Arthritis thigh pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

There are many causes of thigh pain and the location of the pain as well as the history often provides clues to diagnosis. Arthritis is only one cause so it's important to be cognizant of the other causes besides arthritis.

Timing is often the most important predictor. For example, if patient says they were engaged in a recreational activity like tennis, basketball, or hockey where there are quick changes in direction and describe groin pain, the likelihood is they have a groin muscle pull. The hip flexor muscles, specifically the iliopsoas muscle and the adductor muscles (the ones that help bring the leg toward the midline) are the ones that are often affected. The pain is aggravated by flexing the hip.

Groin pain can also occur as a result of bursitis. The iliopsoas bursa which helps cushion the front of the hip can become inflamed as a result of trauma or overactivity and cause pain in the groin and front of the thigh.

A common cause of anterior thigh pain in slightly older individuals is osteoarthritis of the hip. The pain from this disorder can radiate down the front of the thigh all the way to the knee. As the arthritis gets worse, pain can also be felt in the buttock.

A hamstring pull is also often seen as a result of sports where a sudden acceleration and deceleration occurs. Examples would be sprinters, football players, soccer players, and the like. The hamstring group of muscles are located in the back of the thigh and connect the lower portion of the pelvis to the back of the knee. They help with knee flexion and hip extension. Hamstring injuries can affect the mid portion of the muscle or the insertion at the rear of the pelvis. They are intensely painful and slow to heal.

Bursitis in the ischiogluteal bursa literally causes a pain in the butt. It is also known as "weaver's bottom." The pain radiate further down into the back of the thigh.

Bursitis can also occur on the outside (lateral) part of the hip. The area around the greater trochanter of the hip is replete with bursae and they can become inflamed or irritated as a result of trauma and overactivity. Excessive weight is also a risk factor.

Tendonitis can also cause thigh pain. The most common tendons involved are the lateral tendons of the gluteus minimus and gluteus medius. This causes pain at the greater trochanter. Tendon problems here are often misdiagnosed as trochanteric bursitis.

Lumbar spinal stenosis also can cause thigh pain. Typically the pain of spinal stenosis is felt in the rear of the thighs and is aggravated by prolonged standing or walking. It is relieved by sitting.

Spinal stenosis is caused by narrowing of the spinal canal as a result of bony spurs in the facet joints, bulging of the discs centrally, and/or hypertrophy or calcification of spinal ligaments.

Malignancies involving muscle such as rhabdosarcomas can also cause thigh pain but, fortunately, are rare. Likewise, osteosarcoma, a malignancy of bone can also cause thigh pain.

Patients with cementless hip replacements may have thigh pain for 18 to 24 months after surgery, until the implant is securely locked in place by bone growth. This pain can be expected to be minimal and can be ignored.

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