.
Age features of theHip joints change during the growing up of the body, which is associated with structural changes in the bones that are connected in the joint. Thus, in the newborn the head of the femur has a cartilaginous structure, and the nucleus of ossification becomes noticeable only by the age of six months. In a child of six years of age, ossification increases by an average of 10 times.
The size of the neck of the femur increases for a long time, its growth stops only by 20 years. Complete formation of the pelvic bones and cartilage structure in the acetabulum zone is completed only by the age of 14-17.
Defects in the development of the hip joint
In the process of age development of the hip joint, defects( defects) can occur, manifested by insufficient development of the joint elements or their deformation.
A dangerous defect is hip dysplasia, which is the inadequate formation of the acetabulum of the pelvic bone and the proximal femur. Most often, the primary cause of this vice is congenital. At the same time in a child at an early age, dysplasia can develop into a shift in the head of the femur.
Joint dysplasia can be classified into three degrees of joint damage: preluxation, subluxation and dislocation. Dysplasia in a child can manifest itself in the first months of life in the form of restriction of the hip, skin folds on the thigh, reduced length of the leg, turning the leg outward at rest. At the age of 3-5 years in a child, the subluxation may manifest as an instability or limping, and dislocation - through a swinging gait.
Important pathological abnormalities indicative of dysplasia are the elevation of the acetabular roof slope, the displacement of the femur end in the outward and upward directions, and later the ossification of the head. The most common reason is the displacement of the head of the femur, which is divided into five degrees.
Vervous deformation of the femoral neck is characterized by a decrease in the cervico-diaphysial angle and displacement of the trochanter. The main symptoms of the defect: limping, a slight change in the length of the foot, turning the leg outward, the motion of the joint is limited.
Damage from injuries
The hip joint is frequently traumatized. The most common contusions are manifested in the form of pain in the joint area or as a slight restriction of movement, bruising in the tissues or knocking in the articulation zone. Traumatic dislocation is determined by the displacement of the femoral head relative to the pelvic bone.
Depending on the direction of deformation, the front, back and central dislocations are distinguished. With central dislocations at the bottom of the acetabulum, cracks are often observed. The bone fractures have the strongest effect.
In fractures, in addition to the destruction of bone tissue, as a rule, ligaments and muscles are damaged.
Diseases of the hip jointSignificant destruction of the joint tissues occurs with osteochondrosis, which is a dystrophy of the bone structure and cartilage. The most characteristic form of the disease is osteoporosis( coxarthrosis).In this disease, cartilage gradually lose its elasticity and cease to fully perform its function, because of which the bones are deformed. Deterioration of blood circulation leads to the fact that the muscles begin to atrophy. The main symptoms of the disease: pain in the thigh and groin, limited mobility of the joint, lameness, muscles weaken.
The causes of inflammatory processes in the hip joint often lie in a disease such as a coke that is usually infectious. With such a disease, the synovial membrane, articulated bone sites are affected. The first symptoms are manifested in the form of pain in the pelvic region, stiffness of movement, increased temperature in the joint area. If the coxite has developed into a purulent form, then symptoms appear in the form of an unnatural position of the limb, pulling the leg upwards.
Tumors of a different nature can develop on the capsule of the joint or articular tissues( cartilage and bones).The reason - the development of diseases such as synovioma, osteoma, chondroblastoma, chondroma, etc. Such diseases, as a rule, require surgical intervention.
Hip pain may be caused by diseases that occur in the muscles adjacent to the joint. Hypertension of the muscles is one of the diseases. In mild forms, hypertonus causes inconvenience and a feeling of stiffness, but in the future can lead to muscle spasms, limited movement, tightening of the limb. In severe form, hypertonicity can cause significant muscle contraction and pain in them under stress.
Treatment of the hip jointTreatment of the hip joint primarily requires a therapeutic and preventive approach. Good results show different methods of physiotherapy. So, ozocerite has become a valuable material for health procedures. It is especially noticeable how ozocerite helps in the treatment of arthrosis( coxarthrosis), osteochondrosis, myositis, traumatic consequences. Ozokerite, because of its low thermal conductivity and natural basis, has become the source of the creation of such a kind of physiotherapy as ozoceritherapy.
Therapeutic procedures in the treatment of hip joints can be based on manual therapy. In particular, post-isometric relaxation is recommended, which is especially good for hypertension of muscles. This method of manual therapy is based on the combination of passive stretching of muscles and impulse isometric work of minimum intensity. The affected joint is sensitive to vibrational loads, which causes widespread use of therapeutic massage. The use of ointments and creams is recommended for all patients. Damaged( susceptible) place can be smeared with warming compounds of different types.
With severe pain and serious inflammation, it is difficult to do without a drug treatment. Dexamethasone is a glucocorticoid drug. When treating various diseases of the musculoskeletal system, dexamethasone proved to be reliable and effective. Dexamethasone has an anti-inflammatory and analgesic effect, there are no contraindications for allergies. The dosage should be specified by a specialist.
The use of a complex of therapeutic physical exercises is necessary for any diseases of the hip joint. From how we strengthen the hip joint, the speed of recovery and recovery of mobility depends. The complex of exercises improves blood circulation, stabilizes muscular activity, restores the elasticity of ligaments.
Surgery is the last resort and is only used for severe injuries when there is no alternative. Redirection of the bone element or replacement of the articular tissue can be the goal of the operation. Recently, transplantation( replacement) of the articular tissue has become quite an ordinary event in the treatment of complex cases of disease or trauma. Especially important is the availability of such a method as the replacement of joint formation, in the treatment of tuberculosis cocksites and tumors.
The hip joint is a complex organ in the human body. If it hurts, grows numb or knocks, then immediate action should be taken. This joint largely determines the motor abilities and stabilization of the whole body: any pain, knocking can cause big problems.
Diseases of the hip joint in women
Structure of the hip joint
Time to diagnose the disease is part of the correct treatment.
The hip joint performs in the human body a very important role - without it, it would be inconceivable to move, sit or stand. This joint plays a crucial role in maintaining the direct position of the back. It is important for flexion and extension of the trunk, its corners. And any pain or discomfort in the hip joint can be detrimental to the whole life and well-being of a person.
Diseases of the hip joint can lead to gradually increasing lameness, restriction and loss of mobility of the affected limb, general changes in the internal organs caused by the patient's constant gait.
When you have pain, do not expect that it is not strong and will eventually pass. It is at the stage of mild discomfort or mild pain that it is best to begin treatment of hip joint diseases in order to achieve the maximum positive effect. In this case, bone and joint dystrophy, changes in gait, lameness, the use of walking sticks or even crutches, and eventually the surgical intervention can be avoided.
If you start the disease, all the previously listed troubles will have to be tested in full. After all, without treatment by qualified specialists, it will not pass by itself, but will only progress.
Hope only for folk remedies in this case will not only be not justified, but also harmful. Such funds can, and at times very efficiently, only remove for a time the pain syndrome, without struggling with the disease itself. And it is insidious that after a certain stage of development the patient can be helped only by prosthetics of the degraded joint.
Diseases of the hip joint in women are similar in many respects to diseases in men, but there are a number of unpleasant factors for the female sex. The fact is that women are more prone to a number of diseases that become the root cause of diseases of the femoral joint, which means that belonging to the female becomes an additional risk factor.
Women, especially with the onset of adulthood, should pay more attention to joint health. And with the first signs of pain or discomfort, especially in the hip, immediately consult a specialist.
Structure of the hip joint
Capsule of the hip joint
The hip joint carries a large weight load. This is a large joint, which is a mobile joint of the femoral and pelvic bones. In the pelvic bone there is a bowl-shaped acetabulum, which includes the upper part of the femur - the head and partly the neck of the thigh. Bones are held together with the help of ligaments, which form the capsule connecting them.
Inside the cup-shaped cavity and on the head of the thigh is a smooth cartilaginous tissue, which facilitates the rotation of the femoral head in the cavity. In places where muscles or tendons touch the bone, there are synovial bags - sacs filled with fluid, and the capsule surrounding the joint also has a synovial layer - a special coating that produces a synovial fluid designed to lubricate the joint and reduce friction.
When the bone tissue does not have time to renew, the tissue absorbed by the body does not grow in full again - the bone becomes more porous and brittle. Such a disease is called osteoporosis. Women, especially in adulthood, are much more likely than men to be affected by osteoporosis. This disease greatly increases the risk of bone fracture, and one of the most common fractures of the femurs is the fracture of the femoral neck. Such a fracture often happens in people of mature age, when regeneration is weaker, and healing takes a long time.
Fracture of the femur neck
Osteoporosis is treatable. Over the years, the disease only progresses, so treatment should be started as early as possible.
Osteoarthritis of the hip joint
Hip arthrosis is also called coxarthrosis. It is a disease in which degenerative changes occur in the cartilaginous tissue of joints, and in time, and its destruction. A healthy cartilage is a layer of elastic smooth tissue, or an elastic gel-like plate, allowing the bones of the joint to glide smoothly relative to each other.
When insufficient supply of cartilage tissue with the necessary substances, it begins to break down. The necrotic pieces of cartilage are separated and freely float in the joint synovial fluid. They fall into joint articulations, interfere with its free movement and cause pain.
Disturbance of blood circulation of the hip bone
Over time, with the progression of the disease, the cartilaginous tissue from the articular surfaces completely disappears, and the non-cranial surfaces interacting in the joint cause severe pain. A sick person feels such pain even at night, it interferes with normal sleep.
Primary form of deforming arthrosis occurs in people after 60-65 years, and it is known that the disease is hereditary predisposition. Women with hereditary predisposition and overweight are at risk. With this form of the disease, joints are usually affected symmetrically.
Arthrosis of the hip joint
Secondary form of coxarthrosis develops due to other diseases, for example, congenital dislocation of the hip, fractures and trauma of the hip and pelvic bones, inflammatory diseases of the joints, heavy loads, worsening of blood circulation. Disease can cause osteoarthritis, which then will develop independently.
There are three stages of development of coke.
On the first - the patient feels minor pain and discomfort, arising only with significant stress on the joint. At this time, the food cartilage is already deteriorating, it feels oxygen starvation, but still functions normally.
The second stage is characterized by the appearance of severe pain. At this stage, the cartilage is already beginning to deteriorate, and the patient has lameness and the need to walk with a cane.
In the first and second stages, medication and physiotherapy are possible and there is a possibility of avoiding surgery.
Endoprosthetics of the hip bone
The third stage is characterized by the fact that pain medication ceases to help, the pain becomes almost constant, and the joint loses its mobility or moves abnormally. The bone is deformed, the cartilaginous tissue is completely destroyed. With such damages, it is impossible to do without surgical intervention. The patient's joint is replaced with an artificial one.
Diagnosis of hip joint diseases
Diagnosis of the disease can be carried out only by an experienced specialist. After all, sometimes the pain in the pelvic and hip joints testify completely to other diseases, and the pain of the inguinal region, the buttocks, abdomen or even the surface of the thigh, or in the knee can speak of hip joint disease.
But most often the pain in the hip, groin or knee during walking can be a symptom of coxarthrosis. The disease occurs with periods of exacerbation, in which a person experiences severe pain when walking, and sometimes sitting or with the rotation of the trunk. With coxarthrosis, a gradual shortening of the diseased leg is observed, and the constant overstrain of some muscles associated with the disease, which leads to their atrophy.
It is necessary to begin treatment of the disease at its earlier stages. In the future it will only progress. And will not pass independently.
Video - Hip dysfunction in women
Anatomy and structure of the human hip
- 7 Clinical role of the joint
The hip joint is the articulation of the femur with the joint cavity of the bone pelvis. It is one of the largest in the human body. Performs an important role in the movements, carries the load of the upper half of the body.
Unfortunately, the pathology of the hip joint is very common, especially in the elderly. Injuries lead to prolonged immobilization of a person and the development of severe complications.
A prerequisite for trauma is a special pattern of joint structure, unusual blood supply, and an abundance of vulnerable elements.
Bone structures of
Which bones form the joint? In the creation of the joint, important entities are involved: the femoral head and the acetabulum of the bone pelvis.
The head of the hip is a globular structure that connects to the main bone by the neck. Under these formations there are two outgrowths( trochanter).These are the protuberances of bone tissue, to which are attached the large muscles that provide traction to the articulation.
The acetabulum of the pelvis is an element that repeats the outline of the femoral head, but with a larger diameter. Inside this fossa is an articular surface that connects bone tissue with intraarticular cartilage.
The incomplete coincidence of the dimensions of the pelvic cavity and the head causes the presence of auxiliary elements, which give the structure strength, and movements smoothness.
Cartilage elements of
Anatomy of the human hip is designed in such a way that intraarticular cartilages play a significant role in the movements. It is these structures that provide an ideally smooth glide of bones.
Cartilages provide food( catering), amortize, smooth the strength of movement, preventing the load on the bone.
Semilunar surface on the pelvic bone and fossa of the femoral head are covered with cartilaginous layers.
Another joint structure complements the articular cavity - the acetabulum. This element is fixed around the acetabular fossa and makes it deeper, turning a half-moon cavity into a large cavity enclosing the head of the thigh.
To retain the components of the joint, to limit excessive mobility, fibrous connective tissue components - ligaments - help to create a physiological correspondence between the bone formations.
A large fiber bundle that extends from the cartilaginous lip forms a transverse ligament of the acetabulum. To this structure and surrounding bone tissue is attached another fibrous element - a bundle of the head of the femur.
These fibrous structures on the outside are covered with synovial tissue, which nourishes the surrounding formations and ensures smoothness of sliding.
Articulations surround several connective tissue strands that make up the fibrous membrane.
- A circular zone is a fibrous element that has a transverse direction. Surrounds the neck of the hip in the form of a loop, fixed on the bone pelvis under the acetabulum.
- The ileum-femoral ligament is a wide structure 0.8-0.9 cm thick. It performs the most important function - it hinders the re-opening of the hip, which means that it keeps the trunk from falling to the back.
- The sciatic-femoral ligament is a much smaller fibrous element that limits the excessive reduction of the extremity to the inside.
- The pubic-femoral ligament is a thin connective tissue cord on the inner part of the fibrous membrane. Prevents mobility outside.
This arrangement of fibrous fibers is necessary to perform the articulation functions.
The joint capsule is a special fibrous structure that forms the junction of the articulation. This broad stitch originates from the pelvic bone along the circumference of the cavity, and on the femur below the head so that half of the cervix remains under the capsule.
The structure of a capsule made of strong fibers is designed to retain elements of the anatomical region between each other. The space inside the cavity is filled with synovial fluid, which fulfills the nutritional function, helps maintain smoothness.
Features of movements
The hip joint is a bony joint, shaped like a bowl or bowl. This structure allows you to make movements in the following axes: frontal, vertical and sagittal. Mobility is physiologically limited to large fibrous structures forming a thick membrane.
- The front axle bends( at 120 ° in the bent knee) legs, as well as extension, which is severely limited to 14 °.
- In the sagittal plane, the leg is withdrawn and brought to an amplitude of up to 90 °.
- Around the vertical axis, the articulation can rotate up to 50 ° due to the anatomy of the femoral head. The volume is limited by intraarticular ligaments and large muscle elements of the femoral region.
Scheme of blood supply to the joint
The structure of the vessels of the hip joint of a man explains the development of pathological mechanisms that arise in trauma. Therefore, it is worthwhile examining the sources from which the joint feeds:
From the deep thigh artery( a large formation that feeds all the subcutaneous structures of this region), the inner and outer arteries that line the femur extend toward the joint.
From an important vessel feeding the pelvic organs - the occlusal artery - the acetabular branch carrying oxygen and nutrients of the pelvic part of the joint is directed to the joint. The gluteal branches branch out from the system of the internal iliac artery - the upper and lower branches. These vessels through the anastomoses( joints) are involved in feeding the articulation.
The feeding circuit of the femoral head includes vessels from the periarticular plexus that run around and inside the cervix, providing a blood supply to this structure. Therefore, with fractures of this anatomical region, fasting of the head of the femur develops, leading to a disease such as avascular necrosis.
Clinical role of the joint
The human hip joint performs the functions of moving in space, forming posture, holding the body in the right position and others. His whole anatomical scheme is aimed at creating a stable foundation for the trunk on one side, and ensuring limb movements on the other.
These important functions can be affected by the development of diseases such as:
- Fractures of the cervix, acetabulum.
- Osteoarthritis - degeneration of bone and cartilaginous tissue.
- Cartilage trauma.
Anatomy of the joints of the lower limbs of man: pubic symbiosis and the structure of the pelvis
The joints of the lower limbs of man include joints of various bones that provide mobility and enable the movement in space. This material presents the anatomy of the joints of the lower limbs, which includes basic information about the ligaments, the structure of the pelvis of the person, the bones entering the cavity of this or that joint.
Belt of the lower extremities is represented by articulations of the pelvic bones with each other in the anterior section and with the sacrum at the back. The connections of the pelvic girdle include pubic symphysis and paired iliac-iliac joint. The sacrum, wedged between two pelvic bones, is the "key" of the pelvic ring.
Pubic symphysis, formed by jointing symphysial surfaces of the pubic bones. In this place between them there is a cartilaginous interlobar disk with a narrow slit-shaped cavity located in the sagittal plane. The pubic symphysis is strengthened by two ligaments. The upper pubic ligament is a bundle of transversely oriented connective tissue fibers connecting the pubic bones. The lower pubic ligament is due to the pubic symphysis from below, occupying the apex of the sublobe angle.
The sacroiliac joint is formed by several bones.
The sacroiliac joint is formed by the ear-shaped surfaces of the hip bone and the sacrum. A strong capsule of this joint is supported by powerful neperdnymi and posterior sacroiliac ligament. On the back side of the joint there are also interosseous sacroiliac ligaments.
The joint also strengthens the iliac-lumbar ligament, stretched between the transverse processes of the two lower lumbar vertebrae and the crest of the ilium. Outside the sacroiliac joint, there are two powerful ligaments stretched between the sacrum and the pelvic bone. It is a sacro-tubercular and sacral-spinal cord that closes the sciatic cuttings of the hip bone and turns them into large and small sciatic holes. These ligaments deepen the cavity of the small pelvis.
Structure of human pelvic bones: female and male
Pelvic bones and sacrum joined together form a pelvis. The structure of the pelvic bones is an osseous ring, inside of which is the pelvic cavity. The front wall of the pelvis is a short pubic symphysis formed by the symphysial surfaces of the pubic bones facing each other, which are covered with cartilage and are interconnected by the interlobic disc in which the slit is located. The posterior wall of the pelvis is long, formed by the sacrum and coccyx, the lateral walls are formed by the internal surfaces of the pelvic bones and ligaments( sacro-tubercular and sacral-spinous).The locking hole located on the side wall is closed by the membrane of the same name. This is the general structure of the pelvis of a person, which can be divided into male and female types, depending on the gender of the person.
The border line formed by arched lines( right and left) of the iliac bones and pubic bone crests, at the back - with the cape of the sacrum, in front with the upper edge of the pubic symphysis, divides the pelvis into 2 divisions: large and small. The large pelvis is formed by the wings of the iliac bones and the body of the V lumbar vertebra. Small pelvis is limited by branches of pubic and sciatic bones, sciatic tubercles, sacro-tubercular ligaments, sacrum and coccyx. The sacroiliac joint is formed by the sacrum and iliac bone that enter it.
The structure of the pelvis of a woman and a manThe structure of a female pelvis is wider and lower, and all its dimensions are larger than for men. Bones of the female pelvis are thinner than in the male. The male sacrum is narrower and more concave, the head protrudes forward. The structure of the pelvis in women is different in that the sacrum is wider and more flattened, the cape is expressed to a lesser extent than in men. The angle under which the lower branches of the pubic bones( sub-angle angle) connect, in men it is acute: about 70-75 °, in women it approaches the direct and even stupid 90-100 °.The sciatic bumps and wings of the iliac bones of women are located farther apart than in men. Thus, the distance between the two upper anterior iliac spines is 25-27 cm in females and 22-23 cm in men. The lower aperture of the female pelvis is wider than the male one, it has the shape of a transverse oval( the structure of the pelvis of a man has the shape of a longitudinal oval), and the volume of the pelvis is more than that of men. The slope of the pelvis( the angle between the plane of the border line and the horizontal one) is also greater in women( 55-60 °) than in men( 50-55 °).
The straight diameter of the upper aperture is the distance between the cape and the upper edge of the symphysis, the lower aperture is the distance between the tip of the coccyx and the lower edge of such an important joint as the pubic symphysis. The transverse diameter of the upper aperture is the distance between the most distant points of the boundary line, the diameter of the lower aperture is the distance between the inner edges of the ischial tubercles. The oblique diameter of the upper aperture is the distance between the sacroiliac joint on one side and the iliac pubic elevation on the other. So, the sex differences in the structure of the female pelvis are reduced mainly to its large size and volume, an increase in the lower aperture compared with the male pelvis. This is due to the function being performed: the pelvis is the receptacle of the fetus developing in the uterus, which during the delivery leaves the pelvic cavity through the lower aperture.
Structure of the hip joint and its photo
The structure of the hip joint and the free part of the lower limb has features related to their functions: participation in movement in space, maintaining the balance of the body and the vertical position of the person.
Hip joint and in the photo it is perfectly visible, spherical, multiaxial, is formed by the acetabulum of the pelvic bone and the head of the femur. The depth of the acetabulum is increased by the cartilaginous acetabulum, which is firmly fused with the edge of the acetabulum.
Head, nerve and ligaments of the hip joint
The hip joint capsule is very durable. Its strength is significantly increased due to the work of such tissues as the ligaments of the hip joint. The most powerful is the ileum-femoral ligament, its thickness is about 1 cm. The ligament begins slightly below the anterior lower iliac spine and is attached, diverging in a fan-like manner, to the interstitial line. The pubic-femoral and ischial-femoral ligaments are much weaker than the ilio-femoral ligament. If a person is standing, all three bundles are tight. Within the cavity of the hip joint is a bundle of the head of the femur, which plays an important role in the period of formation of the hip joint, holding the head of the femur in the acetabulum. The head of the femur is surrounded by a ligament, which serves as a kind of shock absorber, which softens the tremors experienced by the hip joint during movements. Here also passes the nerve of the hip joint, which innervates the lower limb.
Bones and core of the hip joint
The core of the hip joint is a synovial bag formed by the acetabulum and the femoral bones entering into it. All bones of the hip joint are reliably protected from damage due to friction with synovial bags. Due to the large depth of the acetabulum, the hip joint belongs to a kind of spherical - cup-shaped joint. It has 3 axes of rotation: transverse, sagittal and vertical( longitudinal).In accordance with these axes, the thigh can perform flexion( forward motion) and extension( backward movement), retraction and reduction, inward( pronation) and outward( supination) as well as circular movement( circumduction).
Angulations of the hip joints
There are certain angles of the hip joints within which mobility can be carried out within the physiological norm. The mobility of the hip in the hip joint of a living person reaches 120 ° during flexion and extension;of which 105 ° are due to flexion and 15 ° to flexion. Limitation of the extension of the thigh is related to the tension of the ileo- femoral ligament. Around the vertical axis in the hip joint, the femoral head is rotated inside and out. The total turn volume is 40-50 °.Due to movements around the sagittal axis in the hip joint, the lower extremity is withdrawn and reduced to the midline( up to 80-90 °).
The structure of the knee joint
The structure of the knee joint is complex, it is a condylar, block-rotational apparatus. This is the largest and complex in structure of the joint of a man. Three bones take part in its formation: the femoral, tibial and patella. When flexing and flexing the shin, it works as a block joint. As the lower leg is flexed, due to the decrease in the radius of curvature of the joint surface of the condyles of the femur and the relaxation of the ligaments, movements similar to rotational movements in the globular joint( small turn of the shins inwards and outwards) may occur. The articular surfaces of the tibia and femur are complemented by intraarticular cartilages - the medial and lateral menisci, which increase the congruence of the articulating surfaces.
Medial and internal meniscus of the knee joint and its photos
Each meniscus is a fibrous-cartilaginous plate of a semilunar form, the thick edge of which is turned to the outside and is spliced with the capsule of the joint, and the thinned one is directed medially. The upper surface of the meniscus is concave and corresponds to the surface of the condyles of the femur, and the lower one is almost flat, and is attached to the upper articular surface of the tibia.
The medial knee joint meniscus is articulated from above with a medial condyle, from below - with the medial part of the upper articular surface of the tibia, the inner meniscus of the knee joint, respectively, with the lateral condyle and the lateral part of the upper articular surface of the tibia. Ahead of the meniscus are connected with each other by a transverse ligament of the knee. Look at the knee joint meniscus on the photo on this page:
Crossbones of the knee jointThe knee joint capsule is thin, loose and very extensive. From the side of the joint cavity it fuses with the outer edges of both menisci. The synovial membrane of the capsule forms numerous folds. The most developed are paired pterygopalus folds. Near the knee joint there is a large number of synovial bags( patellar, deep podadikolennikovaya, popliteal cavity, etc.).The knee joint is reinforced by intraarticular( anterior and posterior cruciate ligaments of the knee joint) and extraarticular ligaments( peroneal and tibial collateral ligaments, oblique and arched popliteal ligaments of the patella ligament).
In the knee joint, movements around two axes are possible: transverse and vertical. Around the transverse axis, flexion and extension occur with a total volume of movements of 140-150 °.Because of the relaxation of the collateral ligaments, when bending at the knee joint, it is possible to rotate about the vertical( longitudinal) axis. The total volume of active rotation in the knee joint is on average 15 °, the passive - 30-35 °.
The intercostal joint is the articulation of the flat articular surfaces of the fibular head with the peroneal articular surface of the tibia. A tightly stretched articular capsule is attached along their edge, strengthened by the anterior and posterior ligaments of the fibular head. Interbody syndesmosis is a continuous joint formed by the peroneal incision of the distal epiphysis of the tibia and the articular surface of the lateral ankle. In syndesmosis, the synovial membrane of the ankle is often invaginated, then it becomes the lower interbody joint. The interosseous membrane of the tibia is stretched between both bones of the tibia. In the upper and lower parts of the membrane there are holes for the passage of blood vessels and nerves.
Anatomy of the structure of the foot and toes of a person and its photo
The structure of the human foot is such that its bones are articulated with the bones of the shin and with each other, forming complex joints and functions that can be divided into five groups:
- of the articulation of the foot bones with the bones of the shank;
- articulations of bones tarsely with each other;
- articulations between the bones of the tarsus and metatarsus;
- articulations of metatarsal bones with proximal phalanges;
- articulation of phalanges of fingers between each other.
Anatomy of the foot and the structure implies a high motor activity. The second important factor that affects the structure of the foot and toes is high physical activity. The whole leg and the structure of the foot are designed to ensure the free movement of man in space. You can see the structure of the foot in the photo, which shows the different projections of this part of the lower limb.
The structure, bones and ligaments of the ankle of the foot
Ankle joint is block-shaped, complex, uniaxial, formed by articular surfaces of both bones of lower leg and talus bone. Together, the tibial and fibular bones of the ankle joint, like the fork, cover the block of the talus bone - this is the structure of the ankle joint. In this joint around the transverse axis passing through the block of the talus, flexion( movement toward the plantar surface of the foot) and extension( movement towards its posterior surface) are possible. The total volume of these movements is 60-70 °.In view of the fact that the front of the unit is somewhat wider than the rear, when the foot is bent, it becomes possible for it to be slightly reduced and withdrawn. The foot and ankle joint are strengthened by ligaments located on the lateral surfaces of the joint. The medial collateral( deltoid) ligament is in the form of a broad fibrous plate diverging downward. On the lateral side, the capsule is strengthened by three ligaments of the ankle joint: anterior talon-peroneum, posterior talon-fibular and calcaneocutaneous.
Human foot joints and their photos
Human foot joints are represented by the following joints: subtalar, talus-calcaneal-navicular, heel-cube, transverse joint of tarsus, tarsus-metatarsal, all of which are strengthened with ligaments. For clarity and understanding, we offer you to look at the photos of the foot joints
The subtalar joint is cylindrical uniaxial, formed by the talus and heel bones. Completely congruent in shape and size articular surfaces have a cylindrical shape. This joint is strengthened by a strong interosseous talon-calcaneus ligament, as well as by the medial and lateral talus-calcane ligaments. In the joint, small movements around the sagittal axis are possible.
The Tar-calcaneus-navicular joint is formed by the head of the talus, heel and scaphoid bone. It is strengthened by the talon-navicular rear ligament and calcaneous-navicular plantar ligament. According to the shape of articular surfaces, this joint can be referred to spherical, but movement in it is possible only around the sagittal axis, together with movements in the subtalar joint, i.e.both joints function together as a combined joint. A pronation and supination of the foot occur around the sagittal axis. When pronation with the bones of the shin and with each other, forming, with supination, the reverse movement occurs. Ankle, subtalar and talus-heel-navicular joints, complementing each other with respect to mobility, allow the foot to produce the following movements: flexion and extension, reduction and retraction of pronation and supination, and circular motion.
The transverse joint of the tarsus( Shoparov joint) is formed by two joints: calcaneocuboid and talon-navicular. The talon-navicular joint is spherical, formed by articular surfaces of the head of the talus and scaphoid bone. The heel-cube joint is formed by heel and cube-like bones. The articular surfaces are distinguished by a large congruence. The form of the joint is saddle-shaped. On the plantar side, the capsule of this joint is strengthened by ligaments, the most powerful of which are the long plantar ligament and the plantar heel-cube ligament. The transverse joint has a strong, generally bifurcated ligament that starts on the dorsum of the calcaneus, and is attached by one part to the scaphoid bone, the other on the cuboidal bone. Mobility in this joint is small.
Wedge-like joint, flat in shape, connects three wedge-shaped bones with a navicular bone.
The joints of the tarsal bones are strengthened with dorsum and plantar ligaments, interosseous ligaments. A very important role is played by an extremely strong short intraarticular interosseous talon-calcane ligament. The greatest firmness is possessed by a long plantar ligament, which is tossed between the lower surface of the calcaneus and the bases of II-V metatarsal bones.
Tarsus-metatarsal joints are formed by articulations of cuboidal and wedge-shaped bones with bones of metatarsus. These are three isolated joints. All of them are flat, except for the first( between the medial wedge and I metatarsal bones), which may sometimes be saddle-shaped. Capsules of joints are strengthened with dorsal and plantar tarsal-metatarsal ligaments. Mobility in the joints is minimal.
Interphalangeal and metatarsophalangeal joints of foot
Plususfalangovye joints of the foot are formed by the heads of metatarsal bones and the bases of proximal phalanges of the fingers. These joints are spherical, however, the mobility in them is comparatively small. Joints are strengthened with collateral and plantar ligaments, as well as deep transverse metatarsal ligament. In the joints, flexion and extension are possible, as well as a small withdrawal and reduction.
The interphalangeal joints of the foot are classified as block-shaped, which are laterally supported by collateral ligaments.
Anatomy and structure of the foot
Human foot performs strictly specialized function of movement and support. This is connected with its structure by the type of a strong and elastic arch arch with short fingers. The main features of the human foot, in addition to the arches, are the pierced position, the strengthening of the medial edge, the shortening of the fingers, the strengthening and bringing of the first finger, which is not opposed to the rest, and the expansion of its distal phalanx. Seven bones of tarsus, experiencing great load, massive and very strong. They are arranged in two rows. In the proximal( posterior) row - the ram and heel, in the distal( anterior) lateral there is a cuboid bone, medial - narrow navicular, and in front of it - three wedge-shaped bones. The bones of the medial edge of the tarsus lie higher than the bones of the lateral margin, thereby forming the arch of the foot.
The person has a vaulted foot, it is represented by five longitudinal arches and one transverse arch( arcs) which are turned by convexity upward. Vaults are formed by articulated bones of the tarsus and metatarsus. Each longitudinal arch begins from the same point of the heel bone - the calcaneus and includes the tarsal bones and the corresponding metatarsal bone. In the formation of I of the vault - the medial - the support of the talus bone also participates. The foot as a whole has 3 points of support: the calcaneal tubercle and the head I and V of metatarsal bones. The height of the longitudinal arches is different. The highest II arch( the second arc).As a result of the unevenness of the longitudinal arches, a transverse arch of the foot is formed. The construction of the foot in the form of a vaulted arch in a living person is supported by the shape of bones, the strength of the ligaments( passive "puffs" of the foot) and muscle tone( active "tightening").To strengthen the longitudinal arches of the foot, the longest plantar ligament is most important, the plantar calcaneoclavicular ligament, for the transverse arch - a deep transverse metatarsal and interosseous metatarsal ligaments.
Depending on the condition of the arches, the foot may be normal, flattened or flat.
There is both a lesion of one and both hip joints at once. So bilateral bilateral coxarthrosis of the hip joints is not uncommon. When the primary is very often affected knee joint and spine.
The structure of the hip joint
To gain a deeper understanding of the meaning of all measures for the treatment of coxarthrosis, you need to know a little about the structure of the joint and about the changes that occur with it in arthrosis of the hip joints .
Two jointed bones are involved in the formation of the hip joint: the femoral and iliac bones. It is the acetabulum of the iliac bone that serves as a "pocket", into which the joint ball-shaped head of the femur is inserted. Together, the joint and the acetabulum form a hinge, thanks to which the hip joint is able to produce various rotational movements in a healthy state.
In normal condition, the femoral head and the cavity of the acetabulum are covered with a layer of hyaline cartilage. The articular cartilage is a very smooth, firm and resilient "padding" that provides an ideal glide of the connecting bones relative to each other. Also, the cartilage is involved in depreciation and load distribution during walking and movement.
Ideal slip of articulated bones is possible due to the special physiology of the cartilage. It works on the principle of a wet sponge, which during the squeezing releases water, and after compression again fills its pores with water. Only in contrast to the usual sponge, from the cartilage is not allocated water, and articular fluid, which has a special lubricating properties. It is the articular fluid that forms the protective film on the surface of the cartilage. The thickness of the protective film depends on the degree of stress on the joint. That is, the greater the pressure force, the larger the layer.
Filling the entire free space in the joint cavity, the joint synovial fluid provides nutrition and lubrication of the cartilage. The joint cavity is surrounded by a capsule, which consists of very strong and dense fibrous fibers.
A very important role for the normal functioning of the hip joint is played by the surrounding massive muscles - gluteal and femoral. If the muscles are poorly developed - the correct movement of the joints is impossible. In addition, the femoral and gluteal muscles take on a part of the load when running and walking, thus playing the role of active shock absorbers. It is thanks to very well developed muscles, the joint trauma decreases with unsuccessful movements, running, jumping or long walking.
And do not forget about another very important function of the muscles: during their intense motor work they perform the role of a kind of pump and pump through their blood vessels very large volumes of blood. It is because of this that the blood circulates better around the joint and delivers the necessary nutrients to it. Accordingly, the more perfect the work of the muscles, the more circulating blood circulates through them and the more nutrients the joint gets from the body.
Mechanism of arthrosis development
So what happens with the joint during the development of deforming coxarthrosis? At the beginning of the disease, the properties of the joint fluid change - for various reasons it becomes viscous and dense. And without proper "lubrication" articular cartilage begins to dry up, and its surface becomes rough and covered with cracks. As a result, the cartilage begins to thin, since it does not withstand increased friction during movement. And the distance between the articulating bones of the joint gradually decreases. Bones seem to be exposed from under the cartilage, the pressure on them increases and they begin to deform. That is why the disease of coxarthrosis is called deforming arthrosis of the hip joint.
In addition to changing the properties of the joint fluid, there is a violation of blood circulation and thus slows the metabolism in the joint, due to the reduction of blood circulation through its vessels. Over time, the muscles of the sore leg atrophy. The whole process takes place in the body gradually. But sometimes the chronic course of the disease is accompanied by periods of severe exacerbation of joint pain, this is the so-called period of "reactive" inflammation of the joints. It is during this period that sick patients often seek medical help from a doctor.
Causes of coxarthrosis
Reasons for the appearance of this disease are in fact very many:
- circulatory disturbance in the joint - worsening of venous outflow and arterial inflow. As a result of insufficient supply of tissues, accumulation of under-oxidized metabolic products takes place, activating enzymes that destroy cartilage;
- mechanical factors that cause joint overload. Most often overloads are subject to professional athletes. But you can also include people with excess body weight. And since complete people are also characterized by metabolic and circulatory disorders, then in combination with overload on the joint, it is they who very often joints are affected by arthrosis;
- biochemical changes in cartilage, metabolic disorders in the human body, hormonal changes;
- trauma( pelvic fractures, cervical fractures and traumatic dislocations).It is the trauma that leads to the development of coxarthrosis of the hip joints in young people;
- aseptic necrosis of the head of the hip;
- infectious processes and inflammation of the joints;
- pathology of the vertebral column( scoliosis, kyphosis) and feet( flat feet);
- congenital hip dislocation - takes about 20% of all arthroses of the hip joints;
- congenital dysplasia( joint development disorder);
- "lack of training" as a result of a sedentary lifestyle;
- predisposition and heredity of the body. Undoubtedly coxarthrosis itself is not inherited, but here the weakness of the skeleton, the features of the structure of the cartilaginous tissue and metabolism are transmitted genetically from the parents to the child. Therefore, if your parents or close relatives are ill with arthrosis, then the risk of getting a diagnosis of coxarthrosis rises.
Symptoms of coxarthrosis
General symptoms of coxarthrosis of the hip joint can be identified, but it must be understood that the symptoms depend on the stage of the disease:
- pains in the joint, thigh, inguinal region, at the knee, both under load and at rest;
- stiffness and stiffness of movements;
- the aching leg becomes shorter;
- there is an atrophy of muscles of a femur;
The main symptom of coxarthrosis and the main complaint with which patients turn to the doctor is pain. The nature, duration, intensity and localization of which depends on the stage of the disease. At the initial stage, when it is best to start treatment, joint pain is still quite weak. That's why patients do not immediately rush to see a doctor, hoping that the pain will go somehow miraculously by themselves. And this is the most important mistake, which leads to loss of time and destruction of the joint. Painful sensations begin to increase, and the mobility of the aching leg is limited. Pain appears already at the first steps and subsides only in a state of rest. The patient begins to limp, crouching when walking on a sore leg. The muscles of the thigh atrophy - shrink and decrease in volume.
The most interesting thing is that the atrophy of the hip muscles causes the pain in the knee region and in the attachment of tendons. And the intensity of pain in the knee can be much more pronounced than the femoral or inguinal. That is why very often the wrong diagnosis is made - arthrosis of the knee joint and the doctor prescribes a completely inappropriate treatment, and the present disease only progresses.
By the way, pain in the thigh and groin, can be caused in the patient not only by arthrosis. Very often pains in these areas are given from the inflamed femoral tendon or damaged spine. Moreover, the complaints of such patients almost coincide with the complaints of those people who suffer from coxarthrosis of the hip joint. Therefore, the correct diagnosis should be entrusted only to experienced doctors. Diagnosis of the degree of disease and choice of treatment is determined only by a doctor!
Degrees of coxarthrosis
There are three degrees of arthrosis of the hip joint:
For coxarthrosis of the 1st degree, periodic pains occur after physical exertion( prolonged walking or running).Basically, pain concentrates in the hip joint area, rarely occurs in the thigh and knee area. Usually after rest the pain passes. The amplitude of the movements is not limited, the gait is not violated, muscle strength is not changed. If you make an x-ray at this stage, you will see slight bony growths, but they do not go beyond the joint lip. Bony growths are located around the inner or outer edge of the articular surface of the acetabulum. The cervix and the head of the femur are practically unchanged. The joint gap is unevenly narrowed.
In coxarthrosis of the 2nd degree, the pain intensifies and is more intense. In addition to pain in the joint itself, they are given to the inguinal region, thigh and arise even in a state of rest. Long walking causes lameness. Normally, the joint can no longer function. The internal rotation and hip removal are significantly limited. The muscles that remove and unbend the hip loosen their former strength. On the roentgenogram of the patient, significant bone growths are seen both on the inner and outer edges of the acetabulum, which extend beyond the boundaries of the cartilaginous lip. The head of the femur is deformed, enlarged in volume and has an uneven contour. In the most loaded parts of the head and swivel cavities, cysts are possible. The neck of the femur extends and thickens. The slit of the hip joint is unevenly narrowed( up to 1/3 - 1/4 of the initial height).The patient tends to shift the head of the hip to the top.
Pain in coxarthrosis of 3 degrees is already permanent, arising even at night. When walking, the patient must use a cane. Movement in the joint is severely limited, the muscles of the thigh, lower legs and buttocks - atrophy. Because of the weakness of the hip muscles, the pelvis tilts in the frontal plane, which leads to a shortening of the limb on the affected side. To get to the floor when walking, the patient has to step on the toes and tilt his torso on the sore side. This is how you have to compensate for the shortening of the limb and the slope of the pelvis. But the method of compensation leads to the movement of the center of gravity and to overloads on the joint. On the radiographs, extensive bony enlargements are seen from the side of the femoral head and the roof of the swivel cavity. The joint gap narrows sharply. The neck of the thigh is greatly expanded.
Deforming osteoarthritis of the hip joint and its diagnosis
Diagnostics is based on clinical radiology data. Radiographic examination helps to establish the stage of the disease and its etiology. For example, with dysplastic coxarthrosis, flattening and slanting of the acetabulum and an increase in the neck-diaphyseal angle are clearly visible. If the disease was a consequence of juvenile epiphysiolysis or Perthes disease, then changes in the shape of the proximal end of the femur are noticeable. There is deformation of the head and the neck-diaphyseal angle decreases with the formation of coxa vara. Features of the x-ray picture of posttraumatic coxarthrosis depend on the nature of the resulting injury and the shape of the articular surfaces after the fusion of the bones forming the hip joint.
Recall once again that the complexity of the primary diagnosis is that the symptoms of arthrosis of the hip joint resemble the symptoms of the knee. But X-ray studies help to make an accurate diagnosis. It is from the correct diagnosis of the disease depends on the choice of treatment methods. More details about all possible methods of treatment of this disease, we will talk in the article - "Treatment of coxarthrosis."
And most importantly - do not make a diagnosis yourself. Only an experienced doctor can correctly diagnose and select the optimal method of treatment.