Health and Fitness

Thigh pain: muscular and non-muscular causes

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Thigh pain, more or less intense, is a symptom that can be caused by different clinical conditions, but which in most cases concerns the anatomical structures of this body region. Normally one is led to think only of the muscular component (including the quadriceps femoris, adductors, hamstring, semitendinosus), but they are actually also present:

  • Bones (femur),
  • Hip or knee joints,
  • Nerves (sciatic, crural, lateral cutaneous of the femur),
  • Blood vessels,
  • Tendons and ligaments.

In some cases, the pain does not originate primarily in the thigh but radiates to this area from other regions or structures in the body.

The extent of the pain and the associated symptoms vary by virtue of the triggering cause and, only after having identified the reason for the painful symptomatology, through the implementation of the necessary clinical-diagnostic investigations, it is possible to evaluate the most appropriate treatment.

The recovery time and the possibility of recovery are closely related to the underlying cause of the pain reported by the patient, for which the prognosis is variable (in some cases the symptoms resolve in a short time, in others, due to the presence of complications or a more serious underlying disease, healing times can be extended).

Associated causes and symptoms

Various clinical conditions can cause pain to appear in this region of the body, which extends between the hip and the knee; among the main causes, it is possible to distinguish:

Muscle injuries: these are the most common traumas in sports medicine (they make up 10 to 30% of all sports injuries) and can arise due to a blow received (in this case we will talk about injuries from direct trauma or bruises) or due to incorrect movement (indirect trauma injuries). Pain related to the thigh may be associated with soreness, muscle spasms in the painful region, difficulty in moving the affected region, and bruising.

Bruises: easy to diagnose (in most cases it is possible to clearly identify the exact moment in which the pain appeared, precisely because it resulted from a direct and recent stimulus), they can be of mild, moderate, or severe severity; the implementation of timely treatment usually makes it possible to resolve the painful symptoms, based on the time provided for the individual case in question.

Indirect trauma: they can be due to phenomena of alteration of the tone of the muscle fibers (in cases of lesser severity) or to real injuries of the muscle fibers (in the most severe cases) and usually result from excessive physical efforts, with respect to the ability to contract involved muscle fibers. This type of injury can be further classified, in order of severity, as follows:

  • Contractures (less of a concern);
  • Stretching (of intermediate severity);
  • Strains (the most serious of all).

Arthrosis: is a chronic, degenerative disease that affects the articular cartilage and subchondral bone (located below the cartilage). Thigh pain is associated with:

  • Rigidity,
  • Swollen knee,
  • Circulation problems.

Arthritis: inflammatory condition involving, in the case of pain related to the thigh, the knee joint.

Meralgia paresthetica: it is a pathology of the nerves, also known as Bernhardt-Roth syndrome, due to the entrapment of the lateral femoral cutaneous nerve by the inguinal ligament. The involvement of the sensory component of the nerve causes pain (similar to burning) in the upper and outer part of the thigh, associated with tingling and a sense of numbness, along the course of the femur.

Iliotibial band syndrome: also known as “runner’s knee” (in fact it mainly affects runners), it manifests itself with pain that appears during running, when the heel comes into contact with the ground; it is due to an overload of the connective tissue located on the outside of the knee and thigh, which normally stabilizes the joint during flexion and extension movements.

Peripheral neuropathy: it is a pathology that affects the peripheral nervous system, induced by numerous pathological conditions (for example diabetes, alcoholism, vitamin deficiencies, hypothyroidism, amyloidosis, chronic kidney and liver diseases); thigh pain may be associated (depending on the underlying condition) with:

  • Muscle cramps and tingling along the thigh,
  • Reduction and weakening of the muscle mass of this region,
  • Difficulty moving and loss of balance,

Allodynia (perception of painful impulses following harmless stimuli, such as, for example, simply touching the affected part),

  • Constipation,
  • Diarrhea,
  • Difficulty urinating,
  • Dysfunction in the sexual sphere (for example, erectile dysfunction in men).

Deep vein thrombosis: clinical condition induced by the formation of a thrombus in a deep vein of the human body; it is a very dangerous event because it can cause a stop of blood flow along the involved vessel or the formation of emboli which, after reaching the heart through the venous circulation, can move into the pulmonary artery, obstructing it and causing pulmonary embolism.

Among the most predisposed subjects are obese patients, women who use hormonal contraceptives (for example the pill ), smokers, people who hold a static position for long periods of time, and patients with genetic mutations. In this case, the thigh pain is typically associated with swelling, tenderness, warmth, redness, or bluish discoloration of the skin.

Trochanteritis: inflammatory pathology that concerns the lateral portion of an anatomical district of the hip, at the point of insertion of the prominence of the femur, called the greater trochanter; it can be traced back to traumatic causes (falls, blows, repetitive movements) or postural. It manifests itself with pain affecting the lateral-superior portion of the thigh, swelling, redness, heat, stiffness of the hip, and local soreness.

Symptoms

Thigh pain, of varying intensity, can be described by the patient in a number of ways, including:

  • Acute;
  • Frequent;
  • Burning;
  • Button;
  • Stabbing;
  • Related to movements.

Based on the triggering cause, it will then be accompanied by the specific symptomatological procession of each individual clinical condition, already illustrated previously.

Diagnosis

The diagnostic process is aimed at identifying the underlying cause and mainly uses:

  • Anamnesis and physical examination: the doctor examines the affected region and interrogates the patient in order to identify what the reported symptoms could be traced back to, in the first instance.
  • Instrumental diagnostic tests: ultrasound and/or magnetic resonance imaging may be requested to definitively clarify the clinical suspicion.
  • Neurological tests (neurological examination, electromyography );
  • Blood tests.

Treatment

  • Only once the diagnosis has been established is it possible to set up a specific treatment depending on the case.
  • In cases of simple muscle fatigue, it is important to abstain from physical activity for a variable period of time (sometimes a single day is enough), in order to soothe the tension of the muscle fibers and relieve painful symptoms.
  • In cases of injury to the thigh muscles, in addition to rest, medical or physiotherapy treatments may be necessary.
  • In cases of pain attributable to peripheral neuropathy, in addition to therapy for the underlying disease, it is possible to manage the pain through the use of analgesic drugs ( paracetamol or nsaids ) or, alternatively, under medical advice, with the use of: antiepileptics (pregabalin, gabapentin), antidepressants (amitriptyline and nortriptyline), or through the local application of capsaicin.

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