Most often, the cause of pain in the thigh is a fit or bruise. However, in some cases, the pain syndrome accompanies severe pathologies. The basis of therapy is painkillers, reduced physical activity, as well as treatment of the root cause of the patient’s condition. The reason for this is a long diagnostic search, during which the specialist has to exclude more than twenty different diseases of the bones, muscles, joints, blood vessels and nerves. Diagnostics consists of a clinical examination, laboratory and instrumental methods of research.
Why does it arise?
The thigh is a powerful bone that is movably connected to the human body through the hip joint. This system sets in motion a number of muscles – biceps, quadriceps, tailor and others.
Pain in the thigh is a protective signal that sends a person’s body to his consciousness. Most often, pain occurs with reversible functional disorders. However, in some cases, the pain syndrome appears in response to significant pathological changes in the body.
The possibility of voluntary action, as well as sensitivity provide the femoral and sciatic nerves. And for the “nutrition” of these structures are responsible branches of the iliac artery and veins.
Given the complexity of the structure and functioning of the lower limb, difficulties arise in diagnosing the patient’s condition. After all, the cause of pain can be damage to both the musculoskeletal system and the neurovascular bundle.
Among the most common causes of hip pain are:
Bone pathology. One of the most common pathologies of the femur is injury. At a young age, damage to the body (diaphysis) of the bone is usually found, while in old age – fractures of the femoral neck. They provoke similar fall conditions, traffic acc >
The strength and nature of the pain in the hip largely depends on the immediate cause of the patient’s condition. Most often, pain syndrome provokes a fracture or dislocation of the femoral neck, arthritis, arthrosis, dermatomyositis, sciatica, as well as deep vein thrombosis of the lower extremities.
With a dislocation of the femoral neck, the patient is disturbed by a sharp pain in the hip joint that extends to the thigh. The limb takes a forced position – it is bent at the knee, and also deployed inwards or outwards (which depends on the type of dislocation). The joint itself is curved, the movements in it are difficult and painful, while there is a shortening of the limb from the side of the lesion.
Fracture of the femoral neck has a similar clinic – acute pain and restriction of movement. However, the limb is always turned outward, while turning inward is impossible. A symptom of a “sticking heel” is characteristic, when the patient cannot tear off the injured limb from the bed while lying down. Shortening of the injured leg by 3-4 centimeters is often noted.
Hip inflammation (coxitis) often develops against infections, rheumatism, gout, or psoriasis. Usually pains appear in the area of the joint, groin and thigh. The joint significantly increases in size due to the accumulation of inflammatory contents in it (synovial fluid, pus). The skin above the joint becomes swollen, hot and red. The range of motion is reduced, due to which patients begin to limp.
With rheumatism, these changes are observed from two sides, with gout – from one side. If the cause of the inflammation is psoriasis, a bluish-purple coloration of the skin above the joint occurs, and psoriatic plaques are detected on the body. In infections, the general deterioration of the patient’s condition comes first: fever, fever and muscle weakness.
Destruction of the articular cartilage – coxarthrosis – is accompanied by aching pain in the hip joint, “spreading” to the thigh. As a rule, the pain syndrome has a “starting” character, ie arises at the beginning of movements and disappears at the peak of physical activity. Usually soreness worsens in the evening or during a night’s sleep, while stiffness is observed in the morning (usually up to half an hour).
With the progression of the ailment, pain occurs at rest, meteosensitivity appears (“turns on the weather”), a feeling of tension in the joint, cramps and a characteristic “crunch” during movements. In the later stages of the disease, significant stiffness develops, provoking lameness. Over time, patients cannot move independently, which is why they are forced to use a cane or crutches as additional support.
Typically, patients are disturbed by a symmetrical widespread muscle weakness, which makes walking, climbing stairs and even turning in bed difficult. Over time, the muscles become depleted, there is pain in the thigh. If the diaphragm is damaged, breathing is disturbed (shortness of breath appears, inhalation “full breast” is impossible). If the pathological process covers the larynx, the voice becomes hoarse or disappears altogether.
Muscular manifestations are often accompanied by skin – the appearance of pink plaques on the extensor surface of the joints. A classic symptom is a heliotropic rash that occurs on the eyelids in the form of red spots – “purple glasses”. Often the pathological process affects the joints, heart, lungs, gastrointestinal tract, and also the gonads.
The leading symptom of sciatic nerve damage is hip pain – sciatica. It is observed along the inflamed nerve bundle and is usually one-sided. The severity of the pain syndrome can vary, but more often it is severe pain, limiting the mobility of the affected limb. The maximum pain is on the buttocks and the outer surface of the thigh, but the pain can spread to the lower leg, foot, or lower back.
The nature of the pain syndrome is often burning, sometimes pulling or aching. In this case, the pain worsens during coughing, gagging, changing body position, laughing or sneezing. The provocateurs of pain are riding in shaky vehicles, jumping, running or abrupt turns of the body. The pain in the thigh is also aggravated due to the tension of the nerve fibers – when abducting the leg or lifting it from a prone position. The mobility of the affected limb is limited mainly due to pain and muscle tension.
When a nerve is irritated, “false sensations” appear – paresthesia in the form of goosebumps, burning, numbness on the lateral surface of the thigh, lower leg and foot. During significant infringements of the nerve column in the marked areas, skin and vibration sensitivity drop out. In some cases, complete or partial immobilization of the muscles of the posterior thigh occurs – paresis or paralysis. In the later stages, the skin on the legs peels off, hair falls out, and sweating decreases.
Deep vein thrombosis
The initial stages of the disease are asymptomatic. Over time, patients experience intense, abdominal pain in the lower leg that extends to the thigh and groin. The affected limb significantly increases in volume due to edema (the difference is more than 2 centimeters in girth compared to a healthy leg), the skin becomes bluish, and under it are expanded superficial veins.
The general condition of patients often worsens: the temperature rises to 38 ° C, fever and severe weakness occur. The mobility of the affected limb is significantly limited – patients begin to limp.
Diagnosis of pain in the thigh depends on their immediate causes. Usually a survey is conducted (to clarify the circumstances of the onset of pain) and a clinical examination (in order to confirm the preliminary diagnosis).
Diagnostic searches include laboratory methods – conducting rheumatic tests, determining blood coagulability, the level of muscle breakdown enzymes, etc. Among instrumental studies, ultrasound diagnostics of lower limb vessels, x-rays, as well as computed tomography of the femur and hip joints are more often used.
If the final diagnosis is difficult, an MRI or joint puncture is prescribed (“puncture” with a fence of contents). In some cases, resort to arthroscopy – the introduction of special video equipment into the articular cavity through micro-punctures.
Therapeutic measures depend on the primary disease. However, a protective regime is common, which is to limit the load on the affected limb.
With hip dislocations, a comparison of the articular surfaces is performed. Typically, the procedure is carried out under anesthesia with the use of muscle relaxants necessary for muscle relaxation. After the reduction, limb traction is applied with a load of 3 kilograms to prevent shortening of the leg.
For hip fractures, surgical treatment is preferred. Usually a surgical comparison of bone fragments is performed – osteosynthesis. In some cases, replacement of the hip joint with an artificial prosthesis is required.
With active inflammation, your doctor will prescribe non-steroidal anti-inflammatory drugs (Indomethacin, Diclofenac, Ibuprofen) to reduce hip pain and swelling. In advanced cases, resort to intraarticular injections of corticosteroids (Diprospan, Triamcinolone). In parallel, basic therapy is conducted to treat the underlying disease – rheumatism (Delagil, Plaquenil), gout (Colchicine, Allopurinol), infections (antibiotics of various groups) or psoriasis (Tipodepressin, Apremilast).
With coxarthrosis, non-steroidal anti-inflammatory drugs (Ketorolac, Diclofenac, Analgin) are used as painkillers. Chondroprotectors (Don, Structum) are prescribed as dietary supplements or intraarticular injections. Also, in order to slow down the destruction of cartilage surfaces, hyaluronic acid is introduced into the joint cavity. In the later stages of the disease, endoprosthetics are recommended.
The basis of therapy is a decrease in the reactivity of the immune system due to glucocorticoids (prednisone) or cytostatics (methotrexate, azathioprine).
Treatment of lesions of the sciatic nerve consists in anti-inflammatory effects (Ibuprofen, Nimesulide, Indomethacin). In case of persistent pain, corticosteroids and anesthetics (Hydrocortisone + Novocaine) are injected into the paravertebral region. In some cases, surgical intervention may be required, the volume of which depends on the cause of sciatica (osteochondrosis, spondylolisthesis, etc.).
Deep vein thrombosis
When blood clots form in the veins of the lower extremities, tight bandaging of the legs or the use of compression stockings is recommended. As the main line of treatment used low molecular weight heparins (Enoxaparin, Dalteparin), contributing to the “thinning” of the blood. In order to prevent the spread of thrombotic masses throughout the body, a cava filter is installed inside the vena cava – a special network for the “capture” of blood clots.
Prevention of hip pain includes:
- Early correction of congenital developmental disorders (dysplasia);
- Prevention of injuries – dislocations and fractures of the femoral neck;
- Recovery of trace elements deficiency in order to prevent osteoporosis;
- Treatment of inflammatory diseases of bones and joints (arthritis, osteomyelitis);
- Following basic therapy for incurable diseases – psoriasis, dermatomyositis, etc .;
- Restoring the stability of the spinal column with osteochondrosis and spondylolisthesis in order to prevent sciatica;
- Tight bandaging of the limbs during and after surgical interventions, as well as avoiding prolonged immobilization in order to prevent thrombosis;
- Early diagnosis of oncological diseases of bones (osteoma, osteosarcoma) and other organs (prostate, breast, kidney);
- Reducing physical activity on the lower limbs to prevent the development of arthrosis.
In most cases, the pain in the thigh has a benign course and passes on its own within 2-4 days. However, persistent pain syndrome in combination with additional symptoms may indicate serious pathologies that contribute to persistent disability and early mortality of patients!
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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