Lateral Thigh
LATERAL THIGH
Dull Ache / Sharp Pain
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Vastus lateralis mild strain / hypertonicity
Signs and symptoms
- Dull ache on lateral thigh
- Pain can travel from hip down to knee
- May be tender after increased physical training
- May be tender after direct trauma (sport)
- Can be sore to sit cross legged
- Diagnosed through palpation and active resisted testing hip in abduction with patient supine
- Severe strains (tears) may present with increased pain, swelling, bruising, and loss of function (ultrasound / MRI)
- Treatment through manual therapy and rehab exercises
Delayed Onset Muscle Soreness (DOMS)
Signs and Symptoms
- Pain on lateral thigh area felt after gym sessions, exercise, or repetitive activities
- Exercise routine may have included squats, lunges or elliptical cardio machine
- Self resolves within a week
Contusion
Signs and symptoms
- Discolorations / bruising of skin
- Swelling
- Tender area to touch
- Stiffness
- Direct trauma
- Diagnosed through observation, case history, and palpation
- Treatment: Ice and compression of area
Myositis Ossificans (M>F 20–40)
- Bone tissue forming inside a muscle or other soft tissue due to a traumatic injury
- May occur after a contusion (bruising)
- Pain and tenderness may be severe
- May limited limb movement
- Injured area may feel warm
- May have palpable lump
- Diagnosed through observation, case history, and palpation
- Scans may be needed (Ultrasound, CT / MRI scan)
- Treatment: Calcified area may be reabsorbed by the body. Surgery may be performed if nerves or vessels or being impinged. Often times there is no course of action if no clear health risks are observed
Vascular claudication
- Dull pain in buttocks, thighs and calve muscles
- Radiates proximally
- Cramping, aching, squeezing feeling after walking for short distance
- Relieved with rest and sitting down
- Commonly over 50
- Commonly caused by aortoiliac arterial occlusive disease
Diagnosed via:
- Measuring pulse in hands and feet
- Blood pressure measurement in arms and legs (determine location and damage to arteries)
- Walking test: How far can patient walk without pain
- Doppler ultrasound
- MRI or CT angiography (narrowed blood vessels)
Foraminal / Central canal stenosis with nerve root compression at Lumbar vertebra L4
Symptoms:
- May present as deep dull local ache
- Unrelenting back or thigh pain with neurological symptoms
- Radiculopathy down leg – burning, pins and needles, numbness, tingling
- No radiculopathy. Local neurological symptoms in thigh
- Painful to lean backwards (may produce sharp pain or neurological symptoms in thigh)
- Weakness in leg(s)
- Muscle atrophy in thigh muscles
A) Lumbar Disc herniation (M>F 40-60)
Caused by:
- trauma
- poor posture,
- repetitive activity
- overweight
Diagnosed by:
- MRI
Tests:
- Muscle testing (myotomes)
- Sensory testing (dermatomes)
- Patella tendon reflexes
- Lying / Sitting straight leg test
- Valsalva manoeuvre
- Observing for atrophy in muscles
Treatment:
- Surgery
- Cortisone injection
- Conservative – medication, rest, manual therapy to surrounding musculature
- Disc herniations can heal on their own in 6-9 months
B) Vertebral spurs
Caused by:
- Osteoarthritis
- Trauma / Injury / fractures
Diagnosed by:
- X-ray
Treatment:
- Medication to reduce inflammation and pain
- Cortisone injection
- Surgery
- Manual therapy to surrounding musculature
C) Anterior longitudinal ligament ossification (Thickening)
Caused by:
- Unknown
- Hereditary
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Trauma
Diagnosed by:
- X-ray / MRI
Treatment:
- Medication to reduce inflammation and pain
- Manual therapy to surrounding musculature
- Cortisone injection
- Surgery indicated when airways are potentially being blocked
D) Space occupying lesion (Cyst)
Caused by:
- Genetics
- Chronic inflammatory conditions
- Trauma / Injury to arteries, veins, lymphatics
- Blockages to ducts
Diagnosed by:
- MRI
Treatment:
- Surgery
- Drainage
- Injecting cyst to reduce swelling and pain
- Laser removal
E) Space occupying lesion (Tumour)
Symptoms:
- May include systemic signs such as night pain, night sweats, fever, and enlarged lymph nodes
Caused by:
- Genetics
- Trauma / Injury
- Infectious disease
- Obesity
- Cigarette smoking / Excessive alcohol
Diagnosed by:
- MRI
Treatment:
- Surgery
- Radiation / Chemotherapy
![](https://www.diagnostica.education/wp-content/uploads/2024/05/Diagnostica-anatomy-page-inset-15-lateral-thigh-01.jpg)
LATERAL THIGH
Numbness, Tingling, Weakness, Burning or Muscle atrophy
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Foraminal / Central canal stenosis with nerve root compression at L4 Lumbar Vertebra level
Symptoms:
- Numbness, tingling, or burning sensation with radiculopathy down leg
- May also present only locally on side of leg with similar neurological symptoms
- Severe pain in low back region
- Painful to lean backwards (may produce sharp pain or neurological symptoms in thigh)
- Weakness in leg(s)
- Muscle atrophy in thigh muscles
- Patient may find relief laying on their back with knees bent and legs raised onto a chair
A) Lumbar Disc herniation (M>F 40-60)
Caused by:
- trauma
- poor posture,
- repetitive activity
- overweight
Diagnosed by:
- MRI
Tests:
- Muscle testing (myotomes)
- Sensory testing (dermatomes)
- Patella tendon reflexes
- Lying / Sitting straight leg test
- Valsalva manoeuvre
- Observing for atrophy in muscles
Treatment:
- Surgery
- Cortisone injection
- Conservative – medication, rest, manual therapy to surrounding musculature
- Disc herniations can heal on their own in 6-9 months
B) Vertebral spurs
Caused by:
- Osteoarthritis
- Trauma / Injury / fractures
Diagnosed by:
- X-ray
Treatment:
- Medication to reduce inflammation and pain
- Cortisone injection
- Surgery
- Manual therapy to surrounding musculature
C) Anterior longitudinal ligament ossification (Thickening)
Caused by:
- Unknown
- Hereditary
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Trauma
Diagnosed by:
- X-ray / MRI
Treatment:
- Medication to reduce inflammation and pain
- Manual therapy to surrounding musculature
- Cortisone injection
- Surgery indicated when airways are potentially being blocked
D) Space occupying lesion (Cyst)
Caused by:
- Genetics
- Chronic inflammatory conditions
- Trauma / Injury to arteries, veins, lymphatics
- Blockages to ducts
Diagnosed by:
- MRI
Treatment:
- Surgery
- Drainage
- Injecting cyst to reduce swelling and pain
- Laser removal
E) Space occupying lesion (Tumour)
Symptoms:
- May include systemic signs such as night pain, night sweats, fever, and enlarged lymph nodes
Caused by:
- Genetics
- Trauma / Injury
- Infectious disease
- Obesity
- Cigarette smoking / Excessive alcohol
Diagnosed by:
- MRI
Treatment:
- Surgery
- Radiation / Chemotherapy
Lateral femoral cutaneous nerve entrapment (Meralgia paresthetica)
- Burning, numbness or tingling in the outer thigh
- Weakness feeling in hip and knee
- Symptoms may be reproduced with passive knee flexion and hip extension
- May be difficult to go up and down stairs
- May be caused by recent trauma to hip and leg
- Compression caused by swelling and pressure
- Thorough case history regarding trauma, surgeries, and swellings
- Diagnosed through pelvic compression test and Tinel’s sign
- Neurologist may also perform a nerve conduction study
- Conservative treatment involves manual therapy to ease surrounding tissues and joints
- Treatment may also involve corticosteroid injections and surgery to relieve pressure
Multiple sclerosis (F>M 20-40)
- Peripheral neuropathies
- Commonly unilateral
- Blurred or loss of vision in one eye
- May cause atrophy of muscles or loss of motor control
- May cause tremors
- Weakness in one or both legs
- Clumsiness of limb
- Feeling of walking on cotton wool
- Diagnosed through MRI (looking for lesions on brain or spinal cord), Lumbar puncture looking for abnormalities in antibodies in cerebrospinal fluid associated with MS)
- Often a diagnosis of exclusion as other conditions produce similar symptoms
- Treatment: medications
Diabetes
- Feeling of thirst
- Losing weight
- Urinating often
- Blurry vision
- Hunger
- Numbness and tingling
- Tiredness
- Dry skin
- Wounds may have trouble healing
- Prolonged bruising
Type 1
- Condition where the pancreas produces little or no insulin
Caused by:
- Unknown, has genetic links
Diagnostic tests:
- Random blood-sugar test
- Glycated Hemoglobin A1C blood test measures your blood sugar level over 2–3-month period to determine if it is consistently high
Management:
- Insulin injections
- Insulin pump
Type 2 (More common)
- Condition where the pancreas does not produce enough insulin
- Insulin that is produced in the pancreas does not work effectively
- Insulin is produced in the pancreas, but the body’s cells do not respond effectively
Caused by:
- Family history
- Age 45+
- Overweight
- High blood pressure
- Polycystic ovarian syndrome
- Gestational diabetes
- Giving birth to baby over 4.5kg (9lbs)
Diagnostic tests:
- Glycated Hemoglobin A1C blood test measures your blood sugar level over 2-3 month period to determine if it is consistently high
- Fasting glucose test
Management:
- Medication
- Lifestyle changes
Local peripheral nerve damage (Lateral femoral cutaneous nerve)
- Numbness and tingling
- Sharp, jabbing, or throbbing pain
- Sensitive to touch
- Gradual onset of symptoms
- Caused by local trauma, repetitive movements, crushed, or cut nerves (surgery),
- Medical causes: Diabetes, Multiple sclerosis, Guillain-Barre syndrome
- Electromyography (EMG test), Ultrasound, Nerve conduction test
- Treatment: self-resolving in 12 months, Surgery, or may not fully resolve
Reflex sympathetic disorder (Complex regional pain syndrome)
- Chronic limb pain
- Pain is greater than expected from injury that may have caused it
- Continuous throbbing, burning, numbness and tingling
- Sensitive to touch (painful)
- Skin colour and temperature changes
- Not well understood
- May be post-surgery, injury, stroke, or heart attack
- May involve abnormal inflammation or nerve dysfunction
![](https://www.diagnostica.education/wp-content/uploads/2024/05/Diagnostica-anatomy-page-inset-15-lateral-thigh-02.jpg)
LATERAL THIGH
Medical Considerations
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Myositis Ossificans (M>F 20–40)
- Bone tissue forming inside a muscle or other soft tissue due to a traumatic injury
- May occur after a contusion (bruising)
- Pain and tenderness may be severe
- May limited limb movement
- Injured area may feel warm
- May have palpable lump
- Diagnosed through observation, case history, and palpation
- Scans may be needed (Ultrasound, CT / MRI scan)
- Treatment: Calcified area may be reabsorbed by the body. Surgery may be performed if nerves or vessels are being impinged. Often times there is no course of action if no clear health risks are observed
Fractured femur
- History of trauma
- Immediate swelling
- Tender to touch
- Bruising
- Limping
- May have visible signs of deformity
- Unable to weight bear
- Diagnosed via X-ray
Vascular claudication
- Dull pain in buttocks, thighs and calve muscles
- Radiates proximally
- Cramping, aching, squeezing feeling after walking for short distance
- Relieved with rest and sitting down
- Commonly over 50
- Commonly caused by aortoiliac arterial occlusive disease
Diagnosed via:
- Measuring pulse in hands and feet
- Blood pressure measurement in arms and legs (compare locations)
- Walking test: How far can patient walk without pain
- Doppler ultrasound
- MRI or CT angiography (narrowed blood vessels)
Treatment
- Conservative treatment involves walking-resting-walking for 30 minutes approximately 3x/week
- Severe cases with increased symptoms require surgery. Angioplasty involves widening a damaged artery and vascular surgery involves taking a healthy blood vessel from another part of the body to replace the damaged one.
Deep Vein Thrombosis (DVT)
- Blood clots forming in a deep vein
- Swelling and bruising
- Painful
- Increase in temperature
- May have NO symptoms
- Caused by: sitting for long periods, pregnancy, injury to vein, obesity, post-surgery, increased age, blood disorders
- Duplex ultrasonography: an imaging test that uses sound waves to look at blood flow in the veins
- Compression stocking and anti-coagulants (blood thinners given orally or by injection, typically do not break up clots, but prevent new ones from forming)
Reflex sympathetic disorder / Complex regional pain syndrome (CRPS)
- Chronic limb pain
- Pain is greater than expected than injury that may have caused it
- Continuous throbbing, burning, numbness and tingling
- Sensitive to touch (painful)
- Skin colour and temperature changes
- Not well understood
- May be post-surgery, injury, stroke, or heart attack
- May involve abnormal inflammation or nerve dysfunction
Treatment: Challenging to manage as results vary between patients. Some options may include:
- Acupuncture
- Pain relief medication, anti inflammatory medication
- Nerve block injection, morphine
- Intravenous Ketamine
- Manual / Physical / Exercise therapy
- Meditation, relaxation therapies
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