Elderly hip pain



Because the elderly are prone to osteoporosis, this makes the femoral neck of the elderly more vulnerable, and sometimes a slight fall can cause a fracture. In addition, the blood flow in the femoral neck of the elderly is relatively poor, which leads to the clinical symptoms of hip pain after the fracture of the elderly, the wound does not love healing or the avascular necrosis of the femoral head.



Femoral neck fracture is one of the common fractures of middle-aged and elderly people. The femoral neck fracture of middle-aged and elderly people is caused by indirect violence, mainly due to external rotation violence, such as flat fall and sudden torsion of lower limbs. Most of them are due to road slippage, uneven roads, and lower limb torsion, inversion or eversion when the upper and lower steps fall. At the same time, there are internal factors, such as osteoporosis, which are important because of the frail old age, low neuromuscular regulation ability, inflexible joints, and lack of defense against external injuries. Because the osteoporosis of the femoral neck is fragile and the pressure is high, only a small amount of external force is required to cause a fracture.

Hip pain in the elderly after trauma, inability to move, should be considered hip fractures, including femoral neck fractures. A common special manifestation is pain and tenderness. Hip pain after a fall injury, tenderness in front of the hip and slamming pain in the sole of the foot, called indirect snoring, is an important sign of the fracture. Older people have hip pain after falling, do not dare to stand and walk, it is likely to be a femoral neck fracture. In addition to spontaneous pain in the hip, the pain is more obvious when the limb is active, but sometimes the fracture has only cracks and no displacement. The patient's pain is not obvious, and even standing and walking can be easily missed.


an examination

Related inspection

Hip and knee flexion test hip joint overextension test

Hip fractures often occur after the fall of the elderly. After the fall, there is general pain in the affected hip. Sometimes, or self-reported knee pain (the reason for obturator nerve reflex), can not stand, the external rotation of the limb ("outer eight characters") With a slight shortening that causes the lower limbs to be unequal, these are very diagnostically valuable. Pain can occur in the front of the affected hip when examined, and slamming the heel can exacerbate the pain. The diagnosis of X-ray confirmed fracture should be taken immediately, and the type should be judged. In general, elderly patients with hip fractures need only have a timely X-ray examination, and there is no difficulty in accurate diagnosis. However, special attention should be paid to some non-displaced fractures. After the injury, the patient can still walk. At this time, the fracture line can not be seen, which may easily lead to missed diagnosis. The patient often walks and eventually causes the fracture to be completely dislocated. Therefore, for some elderly patients with injuries who have no obvious symptoms and examinations, you can take a further CT examination, or let the patient wear special "T" shaped wooden shoes for 2-3 weeks, and then do X-ray examination.


Differential diagnosis

Differential diagnosis of hip pain in the elderly:

1, lateral hip swelling and tenderness: lateral hip swelling, tenderness is one of the clinical diagnosis of femoral intertrochanteric fractures. Intertrochanteric fractures occur mostly in the 66 to 76 years old. The incidence of women is three times higher than that of men. Griffin and Boyd's study of 300 cases of intertrochanteric fractures showed that the mortality rate of patients within 3 months after injury was 16.7%, which was about twice the mortality rate of patients with femoral neck fractures. The reason for such a high case fatality rate is that the patient is older, causing a heavier fracture, a large amount of blood loss after the fracture, and a relatively large treatment operation. It can be seen that the intertrochanteric fracture is a more serious fracture.

2, hip joint pain: folks commonly known as "squatting pain." In medicine, we call it "hip pain", referred to as "hip pain", which is an uncomfortable pain around the hip or joint. There are many causes of hip pain, and there are different reasons for different age groups.

3, hip soreness discomfort: acid swell caused by acetabular dysplasia will initially be located in the knee joint, and then mainly located in the hip, thigh root, groin area. The initial performance is the soreness of the hips. It will increase after standing for a long time or after a long walk. It will generally improve after the break. Most patients will think that they are tired or sprained and have not paid attention to it.

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