What are the symptoms of a rectus femoris tendon strain. How is it diagnosed and treated. What causes this condition and how can it be prevented. What is the difference between a strain and an avulsion fracture.

Understanding Rectus Femoris Tendon Strain: An Overview

A rectus femoris tendon strain is a common injury that affects the front of the thigh. It involves tearing of the tendon connecting the rectus femoris muscle to the hip bone. This condition often occurs during explosive activities like running or jumping, causing sudden pain and discomfort in the anterior thigh region.

The rectus femoris muscle is a crucial component of the quadriceps group, playing a vital role in both knee extension and hip flexion. Its biaxial nature, spanning both the hip and knee joints, makes it susceptible to high forces during dynamic movements, increasing the risk of injury.

Key Characteristics of Rectus Femoris Tendon Strain

• Affects the anterior thigh region
• Often occurs at the muscle origin near the hip
• Can range from mild to severe, including complete ruptures
• May lead to chronic conditions if not properly treated

Recognizing the Symptoms: What to Look For

Identifying a rectus femoris tendon strain early is crucial for proper management and recovery. The symptoms can vary depending on the severity of the injury, but there are several common signs to watch for:

• Sudden, sharp pain at the front of the hip or groin
• Swelling and bruising over the injured area
• Tenderness when pressure is applied to the tendon attachment site
• Difficulty or inability to contract the muscle (in severe cases)
• Visible deformity or gap in the muscle (in complete ruptures)

Can the severity of symptoms indicate the extent of the injury? Indeed, the intensity and duration of symptoms often correlate with the degree of tendon damage. Mild strains may cause only slight discomfort, while complete ruptures can result in severe pain and functional impairment.

Diagnosing Rectus Femoris Tendon Strain: Professional Assessment

Accurate diagnosis of a rectus femoris tendon strain requires a professional evaluation. Healthcare providers employ various methods to assess the injury and determine its severity:

1. Physical examination
2. Specific muscle tests (e.g., resisted flexion)
3. Imaging studies (in some cases)

During the physical examination, the healthcare provider will palpate the affected area and assess range of motion. They may also perform specific tests, such as the resisted flexion test, where the patient attempts to lift their knee or leg against resistance. Pain during this test can indicate a rectus femoris strain.

Are imaging studies always necessary for diagnosis? While not always required, imaging studies like MRI or ultrasound may be recommended in cases of severe injury or when the diagnosis is unclear. These tests can provide detailed information about the extent of tendon damage and help guide treatment decisions.

Exploring the Causes: Why Does Rectus Femoris Tendon Strain Occur?

Understanding the underlying causes of rectus femoris tendon strain is essential for both prevention and effective treatment. Several factors can contribute to this injury:

• Sudden, explosive movements (e.g., sprinting, kicking)
• Overuse and repetitive stress
• Muscle imbalances or weakness
• Inadequate warm-up or flexibility
• Previous injury or chronic tendinopathy

The rectus femoris muscle is particularly vulnerable to strain due to its dual function in hip flexion and knee extension. This unique role exposes it to high forces during activities that involve rapid acceleration or deceleration of the leg.

Does age play a role in the risk of rectus femoris tendon strain? While this injury can occur at any age, adolescents may be at higher risk for a specific type of injury called an avulsion fracture. This is due to the incomplete ossification of the bone at the tendon attachment site during growth periods.

Treatment Approaches: From Conservative Care to Surgical Intervention

The treatment of rectus femoris tendon strain varies depending on the severity of the injury and individual patient factors. A comprehensive approach often includes:

Immediate First Aid (PRICE Protocol)

• Protection: Avoid further injury to the affected area
• Rest: Limit activity to allow healing
• Ice: Apply cold therapy to reduce pain and swelling
• Compression: Use elastic bandages to minimize swelling
• Elevation: Raise the affected limb to promote circulation and reduce swelling

Conservative Treatment

For most cases of rectus femoris tendon strain, conservative treatment is the primary approach:

• Rest and activity modification
• Physical therapy and rehabilitation exercises
• Gradual return to activity
• Pain management (e.g., NSAIDs, if recommended by a healthcare provider)

Advanced Therapies

In some cases, additional treatments may be beneficial:

• Electrotherapy (e.g., ultrasound, laser treatment)
• Sports massage or foam rolling
• Corticosteroid injections (in select cases)

Surgical Intervention

Surgery is typically reserved for severe cases, such as complete tendon ruptures or large avulsion fractures. The decision to pursue surgical treatment is based on factors such as the extent of injury, patient age, and activity level.

How long does recovery from a rectus femoris tendon strain typically take? Recovery time can vary significantly, ranging from a few weeks for mild strains to several months for severe injuries or those requiring surgical intervention. Adherence to the prescribed treatment plan and gradual return to activity are crucial for optimal healing and prevention of re-injury.

Rehabilitation and Prevention: Strategies for Long-Term Health

Effective rehabilitation and prevention strategies are essential for recovering from a rectus femoris tendon strain and reducing the risk of future injuries. A comprehensive approach includes:

Rehabilitation Exercises

1. Stretching exercises to improve flexibility
2. Strengthening exercises for the quadriceps and hip flexors
3. Balance and proprioception training
4. Functional exercises specific to the individual’s sport or activity

Prevention Strategies

• Proper warm-up before physical activity
• Regular stretching and flexibility work
• Balanced strength training program
• Gradual increase in training intensity and volume
• Adequate rest and recovery between workouts

Is it possible to completely prevent rectus femoris tendon strains? While it’s impossible to eliminate all risk, implementing a comprehensive prevention program can significantly reduce the likelihood of injury. Regular assessment of muscle balance, flexibility, and strength can help identify and address potential risk factors before they lead to injury.

Avulsion Fractures: A Special Consideration in Rectus Femoris Injuries

Avulsion fractures represent a unique subset of rectus femoris injuries, particularly common in adolescent athletes. These injuries occur when the tendon pulls away a small piece of bone at its attachment site, rather than tearing the tendon itself.

Key Points About Avulsion Fractures

• Most common in adolescents due to incomplete bone ossification
• Symptoms similar to tendon strains but may require different treatment
• Diagnosis confirmed through imaging studies (X-ray or MRI)
• Treatment depends on the degree of bone displacement

How is the treatment of avulsion fractures different from typical tendon strains? While conservative treatment is often sufficient for avulsion fractures with minimal displacement, surgical intervention may be necessary for fractures with significant displacement (typically 3 cm or more). The goal of treatment is to ensure proper healing of the bone fragment and restore full function of the rectus femoris muscle.

Differential Diagnosis: Distinguishing Rectus Femoris Strain from Other Conditions

Accurate diagnosis of rectus femoris tendon strain requires careful consideration of other conditions that may present with similar symptoms. Some conditions that can mimic rectus femoris strain include:

• Meralgia paresthetica
• Hip joint pathologies (e.g., labral tears, osteoarthritis)
• Other quadriceps muscle strains
• Inguinal hernias
• Lumbar spine referred pain

Healthcare providers must conduct a thorough evaluation to differentiate between these conditions and ensure appropriate treatment. This may involve a combination of physical examination, patient history, and imaging studies when necessary.

Why is differential diagnosis crucial in managing anterior thigh pain? Proper identification of the underlying cause is essential for developing an effective treatment plan. Misdiagnosis can lead to inappropriate interventions, delayed recovery, and potential complications. For example, meralgia paresthetica, a condition involving compression of the lateral femoral cutaneous nerve, may present with similar pain patterns but requires a different treatment approach compared to rectus femoris strain.

Key Diagnostic Considerations

1. Detailed patient history, including mechanism of injury and pain characteristics
2. Comprehensive physical examination, assessing strength, flexibility, and specific provocative tests
3. Imaging studies when indicated (e.g., X-ray for suspected avulsion fractures, MRI for soft tissue evaluation)
4. Consideration of referred pain patterns and systemic conditions

By carefully evaluating all potential causes of anterior thigh pain, healthcare providers can ensure accurate diagnosis and implement the most appropriate treatment strategies for each individual patient.

Rectus Femoris Tendon Strain – Symptoms, Causes, Treatment & Rehab

May 15, 2023

A Rectus femoris tendon strain is a tear of the tendon of one of the quadriceps muscles at the front of the thigh. It often occurs at the muscle origin at the front of the hip.

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Rectus femoris tendon strain symptoms

Symptoms include:

• Sudden sharp pain at the front of the hip or groin.
• Swelling and bruising may develop over the site of injury.
• It will feel particularly tender when pressing in (palpating) where the tendon attaches at the front of the hip.
• If a complete rupture has occurred then it will be impossible to contract the muscle and a gap or deformity may be visible.

Diagnosis

A professional therapist will do a number of specific tests to help diagnose your injury.

Resisted flexion – your doctor or therapist will get you to lift your knee (or leg) up whilst resisting the movement. If pain is triggered then this may indicate a rectus femoris strain.

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However, the severity of your symptoms depends on whether the rupture is partial or complete.

What is a Rectus femoris tendon strain?

A rectus femoris tendon strain usually occurs whilst doing explosive activities such as running or jumping.

The rectus femoris muscle is the large quadriceps muscle that runs down the centre of the front of the thigh. It is a biaxial muscle meaning it crosses two joints; the hip and knee joints. It is used to straighten the knee (knee extension) or lift the knee up (hip flexion).

As a consequence, there are often very large forces transmitted through this muscle, especially when kicking or jumping.

A partial rupture of muscle can lead to Rectus femoris tendonitis/tendinopathy after the initial rupture has healed. You can avoid groin injuries by ensuring the muscles are strong and flexible through strengthening and stretching exercises.

Rectus femoris avulsion fractures

A rectus femoris avulsion fracture occurs when the tendon tears, pulling a small piece of bone away. Symptoms are the same as a Rectus femoris tendon strain with sudden pain at the front of the hip.

Avulsion fractures of the rectus femoris attachment point occur most often in adolescents. This is because the area is one of the last to fully harden from cartilage to bone. Therefore, apophysitis develops, which is an inflammatory reaction to repeated stress on the soft bony attachment.

Sudden explosive forces cause the tendon to tear. However, overuse can lead to a rectus femoris tendon rupture. The tendon becomes inflamed and eventually tears following explosive movements. For example, kicking or sprinting starts.

Treatment for a Rectus femoris tendon strain

Immediate first aid consists of applying the PRICE principles of protection, rest, ice, compression, and elevation.

Rest

Complete rest for at least 48 hours. This may be longer depending on how bad your injury is. You may be able to progress to active rest if symptoms allow. You should rest completely until normal daily activities are pain-free.

Cold therapy

Apply cold therapy and compression for 10 to 15 minutes every hour for the first 24 hours or so during the painful acute stage. Reduce frequency to two or three times a day as symptoms subside.

Electrotherapy

Your physio may use ultrasound and laser treatment to help with the pain, inflammation, and healing process.

Massage

Sports massage after the acute stage can be beneficial. Both cross friction massage is applied to the tendon itself, and deep tissue massage to relax the muscles. If you do not have access to regular massage then use a foam roller.

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Exercises

A full thigh strain rehabilitation program of stretching and strengthening exercises should be done before more sports-specific functional exercises to return the athlete back to full fitness.

Surgery

If the tendon has torn completely then you will need an operation to repair it.

Avulsion fractures

If you suspect an avulsion fracture then seek medical attention immediately.

An X-ray or MRI scan confirms the diagnosis and determines the size of the fracture and the amount of displacement.

Conservative treatment (without surgery) is appropriate for most cases. This is exactly the same as a tendon rupture (above).

When pain allows, begin thigh strengthening exercises. The aim is to regain full knee and hip strength. It should be a gradual process.

If the bone fragment is separated by 3cm or more from the attachment point then you may need surgery.

Meralgia Paresthetica—A Common Cause of Thigh Pain

Meralgia paresthetica (MP), a common condition seen by both primary care physicians and specialists, is easily misdiagnosed because it can mimic other disease processes. Often, merely the awareness of the condition and knowledge of a few key differentiating factors helps the clinician quickly recognize this disorder.

MP is a mononeuropathy caused by impingement of the lateral femoral cutaneous nerve (LFCN), which supplies sensation to the lateral aspect of the thigh. When impingement or entrapment of the nerve occurs, the patient can experience numbness, burning, stabbing, and aching along the well-delineated path of the LFCN, from the front of the thigh to just above the knee (Figure 1).

The most common cause of impingement of the LFCN is entrapment of the nerve under the inguinal ligament (Figure 2), which can occur spontaneously or develop after an injury.¹ Causes of LFCN nerve entrapment can be divided into 3 categories: mechanical, metabolic, and iatrogenic. Pregnancy (or any condition that increases abdominal pressure), obesity, wearing tight clothing/belts in the waist area, different leg lengths, and pubic symphysis (pelvic girdle) dysfunction are common mechanical issues leading to MP.² It also has been recognized that carrying items such as a wallet or a cell phone in the front and side pockets of pants can cause unintentional compression of the nerve. Metabolic causes include neuropathy (from diabetes or alcoholism), hypothyroidism, and lead poisoning. Clinicians should ask patients about occupational and living conditions that may have exposed them to lead paint. Prolonged traction during spine surgery or injury to the nerve during retroperitoneal dissection are common iatrogenic causes; therefore, a surgical history is important to consider.³

Differential Diagnosis

It is imperative to differentiate MP symptoms from other causes of pain and nerve discomfort that can have similar clinical presentations. Included in the differential are:

• Spinal nerve radiculopathy at L1-L3⁴

• Malignancy or metastasis to the iliac crest⁵

• Uterine fibroids or pelvic mass that compress the nerve⁶

• Avulsion fracture of the anterior superior iliac spine (ASIS)⁷˒⁸

• Chronic appendicitis⁹

Hip pain that presents with neurological, urogenital, or gastrointestinal symptoms should prompt a more focused evaluation to rule out MP. ¹⁰ Although symptoms may vary between patients, the differential diagnosis of MP is limited, and it usually can be distinguished through clinical evaluation and diagnostic workup.

Clinical Evaluation

The patient’s medical history can elicit key information to direct the clinician to the diagnosis of MP. For example, a thorough discussion of the type of clothing the patient wears (tight), use of thick belts, or work apparel that can lead to pinching at the ASIS can elicit whether symptoms are worse during their use. Another clue is if symptoms worsen with prolonged standing and hip extension and improve with sitting.¹¹

The pelvic compression test is a diagnostic tool that involves placing the patient in the lateral recumbent position while an external downward force is applied with the examiner’s hands over the lateral aspect of the ASIS. The pressure is held for 45 seconds to determine if the patient’s symptoms improved. Symptom amelioration is considered a positive test result and helps to rule out lumbosacral radicular pain. ¹² In a study conducted by Nouraei et al, 19 out of 20 patients who had abnormal nerve conduction studies also had a positive pelvic compression test.12 Based on these results, the pelvic compression test has a sensitivity of diagnosing MP of 95%. The same study found that a negative pelvic compression test was found in 14 out of 15 patients, yielding specificity of 93.3%. The course of the LFCN, from the abdomen to the thigh, can be variable, with 5 separate anatomic subtypes described.¹³

Sensory testing with light touch or monofilament testing can be performed with the patient in the supine position to determine the presence of numbness or paresthesia along the LFCN distribution. The LFCN is a sensory nerve only, so the patient will not have any resulting motor weakness in true MP. The Tinel’s sign also can be used to elicit tenderness and sensitivity over the lateral aspect of the inguinal ligament just medial to the ASIS (where the LFCN typically runs).¹⁴ In the LFCN distribution, often there is a small area of hair loss on the thigh due to persistent rubbing of the area by the patient. ¹⁰

A diminished or absent cremasteric reflex (in male patients) can indicate L1 nerve damage, which would eliminate MP as a possible diagnosis. Manual muscle testing of myotomes L2-L5 is critical, because again, LFCN pathology will not cause motor dysfunction in any of lower extremity muscles. The patellar tendon reflex will be normal, and a straight leg test also should be performed to rule out lumbar radiculopathy.¹⁰ If a motor or sphincter dysfunction is present on exam, the patient’s symptoms likely are secondary to a spinal cord or nerve root lesion.

Diagnostic Evaluation

Plain radiographs (x-rays) of the pelvis and hip (AP and frog leg views) should be obtained first to rule out osteoarthritis of the hip joint or bone metastasis to the ileum.⁵ Magnetic resonance imaging or computed tomography can rule out disc herniation, nerve lesions, annular tears, or other spinal pathology that may be causing radiculopathy. A pelvic ultrasound should be obtained in women of childbearing age with a history of prolonged menstrual bleeding to rule out uterine fibroids. ⁶ A detailed history also will indicate a history of alcoholism or lead exposure.

During the initial work-up, the clinician should order blood work to test for thyroid function, vitamin B12 and folate levels, and serum lead levels because these are common causes of MP.³ A complete blood count may be ordered to evaluate for macrocytic anemia and diabetes in patients with neuropathy symptoms.

A nerve test (blockade) may be both diagnostic and therapeutic in patients suspected of having MP. Using a nerve stimulator, the LFCN can be located and injected with a local anesthetic. Relief of the numbness and pain confirms the diagnosis of MP. Newer methods of conducting nerve blocks include landmark-based and ultrasound-guided techniques.¹⁴ The landmark approach can present a challenge because the normal course of the LFCN and anatomy can vary in patients. This method involves insertion of a needle, 2.5 cm medial to the ASIS and caudal to the inguinal ligament. Lidocaine can be injected when a “loss of resistance” or “pop” is felt as the needle goes through the fascial layer. ³˒⁸˒¹⁵

Since the landmark approach essentially is a blind approach, ultrasound-guided techniques greatly improve the success rates for contacting the LFCN (84% vs 5%, respectively).¹⁶ If ultrasound cannot identify the LFCN, an injection of 5% dextrose can be used to dissect between the fascia lata and the iliacus muscle, decompressing the trapped nerve.

A study by Dureja et al examined the benefits of using regular steroid and bupivacaine injections (minimum of 5 total injections), with the use of diphenylhydantoin as a possible treatment of MP. These regular injections are thought to disrupt the afferent efferent loop at the spinal level, thereby reducing the pain caused by irritation of the LFCN.¹⁴ In combination with injections, patients can also be prescribed tricyclic antidepressants and anticonvulsants to help treat neuropathic pain.¹⁷

The diagnostic capability of nerve conduction studies, however, has been questioned. A study by Seror et al demonstrated that somatosensory-evoked potential (SSEP) studies of the LFCN were not sensitive or specific for the diagnosis of MP. In this study, SSEP shows sensitivity of 5% and specificity of 95%, whereas thigh stimulation had a sensitivity of 52% and specificity of 76%. Following this study, it is generally accepted that SSEP testing is not effective in the diagnosis of MP.¹⁸

Neurodiagnostic testing is highly dependent on the skill of the user to obtain an accurate result. Two techniques for evaluating nerve conduction have been described: stimulating the LFCN as it exits the pelvis near the ASIS and recording potentials distally, or stimulating distally and recording proximally in the region of the ASIS. The responses are typically of small amplitude; therefore interpretation is highly user-dependent. It is important to study both sides to compare amplitudes, and the study can be difficult to perform in an overweight individuals.¹³

Treatment Options

The treatment of MP firsts consists of removing any underlying cause of the impingement (tight pants, belts, wallets, cellphone). This is followed by conservative treatment with oral anti-inflammatory medications. Typically, 85% of patients will have improved symptoms with conservative treatment alone.¹⁹ Patients who are obese should be counseled to lose weight, which can aid in resolution of their symptoms.

Physical therapy should be considered as a non-surgical modality to treat MP, although there is no current data that supports its effectiveness.²⁰ Manual therapeutic techniques, including Active Release Technique and myofascial therapy for the rectus femoris and iliopsoas muscles, have been suggested as viable options, but most of the evidence for these techniques come from individual case studies.²⁰ Other useful therapies include moist heat, transcutaneous electrical nerve stimulation (TENS), phonophoresis, and use of soft tissue techniques that can improve pain and increase range of motion.²¹

Use of non-steroidal anti-inflammatory medications (NSAIDs) generally is accepted among the literature as part of the initial treatment, although there does not appear to be a consensus about any particular NSAID or duration of treatment. It is important to keep in mind contraindications to NSAID use, including, but not limited to, gastrointestinal ulcers, kidney impairment, and bleeding disorders. Oral steroids also can be considered as a conservative option for management of inflammation, although it appears that there is no current research to support this.

Injection therapies using either the landmark-based or ultrasound-guided techniques should be attempted prior to surgical intervention. Symptoms that are unyielding or disabling can be referred for earlier surgical evaluation.¹³

Surgical management to correct the impingement typically is reserved for patients who continue to have symptoms despite treatment with conservative measures. Three approaches to surgical treatment of MP include: neurolysis of constricting tissue, neurolysis and displacement of LFCN, and excision of part of the LFCN.¹³ A study by Son et al examined the effectiveness of neurolysis as a means of treating persistent MP. The study found the technique provided complete relief in 81. 8% of patients and partial relief in 18.2% of patients.22 LFCN decompression can be performed surgically with a 2- to 3-cm incision inferior to the ASIS along the line of the inguinal ligament. Careful blunt dissection of the fascial planes can identify the LFCN and allow the surgeon to follow it towards the inguinal ligament. At the point where the LFCN meets the inguinal ligament, the ligament is divided to decompress the nerve.¹² Surgical management typically is the last option for treatment of MP; again conservative measures should be performed first in the treatment plan.

Summary

In our experience, the prevalence of MP has been increasing, perhaps because of the demographic shift in risk factors including obesity, jobs that require prolonged sitting, and fashion trends. The well-demarcated zone of pain and paresthesias that characterizes MP is the primary clue that raises a clinician’s index of suspicion in identifying this condition. Patient education is paramount because modifying risk factors are essential to resolving nerve irritation. Ultrasound has become a valuable tool for identifying nerve entrapment and accurately guiding therapeutic injections. Hydrodissection of tissues is an evolving option, poorly described in the literature but practiced by many versed in the technique. Advanced imaging and neurodiagnostic testing often is not necessary when the history and clinical evaluation are consistent for MP.

References

1. Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med. 2007;8(8):669-677.
2. Williams PH, Trzil KP. Management of meralgia paresthetica. J Neurosurg. 1991;74(1):76-80.
3. Patijn J, Mekhail N, Hayek S, Lataster A, van Kleef M, Van Zundert J. Meralgia paresthetica. Pain Pract. 2011;11(3):302-308.
4. Yang SN, Kim DH. L1 radiculopathy mimicking meralgia paresthetica: a case report. Muscle Nerve. 2010;41(4): 566-568.
5. Tharion G, Bhattacharji S. Malignant secondary deposit in the iliac crest masquerading as meralgia paresthetica. Arch Phys Med Rehabil. 1997;78(9):1010-1011.
6. Suber DA, Massey EW. Pelvic mass presenting as meralgia paresthetica. Obstet Gynecol. 1979;53(2):257-258.
7. Cedoz ME, Larbre LP, Lequin C, Fischer G, Llorca G. Upper lumbar disk herniations. Rev Rhum Engl Ed. 1996;63(6):421-426.
8. Shannon T, Lang SA, Yip RW, Gerard M. Lateral femoral cutaneous nerve block revisited. A nerve stimulator technique. Reg Anesth. 1995;20(2):100-104.
9. Ghavanini MR, Ghavanini AA. Meralgia paresthetica as the presenting feature of chronic appendicitis. Am J Phys Med Rehabil. 2001;80(9):703-705.
10. Beltran LS, Bencardino J, Ghazikhanian V, Beltran J. Entrapment neuropathies III: lower limb. Semin Musculoskelet Radiol. 2010;14(5):501-512.
11. Stookey B. Meralgia paresthetica etiology and surgical treatment. JAMA. 1928;90:1705-1707.
12. Nouraei SA, Anand B, Spink G, O’Neill KS. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery. 2007;60(4):696-700.
13. Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(5):336-344.
14. Hui GK, Peng PW. Meralgia paresthetica: what an anesthesiologist needs to know. Reg Anesth Pain Med. 2011;36(2):156-161.
15. Hopkins PM, Ellis FR, Halsall PT. Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve. Anesthesia. 1991;46(2):95-96.
16. Ng I, Vaghadra H, Choi PT, Helmy H. Ultrasound imaging accurately identifies lateral femoral cutaneous nerve. Anesthesia Analg. 2008;107(3): 1070-1074.
17. Massey E. Sensory mononeuropathies. Semin Neurol. 1998;18(2):177-183
18. Seror P. Lateral femoral cutaneous nerve conduction v somatosensory evoked potentials for electrodiagnosis of meralgia paresthetica. Am J Phys Med Rehabil. 1999;78(4):313-316.
19. Majkrzak A, Johnston J, Kacey D, Zeller J. Variability of the lateral femoral cutaneous nerve: an anatomic basis for planning safe surgical approaches. Clin Anat. 2010;23(3):304-311.
20. Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther. 2013;8(6):883-893.
21. Luzzio C, Lorenzo C. Physical medicine and rehabilitation for meralgia paresthetica treatment and management. Medscape. May 10, 2013.
22. Son B, Kim D, Kim I, Hong J, Sung J, Lee S. Neurolysis for meralgia paresthetica. J Korean Neurosurg Soc. 2012 51(6): 363-366.

Notes: This article was originally published August 4, 2014 and most recently updated August 6, 2014.

Hip numbness – causes, diseases, diagnosis

How is the differential diagnosis of hip numbness done? The patient, first of all, needs to sign up for a consultation with an orthopedist, a neurologist. After the initial appointment, the doctor may prescribe additional examinations:

• MRI of the hip joints
• MRI of the lumbosacral spine
• laboratory tests.

Causes of thigh numbness

Paresthetic meralgia

Paresthetic meralgia is a condition resulting from compression of the lateral femoral cutaneous nerve. This large nerve provides sensation to the front and sides of the thigh. Paresthetic convolutions cause a sensation of pain, burning, numbness or tingling in the thigh. Symptoms of paresthetic meralgia occur when the nerve is compressed. Compression of the lateral cutaneous nerve of the thigh is caused by various factors. These may be injuries to the thigh area; medical conditions such as obesity, pregnancy and diabetes; wearing too tight clothes or belts around the waist.

Deficiency of vitamins B 12, potassium and magnesium

Vitamin B12 is essential to maintain nerve function and health. A severe B12 deficiency can cause numbness in the arms, legs, face, and hips on both sides of the body. Sometimes potassium and magnesium deficiency can also cause tingling and numbness in the hip and leg.

Hernia of the lumbosacral spine

Hernia of the lumbosacral spine is a condition of violation of the structures of the nucleus pulposus. The spine is made up of vertebrae that extend from the base of the skull to the coccyx. Between the vertebrae are round pads called intervertebral discs. Discs act as buffers between bones, allowing the spine to flex and move easily. When one of these intervertebral discs rupture or bulge, the condition is called a herniated disc. The symptoms of a herniated lumbosacral spine vary depending on where in the spine it is located. The symptoms are aggravated by motion and are better by rest. A herniated lumbar disc often causes “sciatic nerve” pain. This sharp pain usually shoots one side of the thigh into the leg and sometimes into the foot and causes a feeling of numbness in the thigh and legs.

Herpes zoster

Shingles is an infection that causes a painful rash on the skin. The first signs of the disease may be tingling, numbness or soreness in the skin area, headache or general malaise, and only a few days later a rash will appear. Shingles often first appears on the chest, abdomen, and thighs, but it can develop anywhere on the body. The rash looks like red spots on the skin on only one side of the body.

Uterine fibroids

Uterine fibroids are formations consisting of smooth muscle cells and fibrous connective tissue. These growths develop in the uterus and appear singly or in groups. Their size ranges from as small as a grain of rice to as large as a melon. In some cases, fibroids can grow into or out of the uterine cavity. Usually, women with uterine fibroids do not experience any noticeable symptoms. If the fibroid grows to a large size, women may experience heavy or prolonged periods, bleeding between periods, pain in the pelvis and thigh, tingling and numbness, lower back pain, frequent urination or difficulty emptying the bladder, constipation or excessive straining when emptying intestines.

Diagnosis of causes of hip numbness

The neurologist will begin the examination with a medical history to determine the duration of numbness in the thigh and other possible symptoms. Will then do several tests to determine the root cause, including:

• blood tests
• vitamin level tests
• electrolyte tests

More tests are done to rule out serious causes such as tumors and nerve damage. These include:

• magnetic resonance imaging of the lumbar spine
• magnetic resonance imaging of the hip joint
• lumbar puncture to check diseases of the nervous system
• electromyography to check nerve stimulation.

For women of childbearing age, your doctor may order a pelvic ultrasound. This study allows you to exclude uterine fibroids, benign neoplasms in the uterus.

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Babintseva Elena Yurievna 9 0007

Neurologist, Acupuncturist

Reviews: 665

Rating : 5.0 out of 5

Experience:

since 1993

Receptionist:

Riorit Clinic

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Ba owl Pavel Igorevich

Neurologist, Reflexologist

Reviews: 691

Rating: 4.8 out of 5

Experience:

since 2005

9000 2 Receptionist:

Baltmed Ozerki Clinic, Medical On Group Vosstaniya Clinic

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Belyakova Alla Vasilievna

Neurologist, Pediatrician, Reflexologist

Reviews: 686

Rating: 4.6 out of 5

Experience:

9 0002 since 1983

Receptionist:

Medicenter clinic, Profimedica clinic, Family Doctor clinic

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Author: Babintsev Elena Yurievna

Specialization: Neurologist

Appointment appointment: RIORIT Medical Center

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List of scientific literature

1. Ankin NL Osteosynthesis and arthroplasty in fractures of the femoral neck. Bulletin of Traumatology and Orthopedics. N. N. Priorova. 1997. – No. 2. – S. 19-22.
2. Akhmedzhanov FM Radiation diagnostics of the musculoskeletal system: possibilities and prospects // Mater. V scientific and practical. conf. “Modern trends in the complex diagnosis and treatment of diseases of the musculoskeletal system”. – M., 2004. S. 3-6.
3. Transplantation and implantation in surgery of large joints: Sat. scientific works. -N. Novgorod, 2000. S. 20-22.
4. Zolotarev AV X-ray computed tomography in the diagnosis of diseases of the hip joint: Ph.D. / Medical Radiological Research Center of the Russian Academy of Medical Sciences. 1996. – 132 p.
5. Semizorov AN Radiography in the diagnosis and treatment of bone fractures. Moscow: Vidar, 2007. – 175 p.

how to apply, the right choice of tapes

Causes of pain in the hip

Most often, pain is caused by hip sprain – damage to the flexor or adductor muscles, provoked by excessive muscle tension.

Pain may also be caused by:

• bruises,
• damage to the ligaments of the thigh,
• bursitis,
• arthrosis, coxarthrosis,
• overextension of the muscle fiber,
• tendonitis,
• chronic sports injuries.

Taping of the outer surface of the thigh can also be carried out in order to prevent sports injuries. Elastic bands are used in training and sports competitions, during which an increased load on the joint is possible. The application of kinesio tape is especially needed by athletes who have recently suffered a hip joint injury and those who experience chronic pain in this area. As an independent method of treatment, taping is prescribed only for minor injuries, as well as for muscle pain, bruises, and bruising.

Tapes provide the following results:

• accelerated recovery:
• muscle tension relief,
• lymphatic drainage,
• support for weakened tendons and ligaments,
• c management of muscle pain,
• regeneration of damaged tissues, including postoperative period.

The effectiveness of taping is as follows:

• tapes lift the skin in the area of ​​damage, creating decompression of venous and lymphatic vessels, which improves blood circulation and relieves swelling;
• taping helps to reduce pain by affecting the proprioceptive sensitivity of tissues;
• microcirculation is normalized, tissue repair is accelerated;
• Some methods of applying tapes provide a limitation of the range of motion of the joint, which helps to reduce pain and minimize the risk of injury during continued training or exercise therapy.

Treatment of serious injuries and severe diseases may require additional conservative measures, plaster immobilization, surgical intervention.

Preparation for taping

The effectiveness of the procedure and the duration of the tape’s performance depend on the correct application of the tapes.

Before taping, follow these recommendations:

• Dry the skin. A wet surface will reduce the adhesion of the patch to the epidermis. The desired area is wiped with a napkin or dry towel;
• Skin degreasing. The thigh is treated with a special lotion or medical alcohol. Cologne is not recommended because it contains fragrances and other chemical components;
• Hair shaving. You can remove hair with a regular razor or clipper.

When applying tapes, it is important to maintain a certain tension in order to achieve the desired effect.

Choosing the right material

When buying tapes, it is important to pay attention to the following points:

• Shelf life. Conscientious manufacturers always indicate it on the packaging;
• Qualitative composition of the material and adhesive. Also indicated on the packaging. It is noted in the percentage of materials used (cotton, silk, nylon). The higher the nylon content, the harder the tape – such tapes should not be chosen for daily wear, they are more suitable for correction, rehabilitation;
• The presence of a paper backing that hides the adhesive layer with the manufacturer’s name and logo printed on it;
• Leak-tight packaging and the presence of quality marks and basic information about the product on it.

Ribbons are available in solid nude or bright colours, with or without prints. It is important to consider that you need to wear the application for 5-7 days. When choosing the color of teips, do not forget that you may have to go to the office with them.

The classic version is 5 cm wide ribbons, suitable for most applications. Products are made from hypoallergenic cotton or rayon. You can buy teips in rolls or pre-cut. Pre-cut products are more convenient to use, rolled products are more profitable in economic terms.

According to the shape, kinesio tapes are divided into:

• I-shaped. Traditional option, suitable for any applications;
• Y- and V-shaped. Overlay around the borders of a muscle or joint and provide optimal support.

The choice of tape must necessarily take into account the scheme by which taping will be performed. Most often, I-shaped patches or I and Y-shaped tapes are purchased for combined use. The most popular tapes are in rolls 5 cm wide and 5 m long.

Thigh taping scheme

Depending on the purpose, the following methods of patch application are distinguished:

• Muscular. A medical patch is applied to the stretched muscle. The tension should be 45-60%. The end of the tape 5 cm long is fixed without tension;
• Ligamentous. The patch tension is 30-40%. The base is glued on the sides without stretch;
• Corrective. It is carried out with a high degree of tension – 80 – 90%. The tapes are fixed over the ligaments, the ends are glued without tension;
• Lymphatic. With the help of a kinesio plaster, meshes are made and applied along the lines of lymph outflow. Tapes can be cut into strips or use lympho tapes. Gluing is done in several layers on top of each other.

Anterior thigh taping:

Measured with a standard tape 5 cm wide, length from the lower anterior iliac axis to the base of the patella, Y-cut without cutting 5 cm.