Fluid accumulation in the hip joint

Anatomy: The hip joint consists of the hip socket (acetabulum) and the femoral head (caput femoris). The articular surfaces are coated with a cartilage layer a few mm thick, which reduces the load on the articular surfaces.

Cause: Many repeated loads or one violent load can cause an inflammation of the synovial membrane (synovitis), fluid formation, swelling, restriction of movement and pain in the hip joint. The condition is relatively often seen in children(Drawing).

Symptoms: Smerter i leddet ved bevægelse med belastning. Ofte vil der være bevægelsesindskrænkning ved rotation i hofteleddet.

Examination: It will often be necessary to supplement the ordinary clinical examination with an ultrasound scan, where the fluid in the hip joint can easily be seen (Ultrasonic image).

Treatment: The treatment primarily comprises relief from the pain inducing activity until the swelling has abated. Rehabilitation, within the pain threshold, can subsequently be commenced. In cases of lack of progress with relief the treatment can be supplemented with a medical treatment in the form of rheumatic medicine (NSAID) or by drainage of the joint fluid which should be done with ultrasound guidance.

Rehabilitation of children and adolescents: When the pain has diminished, walking and gradually thereafter running, can be cautiously resumed within the pain threshold, in accordance with rehabilitation of children and adolescents in general.

Complications: lack of progress it should be considered if the diagnosis is correct (article). In particular you should consider a bacterial infection in the joint (pyarthron), which is determined by ultrasound guided draining of the joint fluid, the child hip diseases epifysiolysis capitis femoris (article), Calvé-Legg-Perthes disease (article) and inguinal hernia.