What is teninosis of the hip joint and how to treat it

Tendinosis of the hip joint (Tendinosis of TBS) is atrophic changes and subsequent degeneration of fibers within the tendon. Pathology is non-inflammatory in nature and is associated with chronic tendonitis. Violation provokes a partial or complete rupture of the tendon. The cause of the disease is protracted arthritis and arthrosis, previous injuries. The most vulnerable age category is the elderly and the elderly; social – people of great physical and / or monotonous stress, athletes. Calcium deficiency in the body is an aggravating condition that must be taken into account when planning treatment.

Symptoms

Patients who have not previously encountered problems of the musculoskeletal system will not understand that the cause of their pain is tenos of the hip joint; what is it, the doctor explains while taking the patient. From the consultation it is clear what signs the violation manifests itself and how it is better to eliminate it in a particular patient.

Typical symptoms of tendinosis:

  • pain syndrome. Localization – the external or internal surface of the thigh, lower abdomen, lumbar and sacral parts of the back (depending on the type of disease);
  • impaired motor activity. With the defeat of the long adductor muscle, the limb completely loses its functional ability. At all stages of the pathology, hip abduction is difficult;
  • joints crackle with little physical exertion if it was preceded by a state of rest.

The remaining symptoms depend on the stage of the disease, the individual sensitivity of the patient to pain. Additional signs include edema, hyperemia, neurological disorders (sleep disturbance, irritability, fatigue).

Diagnostics

Determining the fact of joint pathology involves interviewing a patient, examining, conducting functional tests. Endoscopic verification of pathology is relevant only if necessary. Laboratory methods are secondary.

Informative sources of the condition of the hip joint are X-ray examination, MRI and ultrasound.

Type of diagnostic procedureDestination purposeAdvantages of the diagnostic method
X-ray examinationConducting differential diagnosis with tuberculous trochanteritis. Diseases have similar clinical manifestations, especially before fistula formation.It is possible to quickly distinguish between TBC tendinosis and trochanteritis. The radiological picture is different, despite the symptomatic similarities of the two diseases. If during tuberculosis a bone defect is established on radiographs, then in osteophytes additional tendencies are visualized due to ossified tendons
MRIDetermine the thickness of the tendon (in a particular case, it is thickened), its structure (in case of TBC tendinosis, it is heterogeneous)Enhanced visualization method. Quick determination of the current state due to equipment features – the increase in signal intensity in all pulse sequences is determined
USThanks to ultrasound scanning (sonography), a clear image of soft tissues is obtained: tendons, ligaments, joint capsule, synovial bagsIt is possible to evaluate all the studied anatomical structures that cannot be examined using a standard X-ray examination

Dr. Epifanov about testing TBS:

Also, a specialist can expand diagnostic appointments based on the expected stage of the disease and related disorders.

Treatment

It is important to confirm by diagnostic methods at what stage the tendinosis of the hip joint is treated conservatively (in 80% of cases) only because patients seek medical attention in a timely manner. It is not worth hoping for the self-liquidation of the disease – this will lead to a loss of time and the need for surgical intervention. The same applies to attempts to treat tendinosis with traditional medicine.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Conservative

The main goal is to anesthetize the patient and restore his motor activity. To achieve the objectives assigned:

  1. Nonstero />
  2. Vitamin complexes (to improve tissue trophism, eliminate neurological disorders, normalize blood supply).
  3. Antibiotics (if tendinosis is caused by an infectious lesion).

When treating tendinosis of the hip joint, doctors are careful when prescribing hormone therapy.

Injections of corticosteroids reduce the tensile strength of the tendon, tearing it, especially if the procedure is performed incorrectly or too often. In this regard, the use of hormones in the form of injections is justified only in the acute period and not more than 1 time in 3 weeks.

It is necessary to limit the mobility of TBS – immobilization is achieved by using elastic bandages, bandages, orthoses. Plaster is superimposed less often.

Surgical

Even “neglected” joint problems can be cured at home! Just remember to smear it once a day.

Tendon repair with autografts is a complicated and rather expensive operation. It assumes a full state of the heart, because in order to ensure an adequate depth of anesthesia, doctors widely use Diprivan and narcotic analgesics in their practice (in 68,3%). This combination puts a strain on the heart, because on the eve of the intervention, special attention is paid to ECG indicators. Given the high risk of complications and a long (more than 3 months) recovery period after surgery, doctors try to prescribe surgery only in severe cases when prolonged administration of NSAIDs and antibiotics is ineffective or contraindicated.

Physiotherapeutic

A competent specialist is never limited to medical treatment if the task is to eliminate the disease. Simultaneous exposure to physiotherapeutic methods allows you to quickly achieve better patient well-being.

Dr. Epifanov about the benefits of physiotherapy:

Among these areas are used UVT. Tendinosis is well eliminated by the impact of shock wave therapy.

The technique provides the following long-term effects:

  • contributes to the loosening of calcium crystals and segments of fibrosis, formed due to acute or chronic damage;
  • improves the degree of blood supply in areas of damaged tissues, stimulates their recovery;
  • helps to normalize the structure and elasticity of ligaments;
  • permanently eliminates pain.

A separate advantage of the procedure is established – the ability to form a new capillary network – neoangiogenesis. The process improves metabolism in the hip joint, which, due to the development of tendinosis, is not adequately supplied with blood. The formation of a new network of capillaries is carried out for 95 hours after exposure to shock waves.

Despite the many advantages of the technique, there are contraindications to its implementation:

  1. Blood clotting disorder.
  2. The presence of confirmed oncological processes in the hip joint (if the tumors are malignant).
  3. The period of gestation and lactation.
  4. The presence of a pacemaker.
  5. Suppuration in the area of ​​the hip joint.

In order to have a positive effect on TBS teninosis, it is enough to carry out 2 procedures for the impact of UVT with the Piezoson 100 brand of the German company Richard WOLF. It is recognized as an efficient equipment, patented and focused on widespread practice. The device meets the requirements for the safety of physiotherapy equipment. Piezoson 100 was approved by members of the German shock wave therapy company.

A course consisting of 2 procedures should be carried out no more than 3 days later. A shock wave should be generated with a frequency of 4 strokes per second – 1 procedure involves the impact on the joint of 2000 strokes.

It is important to increase the level of impact energy from 1 to 3 gradually, taking into account the patient’s sensations. For effective, but safe manipulation, a special silicone gasket is used. Her doctor determines the penetration depth of the pulse, which should be no more than 1 cm in the treatment of tendinosis of the hip joint. For high-quality pulses, a gel is placed between the pad and the skin of the patient. The therapeutic head of the wave is directed to the focus of pathology.

Immediately after the treatment procedure, the patient notes the absence of typical pain inside the joint, there is a sensation of a surge of heat. On day 2, a relapse of pain occurs, gradually decreasing towards evening. After 2 manipulations, discomfort is significantly reduced. The pain syndrome is stopped closer to 7 days from the moment the physiotherapeutic effect began.

Tendinosis of the hip joint suppresses UVT for the following reasons:

  • the technique allows for outpatient care;
  • exposure is non-invasive;
  • case of side effects – 1 out of 1000, minimal risk probability;
  • exposure does not require prior anesthesia;
  • well-being is fast;
  • The achieved therapeutic effect is long-term.

Shock waves activate the body’s own restorative mechanisms for recovery.

Conclusion

Tendinosis of the hip joint involves neuroreflex disorders, under the influence of which trophism of soft-tissue structures changes. Conservative treatment involves the introduction of NSAIDs, painkillers; Active vitamin therapy and unloading measures (orthoses, providing additional support during movement) are also required. Since the type of pathology under consideration is difficult to diagnose, it is important to visit a doctor when the first signs of a violation appear – pain, stiffness in the joint.

Anatoly Kudravets

Anatoly Kudravets, Orthopedic Traumatologist. He works with severe cases, practices operative methods of treating connective tissues

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