What are the common causes of leg and foot pain. How can you identify the underlying issues leading to discomfort in your lower extremities. What treatments are available for various leg and foot pain conditions.

The Complex Web of Leg and Foot Pain: Understanding the Basics

Leg and foot pain can be a complex and multifaceted issue, often stemming from various sources within the body. The severity and type of pain experienced can vary greatly depending on an individual’s lifestyle, medical history, and underlying conditions. To effectively address these issues, it’s crucial to understand the potential causes and their associated symptoms.

Can leg pain originate from areas other than the leg itself? Indeed, it can. In many cases, leg pain may be caused by conditions affecting the lower back, hip, or pelvic region. This phenomenon, known as referred pain, highlights the interconnected nature of our body’s systems and the importance of a comprehensive diagnostic approach.

Spinal Origins: When Your Back is the Culprit

Spinal issues are a common source of leg and foot pain, often manifesting as radiculopathy – a condition where pain radiates along the path of a spinal nerve. What are some common spinal causes of leg pain?

• Herniated or bulging discs
• Spinal stenosis
• Degenerative disc disease
• Spondylolisthesis
• Sciatica

In addition to these conditions, compression of the spinal cord in the neck or the cauda equina in the lower back can also lead to leg pain. These spinal issues often require specialized diagnostic procedures and targeted treatments to alleviate symptoms effectively.

Vascular Culprits: When Blood Flow is Compromised

Blood vessel-related issues can significantly contribute to leg and foot pain. How do vascular problems manifest in the lower extremities? Common vascular causes include:

• Peripheral artery disease (PAD): This condition results in decreased circulation due to blocked arteries.
• Deep vein thrombosis (DVT): Blood clots in the deep veins of the leg can alter blood flow and cause pain.
• Superficial thrombophlebitis: Clots in superficial veins may lead to the formation of varicose veins or spider veins.

In some cases, blood vessels may rupture, causing bleeding within the leg’s tissue spaces. This can result in acute pain and swelling, requiring immediate medical attention.

Hip and Pelvis: The Hidden Sources of Leg Discomfort

Pain originating from the joints and muscles of the pelvis and hip can often be referred to the legs. What conditions related to the hip and pelvis can cause leg pain?

• Piriformis syndrome: Spasm of the piriformis muscle in the pelvis can impinge on the sciatic nerve.
• Sacroiliac joint dysfunction: Abnormal motion or malalignment of the sacroiliac joint can lead to leg pain.
• Hip osteoarthritis: Wear-and-tear arthritis of the hip joint can cause discomfort that radiates to the leg.
• Trochanteric bursitis: Inflammation of a fluid-filled sac on the side of the hip can result in leg pain.

Additionally, pelvic bone fractures or other hip joint problems due to trauma, overuse, or degeneration may contribute to leg pain. Recognizing these potential sources is crucial for accurate diagnosis and effective treatment.

Nerve Damage: When the Wiring Goes Awry

Damage to peripheral nerves in the leg can lead to significant pain and discomfort. What medical conditions commonly cause nerve damage in the legs?

• Diabetes mellitus: High blood sugar levels can damage nerves over time.
• Hypothyroidism: An underactive thyroid can lead to nerve dysfunction.
• Infections: Certain viral or bacterial infections can affect nerve health.
• Autoimmune disorders: Conditions like rheumatoid arthritis can impact nerves.

In rare cases, autoimmune conditions such as Guillain-Barré syndrome, where the body’s immune system attacks the peripheral nervous system, may cause leg pain. These neurological issues often require specialized treatment approaches to manage symptoms effectively.

Nutritional Factors: The Role of Vitamins and Minerals

Nutritional deficiencies can play a significant role in leg and foot pain, often through their impact on peripheral nerves. Which nutrient deficiencies are commonly associated with leg pain?

• Vitamin B12
• Vitamin B6
• Copper

Interestingly, excessive intake of certain substances can also lead to peripheral nerve damage and leg pain. These include alcohol and heavy metals such as arsenic, thallium, or mercury. Maintaining a balanced diet and avoiding toxin exposure are crucial steps in preventing nutrition-related leg pain.

Foot-Specific Pain: Understanding Localized Discomfort

While leg pain can often radiate to the foot, there are several conditions that specifically cause foot pain and numbness. What are some common foot-specific pain conditions?

• Tarsal tunnel syndrome: Compression of the tibial nerve due to various factors.
• Peroneal neuropathy: Compression of the peroneal nerve, often due to trauma or tumors.
• Sural nerve entrapment: Compression of the sural nerve, which can be caused by factors like tight ski boots.
• L5 and/or S1 radiculopathy: Compression of specific nerve roots in the lower back can lead to foot pain.

In severe cases, foot weakness resulting from these conditions can lead to foot drop, a condition characterized by the inability to lift the foot off the ground. Early diagnosis and treatment of these foot-specific issues are crucial for maintaining mobility and quality of life.

Risk Factors: Who’s Most Susceptible to Leg and Foot Pain?

Understanding the risk factors associated with leg and foot pain can help individuals take preventive measures and seek early treatment. What factors increase the likelihood of experiencing leg and foot pain?

• Advanced age: As we get older, the risk of various conditions causing leg pain increases.
• Genetics: Some individuals may have a genetic predisposition to certain pain-causing conditions.
• Poor posture: Improper body mechanics can lead to strain and pain in the legs and feet.
• Occupational hazards: Jobs involving heavy labor, sports, or military service can put extra stress on the lower extremities.

While these risk factors don’t guarantee the development of leg or foot pain, being aware of them can help individuals make informed lifestyle choices and seek medical attention when necessary.

Diagnostic Approaches: Unraveling the Mystery of Your Pain

Given the wide range of potential causes for leg and foot pain, accurate diagnosis is crucial for effective treatment. How do medical professionals approach the diagnosis of leg and foot pain?

• Medical history: A detailed discussion of symptoms, lifestyle, and medical background.
• Physical examination: Assessment of mobility, strength, and pain responses.
• Imaging studies: X-rays, MRIs, or CT scans to visualize internal structures.
• Nerve conduction studies: To assess nerve function and identify areas of damage.
• Blood tests: To check for underlying conditions or nutritional deficiencies.

The diagnostic process may involve multiple steps and specialists, depending on the complexity of the case. It’s essential for patients to provide detailed information about their symptoms and cooperate fully with diagnostic procedures to ensure the most accurate diagnosis possible.

Treatment Approaches: Tailoring Solutions to Your Needs

Once the underlying cause of leg or foot pain is identified, treatment can be tailored to address the specific issue. What are some common treatment approaches for leg and foot pain?

• Medications: Pain relievers, anti-inflammatories, or nerve pain medications.
• Physical therapy: Exercises and techniques to improve strength, flexibility, and posture.
• Lifestyle modifications: Changes in diet, exercise habits, or work ergonomics.
• Orthotics: Custom shoe inserts or braces to provide support and alleviate pressure.
• Injections: Corticosteroid or nerve block injections for targeted pain relief.
• Surgery: In severe cases, surgical intervention may be necessary to address underlying issues.

The most effective treatment plan often involves a combination of these approaches, tailored to the individual’s specific condition and needs. Regular follow-ups and adjustments to the treatment plan may be necessary to ensure optimal results.

Prevention Strategies: Keeping Leg and Foot Pain at Bay

While not all causes of leg and foot pain are preventable, there are steps individuals can take to reduce their risk. What strategies can help prevent leg and foot pain?

• Maintain a healthy weight: Excess weight puts additional stress on legs and feet.
• Exercise regularly: Focus on low-impact activities that strengthen muscles and improve flexibility.
• Practice good posture: Be mindful of your body mechanics during daily activities.
• Wear appropriate footwear: Choose shoes that provide proper support and fit well.
• Stay hydrated: Proper hydration helps maintain healthy blood flow and nerve function.
• Manage underlying health conditions: Keep chronic conditions like diabetes well-controlled.

By incorporating these preventive strategies into daily life, individuals can significantly reduce their risk of developing leg and foot pain. However, it’s important to remember that some causes of pain may be outside of an individual’s control, and seeking prompt medical attention for persistent or severe pain is always advisable.

The Road to Recovery: Patience and Persistence

Recovering from leg and foot pain can be a journey that requires patience and persistence. How can individuals optimize their recovery process?

• Follow treatment plans diligently: Adhere to prescribed medications, exercises, and lifestyle changes.
• Communicate with healthcare providers: Report any changes in symptoms or concerns promptly.
• Set realistic expectations: Understand that recovery may take time and progress may be gradual.
• Stay positive: Maintain a hopeful outlook and focus on improvements, no matter how small.
• Seek support: Engage with support groups or loved ones for emotional encouragement.

Remember that every individual’s recovery journey is unique. What works for one person may not be as effective for another. Staying engaged in the recovery process and maintaining open communication with healthcare providers are key to achieving the best possible outcomes.

Emerging Treatments: The Future of Leg and Foot Pain Management

As medical science advances, new treatments for leg and foot pain continue to emerge. What innovative approaches are being developed to address these issues?

• Regenerative medicine: Stem cell therapies and platelet-rich plasma injections to promote healing.
• Advanced pain management techniques: Targeted drug delivery systems and neuromodulation.
• Minimally invasive surgical procedures: Less invasive options for addressing structural issues.
• Wearable technology: Smart devices that provide real-time feedback on posture and gait.
• Virtual reality therapy: Immersive experiences to aid in pain management and rehabilitation.

While many of these treatments are still in developmental stages or limited to specialized centers, they offer hope for more effective and personalized approaches to leg and foot pain management in the future. Staying informed about these advancements can help individuals make educated decisions about their treatment options as they become available.

Causes of Leg Pain and Foot Pain

Leg pain and foot pain vary in type and severity and typically depend on a person’s lifestyle and associated medical problems.¹ In addition to leg pathology, leg pain may be caused by a condition affecting the lower back, hip, or pelvic region. The type of pain may differ based on the underlying cause.

This article provides a guide to the potential causes, specific diagnostic procedures, and the different types of treatment approaches available for leg and foot pain.

Spinal Causes of Leg Pain

Problems in the lower spine may affect the spinal nerve roots, causing pain to radiate into the leg and/or foot (radiculopathy). Common causes of leg and foot pain that originate in the spine include:

Compression of the spinal cord in the neck and/or cauda equina in the lower back can also cause leg pain.

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Blood Vessel Causes of Leg Pain

The arteries and/or veins in the legs may get inflamed or blocked, causing leg and foot pain. Common causes include:

• Peripheral artery disease: Decreased circulation caused due to blocked arteries.²
• Deep vein thrombosis: Blood clot in the deep vein(s) of the leg causing decreased or altered blood flow.³
• Superficial thrombophlebitis: Blood clots in the superficial veins of the leg causing varicose veins or spider veins to form underneath the skin surface.⁴

Blood vessels may also get ruptured and cause bleeding within the tissue spaces of the leg, causing acute pain and swelling.

In This Article:

Pelvis and Hip Related Causes of Leg Pain

Pain from the joints and/or muscles of the pelvis and hip may be referred into the legs. Common causes include:

• Piriformis syndrome: Spasm of the piriformis muscle in the pelvis impinging the sciatic nerve.

  See What Is Piriformis Syndrome?

• Sacroiliac joint dysfunction: Abnormal motion or malalignment of the sacroiliac joint.

  See Sacroiliac Joint Dysfunction (SI Joint Pain)

• Hip osteoarthritis: Wear-and-tear arthritis of the hip joint.

  Read about Hip Osteoarthritis on Arthritis-health.com

• Trochanteric bursitis: Inflammation of a fluid-filled sac (bursa) on the side of the hip.

  Read about Hip Bursitis on Arthritis-health.com

Pelvic bone fractures or other hip joint problems due to trauma, overuse, or degeneration may also cause leg pain.

Leg Pain due to Nerve Damage

Certain medical conditions may cause damage to the peripheral nerves in the leg. Common causes are:

Rarely, autoimmune conditions such as Guillain-Barré syndrome, where the body’s immune system attacks the peripheral nervous system may cause leg pain.⁵

Nutritional Causes of Leg Pain

Deficiency of certain vitamins and minerals may cause damage to the peripheral nerves (peripheral neuropathy) resulting in leg pain and/or weakness. Typical nutrient deficiencies include⁷:

• Vitamin B12
• Vitamin B6
• Copper

Excessive intake of alcohol and heavy metals, such as arsenic, thallium, or mercury may also cause peripheral nerve damage and pain in the legs.

Causes of Foot Pain and Numbness

Certain conditions may cause pain and/or numbness in the foot with or without leg pain. Foot pain commonly occurs in:

• Tarsal tunnel syndrome: Compression of the tibial nerve due to trauma, swelling, poorly fitting shoes, tendon problems, or enlarged arteries or veins.⁸
• Peroneal neuropathy: Compression of the peroneal nerve due to trauma, tumors, or other systemic conditions.⁹

  See All About Neuropathy And Chronic Back Pain

• Sural nerve entrapment: Compression of the sural nerve due to tumors, scar tissue, or from wearing tight ski boots.¹⁰
• L5 and/or S1 radiculopathy: Compression of the L5 or S1 nerve roots in the lower back.

  See All about L5-S1 (Lumbosacral Joint)

Severe foot weakness can cause foot drop (inability to lift the foot off the ground).

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Risk Factors for Leg Pain

A few risk factors associated with leg and foot pain include:

• Advanced age
• Genetics
• Poor posture
• Occupations, such as heavy labor, sports, or military service

While the listed causes and risk factors are not comprehensive, one or more of these conditions are typically associated with leg and foot pain.

Read more: Leg Pain and Numbness: What Might These Symptoms Mean?

Several causes of leg pain can produce overlapping signs and symptoms. It is important to accurately diagnose the underlying cause of leg pain in order to effectively treat the condition as well as rule out serious problems, such as tumors, infections, or nerve damage.

References

• 1.Brewer RB, Gregory AJ. Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment.  Sports Health. 2012;4(2):121–127. doi:10.1177/1941738111426115
• 2.Zemaitis MR, Bah F, Dreyer MA. Peripheral Arterial Disease. [Updated 2019 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430745/
• 3.Stone J, Hangge P, Albadawi H, et al. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 2017;7(Suppl 3):S276–S284. doi:10.21037/cdt.2017.09.01
• 4.Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2018;2(2):CD004982. Published 2018 Feb 25. doi:10.1002/14651858.CD004982.pub6
• 5.Grimm BD, Blessinger BJ, Darden BV, Brigham CD, Kneisl JS, Laxer EB. Mimickers of Lumbar Radiculopathy. Journal of the American Academy of Orthopaedic Surgeons. 2015;23(1):7-17. doi:10.5435/jaaos-23-01-7
• 6.Hanewinckel R, Ikram MA, Van Doorn PA. Peripheral neuropathies. In: Neuroepidemiology. Elsevier; 2016:263-282. doi:10.1016/b978-0-12-802973-2.00015-x
• 7.Staff NP, Windebank AJ. Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneap Minn). 2014;20(5 Peripheral Nervous System Disorders):1293–1306. doi:10.1212/01.CON.0000455880.06675.5a
• 8.Kiel J, Kaiser K. Tarsal Tunnel Syndrome. [Updated 2019 Feb 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK513273/
• 9.Poage C, Roth C, Scott B. Peroneal Nerve Palsy. Journal of the American Academy of Orthopaedic Surgeons. 2016;24(1):1-10. doi:10.5435/jaaos-d-14-00420
• 10.Brewer RB, Gregory AJ. Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment. Sports Health. 2012;4(2):121–127. doi:10.1177/1941738111426115

Why Does My Hip Hurt? 8 Causes of Hip Pain & Problems: Treatment Options

The hip joint can withstand repeated motion and a fair amount of wear and tear. This ball-and-socket joint — the body’s largest — fits together in a way that allows for fluid movement.

Whenever you use the hip (for example, by going for a run), a cushion of cartilage helps prevent friction as the hip bone moves in its socket.

Despite its durability, the hip joint isn’t indestructible. With age and use, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. Bones in the hip can break during a fall or other injury. Any of these conditions can lead to hip pain.

If your hips are sore, here is a rundown of what might be causing your discomfort and how to get hip pain relief.

Causes of Hip Pain

These are some of the conditions that commonly cause hip pain:

Arthritis.Osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, especially in older adults. Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that cushions your hip bones. The pain gradually gets worse. People with arthritis also feel stiffness and have reduced range of motion in the hip. Learn more about hip osteoarthritis.

Continued

Hip fractures. With age, the bones can become weak and brittle. Weakened bones are more likely to break during a fall. Learn more about hip fracture symptoms.

Bursitis. Bursae are sacs of liquid found between tissues such as bone, muscles, and tendons. They ease the friction from these tissues rubbing together. When bursae get inflamed, they can cause pain. Inflammation of bursae is usually due to repetitive activities that overwork or irritate the hip joint. Learn more about bursitis of the hip.

Tendinitis. Tendons are the thick bands of tissue that attach bones to muscles. Tendinitis is inflammation or irritation of the tendons. It’s usually caused by repetitive stress from overuse. Learn more about tendinitis symptoms.

Muscle or tendon strain. Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When they become inflamed due to overuse, they can cause pain and prevent the hip from working normally. Learn about the best stretches for tight hip muscles.

Continued

Hip labral tear. This is a rip in the ring of cartilage (called the labrum) that follows the outside rim of the socket of your hip joint. Along with cushioning your hip joint, your labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket. Athletes and people who perform repetitive twisting movements are at higher risk of developing this problem. Learn more about hip labral tears.

Cancers. Tumors that start in the bone or that spread to the bone can cause pain in the hips, as well as in other bones of the body. Learn more about bone tumors​​​​​​​.

Avascular necrosis (also called osteonecrosis). This condition happens when blood flow to the hip bone slows and the bone tissue dies. Although it can affect other bones, avascular necrosis most often happens in the hip. It can be caused by a hip fracture or dislocation, or from the long-term use of high-dose steroids (such as prednisone), among other causes.

Symptoms of Hip Pain

Depending on the condition that’s causing your hip pain, you might feel the discomfort in your:

• Thigh
• Inside of the hip joint
• Groin
• Outside of the hip joint
• Buttocks

Sometimes pain from other areas of the body, such as the back or groin (from a hernia), can radiate to the hip.

You might notice that your pain gets worse with activity, especially if it’s caused by arthritis. Along with the pain, you might have reduced range of motion. Some people develop a limp from persistent hip pain.

Hip Pain Relief

If your hip pain is caused by a muscle or tendon strain, osteoarthritis, or tendinitis, you can usually relieve it with an over-the-counter pain medication such as acetaminophen or a nonsteroidal anti-inflammatory drug such as ibuprofen or naproxen.

Rheumatoid arthritis treatments also include prescription anti-inflammatory medications such as corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and sulfasalazine, and biologics, which target the immune system.

Another way to relieve hip pain is by holding ice to the area for about 15 minutes a few times a day. Try to rest the affected joint as much as possible until you feel better. You may also try heating the area. A warm bath or shower can help ready your muscle for stretching exercises that can lessen pain.

Continued

If you have arthritis, exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase your range of motion.

When osteoarthritis becomes so severe that the pain is intense or the hip joint becomes deformed, a total hip replacement (arthroplasty) may be a consideration. People who fracture their hip sometimes need surgery to fix the fracture or replace the hip.

Call your health care provider if your pain doesn’t go away, or if you notice swelling, redness, or warmth around the joint. Also call if you have hip pain at night or when you are resting.

Get medical help right away if:

• The hip pain came on suddenly.
• A fall or other injury triggered the hip pain.
• Your joint looks deformed or is bleeding.
• You heard a popping noise in the joint when you injured it.
• The pain is intense.
• You can’t put any weight on your hip.
• You can’t move your leg or hip.

Lower Extremity joint pain – Cancer Therapy Advisor

I. Problem/Condition.

Pain in the lower extremity, including hip, thigh, knee, lower leg, ankle and foot pain.

II. Diagnostic Approach.

A. What is the differential diagnosis for this problem?

When evaluating a hospitalized patient with lower extremity pain, there are several questions one must ask. The first, and most important of these is: Has the patient sustained recent trauma? Recent trauma (e.g., falls to the ground, syncope, falls from bed) will change the evaluation of these patients dramatically. This includes patients who are unable to describe periods of time, such as alcohol withdrawal, etc. In terms of urgency of diagnosis and management of lower extremity pain, the clinician must consider a recent fracture. To evaluate this, if there is any question of possible fracture, radiographs should be taken.

If radiographic evaluation reveals no fracture, but there is high suspicion, the clinician should consider more advanced imaging, including a computed tomography (CT) scan or magnetic resonance imaging (MRI). In some instances, a non-displaced fracture that is less than 3 to 5 days old may appear negative on a radiograph, so further evaluation may be warranted. If fracture is identified, an orthopedic consult is generally warranted for the hospitalized patient.

The second question one should ask when evaluating the hospitalized patient with lower extremity pain is: Is the pain articular or non-articular? This will help the clinician identify the possible source of he pain. For example, a deep groin pain that worsens with internal or external rotation of this hip may be arthritis or avascular necrosis of the hip, while the absence of these findings with lateral pain of the upper thigh to palpation may be a simple trochanteric bursitis.

The third question to keep in mind is: What is the underlying cause of the pain? The differential diagnosis for pain is long, and for the purposes of brevity, this chapter will focus mainly on the focal musculoskeletal causes of lower extremity pain. However, one must always consider the broad categories of infectious, inflammatory, vascular and neoplastic causes of pain. While a septic knee is rarely a subtle finding, the hospitalized patient may have many sources of infection. Similarly, a patient with large swollen legs from fluid overload may have stretching of their skin from the edema that can cause pain. A patient with a clot on an indwelling catheter may infarct part of an extremity, and can be in significant pain before other signs may be noticed.

With these three questions in mind, we can consider the lower extremity in several parts: the pelvis and hip joint, the thigh, the knee, the lower leg, the ankle and the foot.

B. Describe a diagnostic approach/method to the patient with this problem.

Hip and pelvic pain: (see hip and pelvic pain)

The thigh:

Differential Diagnosis: Commonly trochanteric bursitis, sciatic nerve pain or exacerbations of lumbar spinal stenosis; uncommonly bone or muscle tumors, femur fracture, meralgia paresthetica.

The knee joint:

Differential Diagnosis: Osteoarthritis, chronic meniscal injuries (acute if trauma), pes anserine bursitis, baker’s cysts; uncommonly gout, septic arthritis, flares of rheumatoid arthritis, tibial plateau fracture (if trauma).

The lower leg:

Differential Diagnosis: Commonly pes anserine bursitis (see knee), medial tibial stress syndrome (shin splints), uncommonly stress fracture, tibial or fibular fracture, deep vein thrombosis (DVT), compartment syndrome.

The ankle:

Differential Diagnosis: Commonly ankle sprains (may cause distal tibial, fibular or tib/fib fractures if high impact, or may cause “high ankle” fracture of proximal 1/3 of fibula), osteoarthritis; uncommonly gout (see section on Gout), septic arthritis (see knee).

The foot:

Differential Diagnosis: Commonly osteoarthritis, metatarsalgia (pain syndrome of the metatarsal heads), plantar fasciitis, sesamoiditis, diabetic (or other) neuropathy; uncommonly gout, Mortnon’s neuroma, fracture (esp. Jones’ fracture), distal infarction, ulceration, osteomyelitis (see section on Osteomyelitis).

1. Historical information important in the diagnosis of this problem.

Hip and pelvic pain: (see hip and pelvic pain)

The thigh:

Historical Information: Trochanteric bursitis is classically localized superior and posterior to the greater trochanter, Patients with longstanding spinal stenosis have a wide based gait and tend to lean forward (e. g., on shopping carts, etc). Femur fracture is uncommon except with high impact trauma. Muscle or bone tumors are extremely rare. Meralgia paresthetica is the entrapment of a lateral or anterior cutaneous nerve and is not dangerous, but gives a classic well-circumscribed numbness or burning pain in a circular area on the surface of the skin.

The knee joint:

Historical Information: patients with common osteoarthritis generally have a history of such pain, and new meniscal tears are uncommon in inpatients, unless there is a history of fall or trauma. Position in bed may lead to a flare of a pes anserine bursitis, which is typically localized to the medial aspect of the knee 3-5 cm below the joint line. Patients with RA may develop flares as inpatients. Septic arthritis is uncommon in patients with no history of instrumentation or other cause of bacteremia (even if transient). Gout may be caused in hospitalized patients if thiazide diuretic therapy is initiated.

The lower leg:

Historical Information: New onset posterior pain should be evaluated for DVT. A rapid onset pain out of proportion to the exam should raise suspicion for a compartment syndrome. Medial tibial stress syndrome generally follows sustained activity (e.g., worse after walking).

The ankle:

Historical Information: Sprains usually result from trauma. Osteoarthritis might attack a patient who has been bedbound and is recently walking.

The foot:

Historical Information: Plantar fasciitis may affect patients who have been bed-bound and resume weight bearing. Symptoms are typically worse with the first step out of bed, and then a lancing pain down the plantar surface of the foot from the heel distally with each step. Symptoms of plantar faciitis typically resolve when the patient is non-weight bearing again.

Gout typically affects the MTP of great toe (podagra). Sesamoiditis, caused by inflammation or fracture of the small sesamoid bones on the plantar aspect of the first MTP joint, is generally localized to the plantar surface and only painful with weight bearing.

Pain over the lateral aspect of the foot might indicate a fracture of the base of the 5^th metatarsal bone, which is concerning if it affects the vascular supply to the proximal bone hip (named a Jones’ fracture) which may require surgical intervention. Morton’s neuroma (a nerve prolapsing between two metatarsal heads) can present with localized tenderness, generally between, but also above or below the space between two metatarsal heads (most commonly the 3^rd and 4^th metatarsals).

2. Physical Examination maneuvers that are likely to be useful in diagnosing the cause of this problem.

Hip and pelvic pain: (see hip and pelvic pain)

The thigh:

Physical Exam: Lumbar spinal stenosis typically worsens within seconds when the patient lies down. Trochanteric bursitis causes a lateral leg pain with point tenderness. It should not be affected by hip internal or external rotation.

The knee joint:

Physical Exam: Mild effusions are not uncommon in all causes of knee pain. Septic knees are typically very warm and red, while the normal knee will be slightly colder than the skin around it. Knees with mild to moderate effusions may be slightly warm, but are unlikely to be “hot”. An arthritis knee may have some crepitus, and it is not uncommon for an arthritis knee to have medial joint line tenderness. Meniscal tears will occasionally have a palpable click or cause pain with a meniscal stress testing maneuver (e.g., McMurray’s or Apley’s). The pes anserine bursitis is characteristically point tender over the bursa.

The lower leg:

Physical Exam: Testing active resisted dorsiflexion may reproduce shin splints. Fractures will likely be tender to palpation. A DVT may give a positive Homan’s sign. Later stage compartment syndrome may have the distal foot turn dusky or cold, or have a diminished pulse.

The ankle:

Physical Exam: check active and passive range of motion of the ankle for impediment. Palpation of malleoli may indicate a fracture. If ligamentous disruption from ankle sprain is suspected (more commonly on the lateral aspect of ankle), can check anterior and lateral drawer tests.

The foot:

Physical Exam: Exam indicated plantar fasciitis with the foot in dorsiflexion and deep palpation over the plantar surface of the distal aspect of the calcaneous. Tenderness between 3rd/4th or 2nd/3rd MTPs is common with Morton’s neuroma. Point tenderness over the lateral aspect of the foot may indicate a fracture of the base of the 5^th metatarsal. Coldness, color change or splinter hemorrhages under the nail bed, might indicate distal infarction in the foot.

C. Criteria for Diagnosing Each Diagnosis in the Method Above.

Hip and pelvic pain: (see hip and pelvic pain)

The thigh:

Diagnostic Testing: If fracture or tumor is suspected, begin with plain XR and may get MRI if there is high suspicion. If local source of pain is not discovered, consider imaging of the lumbar spine.

The knee joint:

Diagnostic Testing: X-ray a painful knee in the setting of trauma (if looking for tibial plateau fracture, consider CT if X-ray is negative), but an X-ray will be low yield in the setting of pain without trauma, even in the presence of a mild to moderate effusion. In the presence of a moderate to large effusion, consider arthrocentesis (see chapter on arthrocentesis) and send cell count and gram stains. To look for crystals, fluid should be examined in the first 1-3 hours. MRI is the best test for new meniscal or ligamentous injuries, but is rarely necessary in hospitalized patients.

The lower leg:

Diagnostic Testing: Compartment syndrome is a surgical emergency, and should prompt an immediate consultation with orthopedics. Suspected fractures may be worked up with radiographs. Suspected DVT should prompt ultrasound or CT workup.

The ankle:

Diagnostic Testing: Following trauma, the Ottowa ankle rules (test positive if pain near the malleoliand either inability to bear weight both immediately after injury and for four steps on examor bone tenderness at the posterior edge of either mallelous) have 100% sensitivity for malleolar fracture, with radiographs needed only when positive. Suspected osteoarthritis may be supported by weight-bearing ankle films, although these are not necessary for the diagnosis.

The foot:

Diagnostic Testing: Radiographs for fracture of 5^th metatarsal, but if radiographs are negative and suspicion is high, consider MRI. MRI is also the study of choice for Morton’s neuroma.

D. Over-utilized or “wasted” diagnostic tests associated with the evaluation of this problem.

See diagnosis.

III. Management while the Diagnostic Process is Proceeding.

A. Management of Clinical Problem Lower Extremity Joint Pain.

In the inpatient setting, once a specific diagnosis is made, management should be tailored to that diagnosis. If the cause of the pain is deemed to be common musculoskeletal pain, it is appropriate to give analgesia (e.g., acetaminophen or non-steroidal pain medications, if the patient can tolerate them). Rarely, narcotic pain medications are needed, although an escalating need for analgesia may trigger further workup. In rare cases of articular pain, intra-articular corticosteroid injection may be used. For tendon and muscle pain, bedside physical therapy may be helpful, but it’s use in arthritis and ligamentous or meniscal pain is limited.

B. Common Pitfalls and Side-Effects of Management of this Clinical Problem.

See individual diagnoses.

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Lower Extremity Pain – Hip, Knee, Ankle, Foot

Hip Pain and Causes

Hip pain is very common among all ages and can cause mild to severe discomfort when performing daily activities such as standing, walking, squatting, bending, and climbing stairs. Hip pain can be described as dull, achy, sharp, shooting, or tingling.  Muscle strains, tendinitis, or bursitis can occur outside the hip joint and femoral acetabular impingement (FAI), labral tears or osteoarthritis can occur inside the hip joint. The hip joint, also referred to as the femoral acetabular joint, is extremely important because it helps connect the upper body to the lower extremities. It is responsible for dissipating loads from the upper body to the lower body, while providing stability, trunk control, and balance. While the hips are designed to support our bodyweight, every hip is different in terms of alignment and orientation. As movement experts, a physical therapist not only treats conditions such as strains, tendinitis, bursitis, and osteoarthritis, but also assesses each patient’s biomechanics to treat underlying impairments that can cause hip pain.  

Common causes of hip pain include: 

• Muscle Strains and tendinitis: A strain occurs when a muscle supporting the hip is stretched beyond its limits. This results in pain, tenderness, and tightness around the hip. Muscle strains can occur in the front of the hip, in the back of the hip, or on the side of the hip. Strains usually occur when the muscle is in its most lengthened position (think of a runner pulling his hamstring when the leg is completely straight). Overuse of the muscles in these areas can also lead to tendinitis and tendinopathy.  
• Bursitis: A bursa is a fluid filled sac located where muscles and tendons move over bones in order to reduce friction. With trauma or overuse, the bursa can become inflamed or swollen, causing pain and limiting range of motion. The most common is greater trochanter bursitis, which causes pain on the outer most aspect of the hip. Usually, bursitis is a secondary result of tendinopathy of a muscle.  
• Snapping hip syndrome (often referred to as dancer’s hip): Snapping or popping while walking or with leg movement can occur along the front of the hip (snapping of the iliopsoas), or along the outside of the hip (snapping of the IT Band/glute complex).  
• Femoral Acetabular Impingement (FAI): Impingement of the hip is very common and can be described as abnormal contact between the femur (the long thigh bone) and the acetabulum (the socket of the hip bone where the femur inserts). This results in increased friction with hip movement overtime that can to labral tears. Hip impingement causes pain and stiffness throughout the joint and results in progressive loss of motion if not treated. Popping and clicking occur with hip flexion and rotation. 
• Acetabular labral tears: Tears to the labrum be degenerative due to FAI or caused by a trauma to the hip. They are characterized by clicking and popping along the groin area. With labral tears, lying on your back and raising a straight leg will cause pain. 
• Osteoarthritis: Hip OA is one of the leading sources of pain for elderly individuals. Pain is usually worse in the morning and decreases throughout the day with movement. However, there is much more to it than the joint simply being bone-on-bone! Abnormal changes such as cartilage degradation and bone spurs can alter normal joint function, resulting in pain, limited range of motion, and compensation through areas of the body. 
• Pinched nerves: Numbness, tingling, and radiating pain into leg can be caused by impingement of a nerve in the hip (it is not always stemming from the back!). We’ve all heard of the dreaded sciatica that can shoot pain down the back of your leg. Other nerves can also be impinged causing pain to radiate down the front, middle, and outer aspect of the leg as well.  

How can Physical Therapy help? 

A PT will perform a thorough evaluation to determine the structure that is injured or painful, but more importantly why it is injured or painful. Your past medical history will be reviewed to determine any possible underlying causes of pain. The problem is often coming from another non-painful part of the body. If you keep putting air in a tire without fixing the gash, then you will continue to have a problem. For example, progressive hip impingement (FAI) can be the result of stiffness and/or weakness in the core, low back, hip, knee, or ankle. Your PT will design a treatment program to correct any of these underlying mobility or strength deficits, so your problem doesn’t return once the painful structure is healed. For more information on different treatments we offer click here. –   The goal of physical therapy is to get patients moving pain free, so that they can perform activities they enjoy and live life the fullest! 

Knee Pain and Causes 

The knee is arguably the most injured joint in the body. It is a complex joint that takes the brunt of compressive forces during standing, walking, and running. Even in people not experiencing pain, the knee can make sounds like Rice Krispies Cereal: Snap, crackle, and pop. Knee injuries can occur at any age and are the result of sudden trauma, overuse, lack of use, or underlying conditions such as arthritis. Pain can be felt around the kneecap, behind the knee, or inside the joint. Common injuries include muscle strains, ligament sprains, patella femoral pain syndrome, patellar tendinitis, IT band syndrome, bursitis, meniscal injuries, and osteoarthritis. Each can have a negative effect on everyday activities such as standing, walking, squatting, climbing stairs, and even getting in and out of a car. Luckily, most knee injuries respond very well to physical therapy and conservative management.  

Common knee injuries include: 

• Muscle strains: A strain occurs when a muscle supporting the knee is stretched beyond its limits. This results in pain, tenderness, and tightness around the knee, behind the thigh, or in front of the thigh. Strains usually occur when the muscle is in its most lengthened position (think of a runner pulling his hamstring when the leg is completely straight). Overuse of the muscles in these areas can also lead to tendinitis and tendinopathy.  
• Ligament sprains: There are numerous ligaments that stabilize the knee, but the four most important are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Like muscles, a ligament can be sprained when it is stressed beyond its limits. When this occurs, it will leave the knee feeling unstable, often causing it to buckle with weightbearing movements.  
• Patella femoral pain syndrome (PFPS): Pain is usually felt around or underneath the kneecap. PFPS is more common in young, active populations during activities such as running and jumping, but pain can also occur during prolonged sitting. The culprit causing the pain is weakened quadriceps and weak areas of the hip that cause the kneecap to move abnormally.  
• Patellar tendinitis: Pain is felt below the knee, along the patellar tendon, close to the tibial tubercle (the bony area below the knee). It is a common injury in activities requiring sprinting and jumping when the patellar tendon is loaded or stressed excessively.  It can also make going up and down stairs very difficult. In adolescents, you may see similar injuries referred to as Osgood- Schlatters or Sinding-Larsen-Johansson disease.  
• Iliotibial Band Friction Syndrome (IT band syndrome): The most common running injury is known as IT Band syndrome and pain is usually felt along the outside of the thigh and knee. The IT Band moves over the outside of the knee when the knee is flexed and extended. So, activities that slowly and repeatedly bend and straighten the knee such as speed walking and jogging can cause a great deal of friction and tension along the IT Band. However, even though pain is felt in the knee, IT Band syndrome arises from strength deficits at the hip.  
• Bursitis: A bursa is a fluid filled sac located where muscles and tendons move over bones in order to reduce friction. The knee has five bursae, but the pre patella bursa on the front of the knee is the most commonly irritated with kneeling or a direct blow to the kneecap. It becomes inflamed or swollen, which causes pain and limited range of motion. 
• Meniscal injuries: The two menisci play a very important role in making the femur (the long bone in the thigh) and tibia (lower leg) fit together perfectly (the knee would be incongruent without the menisci). They also absorb up to 70% of compressive forces placed on the knee. Injuries to the menisci can be acute from sudden twisting or degenerative in nature due to long periods of poor biomechanics and muscle imbalances. Symptoms include pain around the knee joint, as well as popping and clicking with movement.  
• Osteoarthritis (OA): Knee OA can be debilitating and can get progressively worse if not treated. Pain is usually worse in the morning and decreases throughout the day with movement. However, there is much more to it than the joint simply being bone-on-bone! Abnormal changes such as cartilage degradation and bone spurs can alter normal joint function, resulting in pain, limited range of motion, and compensation through areas of the body. However, surgery does not have to be the answer and should never be the first line of defense.  

How can Physical Therapy help? 

A PT will perform a thorough evaluation to determine the structure that is injured or painful, but more importantly why it is injured or painful. The problem is often coming from another non-painful part of the body. Remember, a great deal of compressive and shear force is placed on the knee with everyday activity. If other structures in the leg are not functioning optimally, these forces will increase, leading to injury. For example, patellar femoral pain can be the result of stiffness in the hip or ankle and/or weakness in the gluteal muscles. IT Band Syndrome stems for hip stiffness and/or weakness in either the gluteals or the tensor fascia late (TFL). Your PT will design a treatment program to correct any of these underlying mobility or strength deficits, so your problem doesn’t return once the painful structure is healed. For more information on different treatments we offer click here. –   The goal of physical therapy is to get patients moving pain free, so that they can perform activities they enjoy and live life the fullest! 

Foot/Ankle Pain and Causes

From elite athletes to a person walking on the street, ankle and foot injuries can happen to anyone, at any time.  The ankle/foot complex consists of 26 bones and over 30 joints, all of which are vital in helping people get around. The ankle and foot have three major functions: 1) An adaptor that conforms to terrain and provides balances strategies. 2) A rigid lever to allow individuals to propel themselves from point A to point B. 3) A shock absorber to transmit forces when the ground is contacted. Examples of injuries to the ankle and foot include ankle sprains, calf strains, Achilles tendinitis, shin splints, plantar fasciitis, calcaneal bursitis, and bunions over the big toe. Overuse injuries can cause pain upon waking up or after prolonged activities. Sudden, acute injuries, such as ankle sprains, can occur out of nowhere, like stepping awkwardly on a curb. Physical therapy will treat the injured structure, as well as address any underlying impairments that may have led to the injury.

• Ankle Sprains: Ligament sprains to the outside of the ankle are considered the most common ankle injury. They occur when the foot twists or rolls inward, causing the ligaments along the outside of the ankle to be overstretched. A less common sprain can occur to the inside of the ankle when the foot rolls or rotates outward. This disrupts the syndesmosis between the tibia and fibula (the joint between the two lower leg bones) and is often referred to as a high ankle sprain. A physical therapist can determine the severity of the sprain by examining range of motion, swelling, bruising, and tenderness.
• Calf strains: The calf runs along the back of the lower leg and can be strained when it is stretched beyond its limits. This occurs when the foot is flexed upward while the knee if fully extended. The result is pain and tightness along the back of the lower leg.
• Achilles tendinitis: The Achilles is the largest tendon in the body. It spans from the calf muscle to the heel. It is commonly injured when the tendon is placed under excessive load during activities such as running, jumping, and climbing. The abrupt action of pushing off and lifting your foot can cause pain just above the heel. Instances where a popping noise occurs could be due to a tear of the Achilles tendon.
• Shin splints (Medial tibial stress syndrome): Aching pain to the lower half of the leg during activity has often been referred to as shin splints (although the more accurate term is medial tibial stress syndrome). The pain usually occurs at the beginning and after running activities due to repeated microtrauma to the lower leg. Also, the aching symptoms are reported along most of the front of the leg. Conversely, stress fractures are characterized by a pinpoint pain location. Muscle imbalances in the lower leg, weakness in foot musculature, and decreased ankle range of motion can cause medial tibial stress syndrome.
• Plantar Fasciitis: Excess pressure to the bottom of the heel can cause irritation to the tissue that runs along the bottom of the foot. Pain is felt on the heel, usually within the first few steps of the day or after prolonged activity. Risk factors for plantar fasciitis include decreased ankle range of motion, decreased big toe extension, an increased body mass index, and even hamstring tightness.
• Calcaneal Bursitis: A bursa is a fluid filled sac located where muscles and tendons move over bones in order to reduce friction. The calcaneal bursa is located between the Achilles tendon and the calcaneus (heel bone). The bursa can get inflamed or swollen with overuse and pain is experienced at the end of the day or after prolonged activity.
• Bunions at the 1^st Ray: When there is decreased ankle/foot range of motion and poor biomechanics with walking, a bony bump (bunion) can form at the base of the big toe. The base of the big toe begins to stick out and the tip is pulled towards the other toes. Poor mechanics with walking can also be caused by impairments higher up the lower extremity chain in the low back, hip, and knee.

How can Physical Therapy help?

A PT will perform a thorough evaluation to determine the structure that is injured or painful, but more importantly why it is injured or painful. The problem is often coming from another non-painful part of the body. If other structures in the leg are not functioning optimally, the ankle and foot will be forced to compensate, leading to injury. For example, a bunion at the first ray can be the result of weakness in the gluteal muscles and/or deep muscles that rotate the hip. This leads to overpronation when walking (the arch of the foot collapses) and excessive stress at the base of the big toe. Your PT will design a treatment program to correct any of these underlying mobility or strength deficits, so your problem doesn’t return once the painful structure is healed. For more information on different treatments we offer click here. –   The goal of physical therapy is to get patients moving pain free, so that they can perform activities they enjoy and live life the fullest!

Five Common Causes of Hip Pain in Women

Monday, January 25th, 2016, 9:45 pm

Hip pain in women can be caused by wear and tear, overuse, and a few other causes. Here are the most common culprits.

Does your hip ache? As with other types of chronic pain, women tend to experience it more than men. But because hip pain can have a number of different causes, determining the correct one is the key to getting the best treatment.

Getting a Hip Pain Diagnosis

When you tell your doctor your hip hurts, the first thing he should do is confirm that your hip is actually the problem. Women might say they have hip pain, but what they may mean is they have pain in the side of the upper thigh or upper buttock, or they may be experiencing lower back pain, saysStephanie E. Siegrist, MD, an orthopedic surgeon in Rochester, N.Y., and spokeswoman for the American Academy of Orthopaedic Surgeons. Hip pain is often felt in the groin or on the outside of the hip directly over where the hip joint (a ball-and-socket joint) is located.

Hip Pain Causes in Women

When a female patient comes to Dr. Siegrist complaining of hip pain, she considers the patient’s age, build, and activity level. If the patient is a thin 20-year-old runner or a heavy, sedentary 80-year-old grandmother, “the possibilities at the top of my list will be different,” she says.

Among the most common causes of hip pain in women are:

1. Arthritis. The most common cause of chronic hip pain in women is arthritis, particularly osteoarthritis, the wear-and-tear kind that affects many people as they age. “The ball-and-socket joint starts to wear out,” Siegrist says. Arthritis pain is often felt in the front of your thigh or in the groin, due to stiffness or swelling in the joint.

2. Hip fractures. Hip fractures are common in older women, especially those with osteoporosis (decreased bone density). Symptoms of a hip fracture include pain when you straighten, lift, or stand on your leg. Also, the toes on your injured side will appear to turn out, a sign that can aid your doctor’s preliminary diagnosis.

3. Tendinitis and bursitis. Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities. One of the most common causes of tendinitis at the hip joint, especially in runners, is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee.

Another common cause of hip pain in women is bursitis, says Marc Philippon, MD, an orthopedic surgeon in Vail, Colo. Fluid-filled sacs called bursae cushion the bony part of the hip that is close to the surface. Like the tendons, these sacs can become inflamed from irritation or overuse and cause pain whenever you move the hip joint.

4. Hernia. In the groin area, femoral and inguinal hernias — sometimes referred to as sports hernias — can cause anterior (frontal) hip pain in women. Pregnant women can be susceptible to inguinal hernias because of the added pressure on the wall of their abdomen.

5. Gynecological and back issues. “Hip pain in women can have gynecological causes,” Siegrist says. “It’s important not to just assume that the pain is caused by arthritis, bursitis or tendinitis. Depending on your age and other health issues, the pain in your hip could be coming from some other system.”

Endometriosis (when the uterus lining grows somewhere else) can cause pelvic tenderness, which some women describe as hip pain. Pain from the back and spine also can be referred and felt around the buttocks and hip, Siegrist says. Sciatica, a pinched nerve, can cause pain in the back of the hip — the pain from sciatica can start in your lower back and travel down to your buttocks and legs.

Hip Pain Treatment Options

Treatment for hip pain depends on the diagnosis, but pain that’s caused by overuse or sports injuries is often treated with heat, rest, and over-the-counter anti-inflammatory medication. To prevent injuries, it is important to stretch before exercising and wear appropriate clothing, especially good shoes when running, Dr. Philippon says.

If certain activities or overuse are causing hip pain, stop those that aggravate the discomfort and talk to your doctor. Excess weight can put pressure on the hip joint, so losing the pounds can provide relief and help you avoid further problems. Some causes of hip pain, such as fractures or hernias, may need surgical repairs. If your hip pain persists, talk to your doctor about the possible causes and treatments.

For more information regarding common causes of hip pain in women, please visit EverydayHealth.com.

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Category: Articles

Causes, Symptoms, Treatment, Prevention & Pain Relief

Overview

True sciatica is an injury or irritation to the sciatic nerve, which starts in your buttock/gluteal area.

What is sciatica?

Sciatica is nerve pain from an injury or irritation to the sciatic nerve, which originates in your buttock/gluteal area. The sciatic nerve is the longest and thickest (almost finger-width) nerve in the body. It’s actually made up of five nerve roots: two from the lower back region called the lumbar spine and three from the final section of the spine called the sacrum. The five nerve roots come together to form a right and left sciatic nerve. On each side of your body, one sciatic nerve runs through your hips, buttocks and down a leg, ending just below the knee. The sciatic nerve then branches into other nerves, which continue down your leg and into your foot and toes.

True injury to the sciatic nerve “sciatica” is actually rare, but the term “sciatica” is commonly used to describe any pain that originates in the lower back and radiates down the leg. What this pain shares in common is an injury to a nerve — an irritation, inflammation, pinching or compression of a nerve in your lower back.

If you have “sciatica,” you experience mild to severe pain anywhere along the path of the sciatic nerve – that is, anywhere from the lower back, through the hips, buttocks and/or down your legs. It can also cause muscle weakness in your leg and foot, numbness in your leg, and an unpleasant tingling pins-and-needles sensation in your leg, foot and toes.

What does sciatica pain feel like?

People describe sciatica pain in different ways, depending on its cause. Some people describe the pain as sharp, shooting, or jolts of pain. Others describe this pain as “burning,” “electric” or “stabbing.”

The pain may be constant or may come and go. Also, the pain is usually more severe in your leg compared to your lower back. The pain may feel worse if you sit or stand for long periods of time, when you stand up and when your twist your upper body. A forced and sudden body movement, like a cough or sneeze, can also make the pain worse.

Can sciatica occur down both legs?

Sciatica usually affects only one leg at a time. However, it’s possible for sciatica to occur in both legs. It’s simply a matter of where the nerve is being pinched along the spinal column.

Does sciatica occur suddenly or does it take time to develop?

Sciatica can come on suddenly or gradually. It depends on the cause. A disk herniation can cause sudden pain. Arthritis in the spine develops slowly over time.

How common is sciatica?

Sciatica is a very common complaint. About 40% of people in the U.S. experience sciatica sometime during their life. Back pain is the third most common reason people visit their healthcare provider.

What are the risk factors for sciatica?

You are at greater risk of sciatica if you:

• Have an injury/previous injury: An injury to your lower back or spine puts you at greater risk for sciatica.
• Live life: With normal aging comes a natural wearing down of bone tissue and disks in your spine. Normal aging can put your nerves at risk of being injured or pinched by the changes and shifts in bone, disks and ligaments.
• Are overweight: Your spine is like a vertical crane. Your muscles are the counterweights. The weight you carry in the front of your body is what your spine (crane) has to lift. The more weight you have, the more your back muscles (counterweights) have to work. This can lead to back strains, pains and other back issues.
• Lack a strong core: Your “core” are the muscles of your back and abdomen. The stronger your core, the more support you’ll have for your lower back. Unlike your chest area, where your rib cage provides support, the only support for your lower back is your muscles.
• Have an active, physical job: Jobs that require heavy lifting may increase your risk of low back problems and use of your back, or jobs with prolonged sitting may increase your risk of low back problems.
• Lack proper posture in the weight room: Even if you are physically fit and active, you can still be prone to sciatica if you don’t follow proper body form during weight lifting or other strength training exercises.
• Have diabetes: Diabetes increases your chance of nerve damage, which increases your chance of sciatica.
• Have osteoarthritis: Osteoarthritis can cause damage to your spine and put nerves at risk of injury.
• Lead an inactive lifestyle: Sitting for long period of time and not exercising and keeping your muscles moving, flexible and toned can increase your risk of sciatica.
• Smoke: The nicotine in tobacco can damage spinal tissue, weaken bones, and speed the wearing down of vertebral disks.

Is the weight of pregnancy the reason why so many pregnant women get sciatica?

It’s true that sciatica is common in pregnancy but increased weight is not the main reason why pregnant women get sciatica. A better explanation is that certain hormones of pregnancy cause a loosening of their ligaments. Ligaments hold the vertebrae together, protect the disks and keep the spine stable. Loosened ligaments can cause the spine to become unstable and might cause disks to slip, which leads to nerves being pinched and the development of sciatica. The baby’s weight and position can also add pressure to the nerve.

The good news is there are ways to ease sciatic pain during pregnancy, and the pain goes away after birth. Physical therapy and massage therapy, warm showers, heat, medications and other measures can help. If you are pregnant, be sure to follow good posture techniques during pregnancy to also ease your pain.

Symptoms and Causes

What causes sciatica?

Sciatica can be caused by several different medical conditions including:

• A herniated or slipped disk that causes pressure on a nerve root. This is the most common cause of sciatica. About 1% to 5% of all people in the U.S. will have a slipped disk at one point in their lives. Disks are the cushioning pads between each vertebrae of the spine. Pressure from vertebrae can cause the gel-like center of a disk to bulge (herniate) through a weakness in its outer wall. When a herniated disk happens to a vertebrae in your lower back, it can press on the sciatic nerve.

• Degenerative disk disease is the natural wear down of the disks between vertebrae of the spine. The wearing down of the disks shortens their height and leads to the nerve passageways becoming narrower (spinal stenosis). Spinal stenosis can pinch the sciatic nerve roots as they leave the spine.
• Spinal stenosis is the abnormal narrowing of the spinal canal. This narrowing reduces the available space for the spinal cord and nerves.

• Spondylolisthesis is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits. The extended spinal bone can pinch the sciatic nerve.
• Osteoarthritis. Bone spurs (jagged edges of bone) can form in aging spines and compress lower back nerves.
• Trauma injury to the lumbar spine or sciatic nerve.
• Tumors in the lumbar spinal canal that compress the sciatic nerve.
• Piriformis syndrome is a condition that develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms. This can put pressure on and irritate the sciatic nerve. Piriformis syndrome is an uncommon neuromuscular disorder.
• Cauda equina syndrome is a rare but serious condition that affects the bundle of nerves at the end of the spinal cord called the cauda equina. This syndrome causes pain down the leg, numbness around the anus and loss of bowel and bladder control.

What are the symptoms of sciatica?

The symptoms of sciatica include:

• Moderate to severe pain in lower back, buttock and down your leg.
• Numbness or weakness in your lower back, buttock, leg or feet.
• Pain that worsens with movement; loss of movement.
• “Pins and needles” feeling in your legs, toes or feet.
• Loss of bowel and bladder control (due to cauda equina).

Diagnosis and Tests

Straight leg raise test helps spot your point of pain. This test helps identify a disk problem.

How is sciatica diagnosed?

First, your healthcare provider will review your medical history. Next, they’ll ask about your symptoms.

During your physical exam, you will be asked to walk so your healthcare provider can see how your spine carries your weight. You may be asked to walk on your toes and heels to check the strength of your calf muscles. Your provider may also do a straight leg raise test. For this test, you’ll lie on your back with your legs straight. Your provider will slowly raise each leg and note the point at which your pain begins. This test helps pinpoint the affected nerves and determines if there is a problem with one of your disks. You will also be asked to do other stretches and motions to pinpoint pain and check muscle flexibility and strength.

Depending on what your healthcare provider discovers during your physical exam, imaging and other tests might be done. These may include:

• Spinal X-rays to look for spinal fractures, disk problems, infections, tumors and bone spurs.
• Magnetic resonance imaging (MRI) or computed tomography (CT) scans to see detailed images of bone and soft tissues of the back. An MRI can show pressure on a nerve, disk herniation and any arthritic condition that might be pressing on a nerve. MRIs are usually ordered to confirm the diagnosis of sciatica.
• Nerve conduction velocity studies/electromyography to examine how well electrical impulses travel through the sciatic nerve and the response of muscles.
• Myelogram to determine if a vertebrae or disk is causing the pain.

Management and Treatment

How is sciatica treated?

The goal of treatment is to decrease your pain and increase your mobility. Depending on the cause, many cases of sciatica go away over time with some simple self-care treatments.

Self-care treatments include:

• Appling ice and/or hot packs: First, use ice packs to reduce pain and swelling. Apply ice packs or bag of frozen vegetables wrapped in a towel to the affected area. Apply for 20 minutes, several times a day. Switch to a hot pack or a heating pad after the first several days. Apply for 20 minutes at a time. If you’re still in pain, switch between hot and cold packs – whichever best relieves your discomfort.
• Taking over-the-counter medicines: Take medicines to reduce pain, inflammation and swelling. The many common over-the-counter medicines in this category, called non-steroidal anti-inflammatory drugs (NSAIDs), include aspirin, ibuprofen (Advil®, Motrin®) and naproxen (Naprosyn®, Aleve®). Be watchful if you choose to take aspirin. Aspirin can cause ulcers and bleeding in some people. If you’re unable to take NSAIDS, acetaminophen (Tylenol®) may be taken instead.
• Performing gentle stretches: Learn proper stretches from an instructor with experience with low back pain. Work up to other general strengthening, core muscle strengthening and aerobic exercises.

How long should I try self-care treatments for my sciatica before seeing my healthcare professional?

Every person with sciatic pain is different. The type of pain can be different, the intensity of pain is different and the cause of the pain can be different. In some patients, a more aggressive treatment may be tried first. However, generally speaking, if a six-week trial of conservative, self-care treatments – like ice, heat, stretching, over-the-counter medicines – has not provided relief, it’s time to return to a healthcare professional and try other treatment options.

Other treatment options include:

• Prescription medications: Your healthcare provider may prescribe muscle relaxants, such as cyclobenzaprine (Amrix®, Flexeril®), to relieve the discomfort associated with muscle spasms. Other medications with pain-relieving action that may be tried include tricyclic antidepressants and anti-seizure medications. Depending on your level of pain, prescription pain medicines might be used early in your treatment plan.
• Physical therapy: The goal of physical therapy is to find exercise movements that decrease sciatica by reducing pressure on the nerve. An exercise program should include stretching exercises to improve muscle flexibility and aerobic exercises (such as walking, swimming, water aerobics). Your healthcare provider can refer you to a physical therapist who’ll work with you to customize your own stretching and aerobic exercise program and recommend other exercises to strengthen the muscles of your back, abdomen and legs.
• Spinal injections: An injection of a corticosteroid, an anti-inflammatory medicine, into the lower back might help reduce the pain and swelling around the affected nerve roots. Injections provide short-time (typically up to three months) pain relief and is given under local anesthesia as an outpatient treatment. You may feel some pressure and burning or stinging sensation as the injection is being given. Ask your healthcare provider about how many injections you might be able to receive and the risks of injections.
• Alternative therapies: Alternative therapies are increasingly popular and are used to treat and manage all kinds of pain. Alternative methods to improve sciatic pain include spine manipulation by a licensed chiropractor, yoga or acupuncture. Massage might help muscle spasms that often occur along with sciatica. Biofeedback is an option to help manage pain and relieve stress.

When is surgery considered?

Spinal surgery is usually not recommended unless you have not improved with other treatment methods such as stretching and medication, your pain is worsening, you have severe weakness in the muscles in your lower extremities or you have lost bladder or bowel control.

How soon surgery would be considered depends on the cause of your sciatica. Surgery is typically considered within a year of ongoing symptoms. Pain that is severe and unrelenting and is preventing you from standing or working and you’ve been admitted to a hospital would require more aggressive treatment and a shorter timeline to surgery. Loss of bladder or bowel control could require emergency surgery if determined to be cauda equine syndrome.

The goal of spinal surgery for sciatic pain is to remove the pressure on the nerves that are being pinched and to make sure the spine is stable.

Surgical options to relieve sciatica include:

Microdiscectomy: This is a minimally invasive procedure used to remove fragments of a herniated disk that are pressing on a nerve.

• Laminectomy: In this procedure, the lamina (part of the vertebral bone; the roof of the spinal canal) that is causing pressure on the sciatic nerve is removed.

How long does it take to perform spine surgery and what’s the typical recovery time?

Discectomy and laminectomy generally take one to two hours to perform. Recovery time depends on your situation; your surgeon will tell you when you can get back to full activities. Generally the time needed to recover is six weeks to three months.

What are the risks of spinal surgery?

Though these procedures are considered very safe and effective, all surgeries have risks. Spinal surgery risks include:

What complications are associated with sciatica?

Most people recover fully from sciatica. However, chronic (ongoing and lasting) pain can be a complication of sciatica. If the pinched nerve is seriously injured, chronic muscle weakness, such as a “drop foot,” might occur, when numbness in the foot makes normal walking impossible. Sciatica can potentially cause permanent nerve damage, resulting in a loss of feeling in the affected legs. Call your provider right away if you lose feeling in your legs or feet, or have any concerns during your recovery time.

Prevention

Can sciatica be prevented?

Some sources of sciatica may not be preventable, such as degenerative disk disease, sciatica due to pregnancy or accidental falls. Although it might not be possible to prevent all cases of sciatica, taking the following steps can help protect your back and reduce your risk:

• Maintain good posture: Following good posture techniques while you’re sitting, standing, lifting objects and sleeping helps relieve pressure on your lower back. Pain can be an early warning sign that you are not properly aligned. If you start to feel sore or stiff, adjust your posture.
• Don’t smoke: Nicotine reduces the blood supply to bones. It weakens the spine and the vertebral disks, which puts more stress on the spine and disks and causes back and spine problems.
• Maintain a healthy weight: Extra weight and a poor diet are associated with inflammation and pain throughout your body. To lose weight or learn healthier eating habits, look into the Mediterranean diet. The closer you are to your ideal body weight the less strain you put on your spine.
• Exercise regularly: Exercise includes stretching to keep your joints flexible and exercises to strengthen your core – the muscles of your lower back and abdomen. These muscles work to support your spine. Also, do not sit for long periods of time.
• Choose physical activities least likely to hurt your back: Consider low-impact activities such as swimming, walking, yoga or tai chi.
• Keep yourself safe from falls: Wear shoes that fit and keep stairs and walkways free of clutter to reduce your chance of a fall. Make sure rooms are well-lighted and there are grab bars in bathrooms and rails on stairways.

Outlook / Prognosis

What can I expect if I have been diagnosed with sciatica?

The good news about sciatic pain is that it usually goes away on its own with time and some self-care treatments. Most people (80% to 90%) with sciatica get better without surgery, and about half of these recover from an episode fully within six weeks.

Be sure to contact your healthcare provider if your sciatica pain is not improving and you have concerns that you aren’t recovering as quickly as hoped.

Living With

When should I contact my healthcare provider?

Get immediate medical attention if you experience:

• Severe leg pain lasting more than a few hours that is unbearable.
• Numbness or muscle weakness in the same leg.
• Bowel or bladder control loss. This could be due to a condition called cauda equina syndrome, which affects bundles of nerves at the end of the spinal cord.
• Sudden and severe pain from a traffic accident or some other trauma.

Even if your visit doesn’t turn out to be an emergency situation, it’s best to get it checked out.

Is the sciatic nerve the only source of “sciatica” pain?

No, the sciatic nerve is not the only source of what is generally called “sciatica” or sciatica pain. Sometimes the source of pain is higher up in the lumbar spine and causes pain in front of the thigh or in the hip area. This pain is still called sciatica.

How can I tell if pain in my hip is a hip issue or sciatica?

Hip problems, such as arthritis in the hip, usually cause groin pain, pain when you put weight on your leg, or when the leg is moved around.

If your pain starts in the back and moves or radiates towards the hip or down the leg and you have numbness, tingling or weakness in the leg, sciatica is the most likely cause.

Is radiculopathy the same as sciatica?

Radiculopathy is a broader term that describes the symptoms caused by a pinched nerve in the spinal column. Sciatica is a specific type, and the most common type, of radiculopathy.

Should I rest if I have sciatica?

Some rest and change in your activities and activity level may be needed. However, too much rest, bed rest, and physical inactivity can make your pain worse and slow the healing process. It’s important to maintain as much activity as possible to keep muscles flexible and strong.

Before beginning your own exercise program, see your healthcare provider or spine specialist first to get a proper diagnosis. This healthcare professional will refer you to the proper physical therapist or other trained exercise or body mechanics specialist to devise an exercise and muscle strengthening program that’s best for you.

Can sciatica cause my leg and/or ankle to swell?

Sciatica that is caused by a herniated disk, spinal stenosis, or bone spur that compresses the sciatic nerve can cause inflammation – or swelling – in the affected leg. Complications of piriformis syndrome can also cause swelling in the leg.

Are restless leg syndrome, multiple sclerosis, carpal tunnel syndrome, plantar fasciitis, shingles or bursitis related to sciatica?

While all these conditions affect either the spinal cord, nerves, muscles, ligaments or joints and all can cause pain, none are directly related to sciatica. The main causes of these conditions are different. Sciatica only involves the sciatic nerve. That being said, the most similar condition would be carpal tunnel syndrome, which also involves a compression of a nerve.

A final word about sciatica. . . .

Most cases of sciatica do not require surgery. Time and self-care treatment are usually all that’s needed. However, if simple self-care treatments do not relieve your pain, see your healthcare provider. Your healthcare provider can confirm the cause of your pain, suggest other treatment options and/or refer you to other spine health specialists if needed.

Foot Pain? New Study Says Look at Hip and Knee, Too, for Complete Diagnosis

New York, NY—September 19, 2017

A study by researchers at Hospital for Special Surgery (HSS) and Harvard Medical School suggests new guidelines may be in order for evaluating and treating lower extremity pain. Investigators set out to determine if there was a relation between foot pain and lower extremity joint pain, and they found a significant association between foot pain and knee or hip pain.

“Our overall goal was to provide practitioners with evidence-based guidance for evaluation and options for treatment for their patients,” the researchers wrote in their paper, which appeared in the Journal of the American Podiatric Medical Association.

“The study shows that a physician evaluating a patient for foot pain should also ask about possible hip or knee pain, and vice versa, so we can address all of a patient’s issues. In medicine, many times it comes down to ‘what does your MRI look like or what does your x-ray look like?’ But it’s really important to conduct a thorough medical history and physical exam,” says Brian Halpern, MD, a sports medicine physician at HSS and study co-author. “A comprehensive orthopedic evaluation may prompt a broader treatment strategy and possibly a referral to another specialist.”

“Studying the interaction between the knee and the foot, or the hip and the foot is very important because it’s a kinetic chain,” says Rock G. Positano, DPM, MPH, director of the Non-Surgical Foot and Ankle Service, Joe DiMaggio Sports Medicine Foot and Ankle Center at HSS. 

The kinetic chain, the notion that the body’s joints and segments have an effect on one another during movement, can play a key role in pain. “The foot is the first part of the body that makes contact with the ground. Its primary function is a shock absorber. If the shock-absorbing capability of the foot is somehow altered or minimized, it’s going to affect other body parts,” Dr. Positano explains.

“The foot is also the foundation of the body,” he adds. “If the foundation is not sound, it could have a deleterious effect on the joints above the foot and ankle, namely the knee and the hip.”

In the population-based study, investigators analyzed information from a database of 2,181 people who had participated in the NIH-funded Framingham Foot Study between 2002 and 2008. “Access to this rich database was indispensable to test our hypothesis that there was a relation between foot pain and hip or knee pain,” explained Howard Hillstrom, PhD, director of the Motion Analysis Laboratory at HSS and co-investigator of the Framingham Foot Study. “It would have been very difficult to organize such a large study from scratch.”

Participants completed a questionnaire evaluating foot pain, pain location (including side of pain) and severity. They also indicated whether they had experienced pain, aching or stiffness in the hip or knee and specified the side of any reported pain. In the study, 16% of participants reported bilateral foot pain, 6% right foot pain only and 5% left foot pain only. Slightly more women than men reported foot pain.

Researchers found that foot pain was associated with bilateral and same-side knee pain in men and women. For example, men with right foot pain compared to those with no foot pain were five to seven times more likely to have pain in their right knee or in both knees.

Foot pain was also associated with hip pain on the same side in men. In women, bilateral foot pain was associated with hip pain on both sides, on the same side or on the opposite side.

A theory that may explain study results looks at how an individual modifies his movements and postures when experiencing pain. This can result in malalignment and other problems, and the challenge for physicians is to develop a treatment plan to address all issues, according to the study authors. “The correlated and compensatory posture and movement theory¹ may explain how multi-joint arthritis develops, as well as other abnormalities and associated pains that can result from overuse or trauma to one or more structures in the kinetic chain,” the researchers wrote.

They went on to state that the findings “advocate for a change in the paradigm of how patients with lower extremity pain should be evaluated clinically… In a world where medical imaging has come to the forefront of patient diagnoses and care, these results remind health care providers that the basic physical examination and patients’ history remain important in identifying pain and related patterns in patients.”

Dr. Positano notes that it is also up to patients to be proactive, making sure they discuss all orthopedic issues they may have during the doctor visit. 

[1] Riegger-Krugh and Keysor, JOSPT. 1996

Coxarthrosis of the hip joint | ortoped-klinik.com

Coxarthrosis of the hip joint © Viewmedica

Wear and tear of the cartilage of the hip joint (Latin Coxarthrose) is a widespread degenerative disease. Many people suffer from hip pain throughout their lives. Coxarthrose is the most common form of arthritis in general.

Typical complaints:

• Groin pain
• deep-seated pain in the lumbar spine
• knee pain
• early symptoms of the disease are pain during the morning warm-up and exertion of the hip
• with progressive osteoarthritis pain at rest and at night
• Decreased joint range of motion (problems with shoe / squatting)
• reduction of distances when walking

Causes of pain

Many patients suffer from pain, pulling symptoms, pressure or burning sensation in the groin area.

The same symptoms can be caused not only by orthopedic diseases, but by a number of other diseases. So, internal diseases of the pelvis, abdomen and even neurovascular disorders can lead to the above complaints.

Symptoms and signs of diseases from different areas often overlap. Especially in rheumatic diseases, the symptoms must be carefully investigated and studied.

Pain in the groin or hip can also be caused by other orthopedic diseases.

More than a hundred causes of hip coxarthrosis are known to medicine. There are primary coxarthrosis of the hip, when the cause is not known, and secondary, caused by a number of major diseases, such as rheumatism, circulatory disorders, congenital structural disorders, trauma, metabolic disorders, genetic disorders, etc.

The diagnosis can be made on the basis of complaints, clinical examinations of orthopedists, as well as using X-rays.

Complaints arising during the development of the disease significantly reduce the patient’s quality of life and require treatment.

What are the treatment options?

Treatment of coxarthrosis of the hip is mainly aimed at relieving pain, avoiding possible inflammation of the hip joint and maintaining the mobility of the hip. Disability should be minimized, and the quality of life of patients, despite the wear of the joint, should be preserved.

At an early stage of the disease, the patient himself can influence the course of its development. An understanding of the development of the disease and the implementation of recommendations for changing daily habits play a very important role in this.The goal is to intelligently combine the stress on the joint during sports and at work, with special exercises aimed at strengthening the muscles of the thigh and maintaining mobility. In particular, the reduction of excess weight contributes significantly to the improvement: Even a decrease in body weight by 5 kg reduces the risk of coxarthrosis by almost 50%!

At the middle stage of the development of the disease, special measures and technical means are recommended to protect joints. Simple pain relievers combined with modern stomach-sparing antirheumatic drugs lead to good results.Pain treatment with and without medication turns off the source of pain, and modern antirheumatic drugs eliminate joint complaints without burdening the body. Physiotherapy measures to relieve symptoms and specific treatment with injections may also be needed.

The use of physiotherapy will strengthen the muscles and increase the mobility of the joint. Local physiotherapy treatments are important components in relieving pain, stimulating metabolism and reducing inflammation.Special training reduces the deformity of the hip joints and the effects of inappropriate loads (eg prolonged standing, kneeling or squatting). This leads to a conscious and gentle treatment of patients with joints. In addition, pain, joint stiffness and other symptoms are often reduced along the way.

Orthopedic aids such as special shoes, thigh relief devices, bandages and orthoses are used to improve treatment.Also, in the process of drug therapy, anti-inflammatory analgesics are used. Treatment with homeopathic medicines as well as with a pulsating magnetic field also leads to good results. Alternative methods for cartilage augmentation have been used very successfully for minor cartilage lesions.

Very good results are achieved with Orthokin therapy, in which the immune proteins of their own act directly in the affected areas and delay the destruction of cartilage.

In advanced stages of the disease, only operative measures are used. Locally limited cartilage lesions can be removed with hip arthroscopy. At the same time, broken pieces of cartilage and rough ones are removed through the minimal invasive holes, the torn surfaces of the cartilage are smoothed. As a result, irritation of the inner skin inside the joint is eliminated and the complaints subside.

There is also the possibility of filling cartilage defects arthroscopically with a cartilage substitute based on the body’s own cells.Treatment includes a range of surgical interventions with hole drilling, microfracture and curettage.

Today, an innovative way to repair minor cartilage damage is spheroid transplantation. For this, their own cartilage cells are taken from the joint zones with minimal stress and then grown in a special laboratory. The cells grow in the shape of a sphere and can then be implanted arthroscopically into the damaged area. This procedure is currently the most effective, but the scope and experience gained are still limited.

Correction of the axis of the deformed joint – osteotomy – with limited cartilage damage can significantly reduce the mechanical stress on the joint. This treatment is especially effective for deformed joints.

As a result, pain is alleviated and the process of disease development slows down.

For advanced forms of the disease, hip arthroplasty is performed. Here, depending on the size of the damage, the affected region and the age of the patient, either a McMinn superficial prosthesis (femoral head prosthesis) or a total endoprosthesis is used.Modern materials and new minimally invasive surgical techniques ensure minimal stress and good long-term results. Thanks to the artificial joint, the functions of the joint are restored and pain disappears. The new generation of prostheses is becoming attractive also for young patients, because offers high strength and durability.

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Leg hurts in the thigh closer to the groin

Pain between the leg and groin can have a different cause.Discomfort in this area arises genetically, after physical exertion, after injuries. Pain in the hip indicates pathology in the internal organs and requires special attention from a medical specialist. Unpleasant sensations are of different nature, duration and intensity, but even with the slightest discomfort, you should contact the clinic. In the institution of the KDS Clinic, as soon as possible, specialists will find out the cause of your discomfort and will assign an effective affordable treatment. You should not run your health to a critical state, since then it will be much more difficult to cure the disease.

The pain between the leg and groin arises abruptly, has a sharp dagger character, stops after a few minutes and soon intensifies again. Unpleasant sensations appear in the upper thigh area, give to the groin. The patient’s malaise is associated with anatomical or physiological changes in the internal organs.

Causes of groin pain

Why does the pain in the right groin radiate to the leg? What treatment will be effective and which specialist should you contact? The onset of pain syndrome could be influenced by many factors.Among them:

1. Joint injury. Pain in the right groin radiates to the leg after injury. Damage to the joints is accompanied by cutting pain, which increases with movement, when turning the body, strongly radiates to the leg. Most often, such symptoms appear in athletes. After heavy physical exertion, muscles and joints are injured, loosened and require long-term treatment. People who work physically are also associated with this problem. For example, builders.
2. Damage to the femoral neck.The leg hurts in the right groin when falling. In some cases, the injury develops after a sharp and wrong turn. Also, the femoral neck is damaged in old age. The musculoskeletal system becomes less elastic, the bones are no longer so strong. With menopause, which occurs in women after forty-five years, osteoporosis develops in the body. The development of the disease is caused by hormonal changes.
3. Contusions of the pelvic bones. If the pelvic bones are damaged, the leg hurts from the groin to the knee.
4. Stretching the muscles in the thigh area.Stretching of the muscles is characteristic of athletes, so you should be especially careful with such symptoms in order to prevent the development of the disease.
5. Inflammatory process in the hip joint. With an inflammatory process in the hip joint, pain appears in the groin of the leg when walking. The patient also has concomitant symptoms. These include fever, weakness, skin redness and dizziness.
6. Infectious diseases. In infectious diseases, leg pain from groin to knee is one of the main symptoms.Immunity is significantly weakened, the patient has vitamin deficiency, and therefore the joints and bones become fragile, often damaged by infection in the body. Infectious diseases often include endocrinopathy, osteomyelitis, and others.
7. Injury to the sacrum. If the sacrum is damaged, pain in the leg in the groin on the right disturbs the patient for several weeks. You need to see a doctor as soon as possible, take a picture and not self-medicate.
8. Injury of the first lumbar vertebral disc.After a fall or an accident, the patient develops damage to the first lumbar vertebral disc, which leads to severe cutting pains. They are eliminated with pain relievers.
9. Problems with blood vessels. In some cases, pain in the groin when raising the leg bothers the patient with problems with blood vessels. This is an artery thrombosis in the thigh and groin area.
10. Deformation of the articular tissues.
11. Arthritis and arthrosis. An unpleasant pulling pain appears with the development of arthritis and arthrosis.The pain syndrome especially increases when moving, when turning and squatting. After several hours of walking, the patient feels severe fatigue, discomfort in the pelvis, which is given to the groin. The pain manifests itself at any time of the day and increases in the absence of treatment and diagnosis.
12. Bursitis. With bursitis, a person suffers from severe pain that increases with movement. After prolonged activity, discomfort appears even in a sitting and lying state.
13. Coxarthrosis. With coxarthrosis, the patient is worried about severe pain in the thigh area.It manifests itself with an increase and intensifies with physical exertion. In some cases, pain relievers are needed to relieve pain.
14. Fluid in the joints. After injury, fluid forms in the joints, which causes painful sensations. In critical cases, the liquid is sucked out to prevent the development of the disease.

If the pain in the pelvis, radiating to the groin, does not stop after a few days, then you should definitely see a doctor. In the absence of effective treatment, the disease will develop and negatively affect neighboring organs.

Diagnosis of pain in the leg closer to the groin

Joint pain cannot be ignored. Any unpleasant sensations indicate a violation of the functionality of the body and the pathology of internal organs. Contact KDS Clinics. Experienced specialists will provide assistance at any time. The patient is sent for tests, for a comprehensive examination of the body. With such symptoms, the patient should make an X-ray of the joints, ultrasound diagnostics. General analyzes will show the details of the body’s internal indicators.To get a more accurate result, it is worth doing magnetic resonance imaging. The procedure is prohibited for pregnant women, women during the lactation period and children under sixteen years of age. Consult your doctor before testing.

Make an appointment with a specialist at 8 (495) 374-03-43. In some cases, the patient is left in the hospital to monitor the improvement in performance. We suggest that you familiarize yourself with the prices for all services on the official website of the medical institution.

When the hip joint hurts and gives it to the leg

Moving parts of the body experience increased stress and “wear out” over time, which in some cases is revealed on a preventive MRI scan.The hip joint has a complex anatomical structure, and the branching of the nerve canals in its area leads to the spread of pain in the leg, back or groin area. This feature makes it difficult to diagnose, and patients often do not associate pain with problems in the bone articulation. At the first manifestations of discomfort, it is necessary to consult a doctor in order to avoid further spread of inflammation and critical consequences.

Description and symptoms of pathologies of the articular zone of the musculoskeletal system

Prolonged manifestations of pain are the reason for MRI of the hip joint.The bony joint itself is not penetrated by nerve fibers, so some diseases can be asymptomatic for a long time. Soreness appears at the stage of damage or compression of the nerve channels passing in the “hinge” region of the body. At the initial stage of the appearance of violations, unpleasant sensations arise in a limited area of ​​the junction of the femur with the pelvis. If the disease is ignored, the focus of inflammation grows and spreads to neighboring tissues: muscle and tendon fibers, cartilage formations, nerve and blood pathways.

A person may experience the following sensations:

• prolonged radiating pain that does not go away for several days, the cause of which can be identified on an MRI of the hip joint;
• nocturnal soreness leading to insomnia;
• desire to change postures as often as possible in order to relieve the pelvic joint with constant discomfort in it.

These signs are the reason for a thorough diagnosis, and urgent clinical care is required if the patient complains of the following conditions:

• Irradiation in the groin.Through the conductive canal of the nerve, pulsating sensations spread to the lower abdomen and inguinal zone, with inflammation of adjacent fibers, the sciatic nerve is affected.
• Lumbago in the lower back. They can be both sharp and dull, pulsating, leading to limited movement of the body and pelvis.
• Spread of pain to the leg, including the knee area. It can be manifested by muscle weakness or itching sensations in the skin.
• “Hinge” clutch, which does not allow free movement of the limb.Acts as a sign of arthritic and arthritic lesions.
• Partial or complete lack of mobility associated with the destruction of pelvic tissue or experienced trauma.
• Lameness associated with mild pain. It requires correction, since a change in motor habits leads to deformation of the entire musculoskeletal system.

Most patients describe such a phenomenon as crunching sounds when changing body position or movement. The semblance of a crunch is produced by individual bundles.If the sound is not accompanied by discomfort, do not worry. Accession of pain requires referral to a medical professional.

Causes of pain in the hip joint

High loads exerted on the natural “hinges” of the human body lead to the development of various diseases. Both old and recent injuries contribute to subsequent disorders. One of the most common anomalies is a fracture or destruction of the femoral neck, adjacent pubic articulation or sacrum bone, which can be recognized not only on x-rays, but also on MRI.The hip joint suffers from severe bruises, muscle and ligamentous sprains.

In some cases, mechanical abrasion of cartilage fibers occurs. This pathology affects people who are forced to engage in heavy physical labor at a professional level, or who go in for sports with a high level of physical stress. Problems can also arise in persons with congenital anomalies in the development of this part of the body. Inflammatory processes also lead to tissue and nerve damage.

The pelvis and its adjacent joints suffer from systemic and degenerative diseases. Bone fibers are susceptible to necrosis if the blood supply to the department is disturbed. Endocrine disruptions lead to the development of articular pathologies, manifested in the following diseases:

• Arthritis, arthrosis and coxarthrosis – erasure and inflammation of the cartilaginous layers and outer surfaces of bones.
• Bursitis – inflammation as a result of mechanical damage or internal infection of the joint capsule, accompanied by severe edema and sharp pain.
• Tendonitis is an inflammatory irritation of the ligamentous apparatus, covering both the articular regions of the pelvis and the rest of the leg, up to the toes.
• Anomalies of bone growth with congenital predisposition and the influence of other pathologies.
• Irradiation from nearby organs of the genitourinary system or gastrointestinal tract.
• Tumor formations that put pressure on the nerve endings.

In case of suspicion of any of these diseases, a targeted examination is prescribed, designed to differentiate pathologies and identify the root cause of the disease state.

Diagnosis of diseases using hardware devices and MRI of the hip joint

The first step in detecting disorders in the joints of the musculoskeletal system is to contact an orthopedist-traumatologist. If necessary, the doctor will resort to the complicity of other narrowly focused specialists: surgeons, oncologists, rheumatologists or neurologists. At the initial stage, it is required to do standard laboratory tests that will determine whether an inflammatory process is taking place in the subject’s body.

MRI of the hip joint is rarely performed as a primary instrumental examination. The site is first checked using X-ray imaging and ultrasound scanning. These diagnostic methods help to fix obvious anomalies that occur in the bones and soft tissue adjacent formations. Most often, the consequences of injuries, fractures, muscle or tendon ruptures are found this way.

If the cause of pain is more complex processes that are not detected by traditional diagnostic methods, the pelvis is scanned by tomographic methods – CT and MRI.Visualization by means of a computer scanner allows you to accurately study the state of the skeleton, the inner surface of the “hinge” zones, the degree of integrity of the blood and nerve channels, as well as to recognize the presence of tumors of various nature. Examination at a nuclear resonance unit allows you to assess the condition of muscles, cartilage and other less dense fibers. Layering of the bones will not interfere with the imaging of the MRI of the hip joint.

Treatment and relief of pain

The primary symptoms of each disease described are identical, but this does not mean that the treatment will also be the same.After identifying the root cause of the anomaly, specific therapy is prescribed to eliminate the source of the disease.

The following recommendations are general in the restoration of functionality after MRI of the hip joint:

• reduction of physical activity from the affected limb, increase in the duration of rest;
• the use of drug therapy aimed at relieving inflammation, pain syndrome, spasms and regeneration of cartilaginous tissues, general strengthening of the body;
• the impact on the pelvis by physiotherapeutic methods (in the remission period), visiting the massage room and conducting a course of medical gymnastics;
• solution of the issue of surgical intervention, if purulent or blood inclusions, fluids, malignant formations are found in the articular cavities.

During the main treatment, it is important to get rid of the debilitating pain, which will help improve the quality of life and overall well-being. Standard analgesics are available but only provide temporary relief. To enhance the effect, it is recommended to limit physical activity, massage the affected area, apply a cool compress, if the cause of pain is injury. On the recommendation of a physician, you can turn to non-steroidal anti-inflammatory drugs.

Evaluation of the effectiveness of treatment on MRI of the hip joint

After the completed restorative procedures, it is important to re-diagnose, allowing you to check the correctness of the prescribed treatment course.The best way to compare the rate of tissue regeneration is MRI. In the presence of pictures of a previously conducted study, a functional diagnostician compares the staging of the disease, reveals the absence or presence of relapses (tumors or infections affecting the pelvis), migration of metastases.

After surgery, the composition of the fluid in the articular cavities, the degree of fiber recovery are examined. In some cases (with cancerous lesions of the bone) it is necessary to remove the hinge part of the thigh and replace it with a prosthesis.The implantation material is a metal alloy, so MRI scanning of the hip joint is contraindicated. An alternative is the same informative examination as a computer scan.

Hardware research can be carried out in specialized diagnostic centers containing tomography rooms. You can choose the nearest medical facility on the website of the “Single Recording Center” in Moscow. An expanded list of clinics simplifies comparison by ratings, location addresses, prices for services.Mark the best offers and sign up for diagnostics through the service. This will open access to additional discounts for the selected type of tomography.

Causes and symptoms – About Palliative

Contents

Causes of occurrence

Component or disease

Stages of pain

Nerve recovery after injury

Neuropathic pain is a companion of many diseases in humans. The cause of its appearance can be damage to various parts of the nervous system. Such damage affects very different levels: from small nerves located deep in tissues, to nerve trunks, plexuses and even parts of the spinal cord and brain. Since a person is laced with nerves, damage to them at any level and area can lead to neuropathic pain.

If you’ve ever hit an elbow or a dentist has “hit a nerve” with a bur while treating your teeth, you understand what neuropathic pain is. People with chronic neuropathic pain experience this feeling on a daily basis.At the first manifestations, patients describe this pain as uncomfortable sensations, burning, “shooting”.

Causes

Neuropathic pain can be caused by a wide variety of factors, including fractures, metabolic disorders, and nerve damage during surgery. Also, it can be caused by a stroke, amputation of a limb, spinal cord injury.

Neuropathic pain occurs as a result of disturbances in the structure and function of the nerve. And it should be said separately about the compression of the nerve, for example, when a benign neoplasm puts pressure on the walls of nearby organs and brings pain due to overstretching of these walls.

Component or disease

Neuropathic disease can occur as an independent disease or accompany other diseases, for example, diabetes mellitus or coronary heart disease – then doctors talk about the neuropathic component.

Several types of pain can occur simultaneously. For example, neuropathic and nociceptive together. If a person breaks his arm, events can develop according to different scenarios. The first case, when a fracture occurs, and a sprain of muscles and ligaments occurs nearby – a person feels only typical nociceptive pain, which he describes as acute, aching and throbbing.Another case is when a nerve bundle is stretched during a fracture or a nerve is torn.

Even when the bone grows together and the person does not have any external reasons to worry, this damaged nerve may hurt. If the area of ​​damage was large, it is likely that the nerve will remain permanently damaged and the person will be dealing with chronic neuropathic pain.

Stages of pain

With damage to the nervous system, pain develops rather slowly and gradually.A typical situation – is the appearance of tunnel syndrome: nerves are compressed in narrow places by tendons, muscles or other structures located nearby. It can happen on the neck, arms, legs due to uncomfortable posture, tight shoes or clothing. Tunnel syndromes often occur in office workers working in the same position at the computer.

Terminology of pain Basic terms and definitions in the topic of pain

Another situation is irritation of a nerve in a herniated disc, to which aseptic inflammation and edema usually join.At this stage, the nerve is only irritated or slightly compressed, but these effects do not pass without leaving a trace and can cause severe pain and discomfort.

As the disease progresses, the second stage of neuropathic pain sets in. The nerve is compressed so that it ceases to function. In the zone of innervation of the compressed nerve, numbness appears, a person’s superficial sensitivity is disturbed.

The third stage is the loss of deep sensitivity. Muscle weakness appears, muscles that are innervated by damaged nerves refuse to work.As a result, muscle atrophy occurs.

You may have heard the phrase “leg withered” or “hand withered” – this, in fact, is muscle atrophy.

When a doctor observes a nerve deficit in a patient, he realizes that an urgent release of this nerve is necessary – decompression. The more time a person is without treatment, the less chances of nerve recovery after decompression. And even if the doctor performs an excellent technical intervention, a person who has endured this pain for a long time can stay with it for life if the nerve does not recover.

Nerve recovery after injury

The nervous system is a very delicate, delicate and complex structure. Its imbalance is quite simple to cause, and self-healing of this structure is slow, if at all. The regenerative capacity of the nervous system is severely limited, and any nerve damage is difficult to treat.

Most often, doctors are faced with a situation where a complete cure is impossible, and it is only about the control of symptoms, in fact, adaptation to neuropathic pain.In this case, the task is to ensure an acceptable quality of life for a person and relieve pain as much as possible so that a person can sleep, communicate, and lead a social life.

Damage to the nerve, as a rule, leads to its restructuring. Secondary changes occur around the very site of damage, and then further and further affect the overlying parts of the nervous system. If in the early period this pain in the immediate focus of damage is not coped with, then there is a very high risk that the changes will go higher and lead first to peripheral sensitization (a pathological process in the nervous tissue) and then to central sensitization with the formation of a certain level of excitation in the central sensory neurons. …Because of this, weak painful and non-painful stimuli begin to be perceived by the brain as severe pain.

Neuropathic pain: treatment Algologist Aleksey Voloshin on the characteristics of pain, pharmacotherapy, targeted therapy and neuromodulation

If the focus of damage affects brain structures, in fact, an autonomous, separate disease develops.

Patients have to take drugs all their lives that affect the regulation of neurotransmitters in the brain. Patients with chronic neuropathic pain can lose 1 cm³ of the cerebral cortex in a year.

With neuropathic pain, a rapid growth of the lesion occurs, and therefore, when the first symptoms appear, you need to consult a doctor, otherwise it is quite difficult to treat it later.

Written down by Diana Karliner

Why do the veins in the legs hurt and there are severe pains with varicose veins?

Varicose veins.

Usually with these words people imagine thick twisted vessels that entangle their legs.But this is only the most famous sign of pathology. There are others.

Sometimes dilated veins cause only cosmetic discomfort, but some of the symptoms of varicose veins directly affect the quality of life. For example, many have pain in the veins in their legs. Basically, the sensations are mild, but in rare cases, even an ordinary walk becomes painful.

Therefore, a little later we will talk about pain with varicose veins. On the reasons and ways of dealing with it.

But first, let’s talk about the disease itself: about the mechanism of development, risk factors and complications.

So, blood moves through the arteries from the heart to organs and tissues, where it gives oxygen and nutrients. Blood flow returns through the veins.

It is especially difficult for blood to flow through the venous system of the legs, because here it must rise from the feet almost always straight up.

Gravity interferes with her.

Part of the blood flows down and accumulates in the vessels. As a result, the veins expand, and their walls stretch too much. Overcrowded vessels are visible on the skin.

In healthy people, the drainage of blood is prevented by a protective mechanism – venous valves. This is the name of the membranes in the vessels. They trap the flowing blood and return it to the bloodstream. However, for many people, this system malfunctions.

For various reasons, the valves are sometimes weakened or injured, which increases the likelihood of overflowing the veins. This is how varicose vessels appear.

The risk of varicose veins is increased by the following factors

• Genetic predisposition

Scientists have not yet figured out why some people are born with weakened venous valves.But this fact is confirmed.

If both parents suffer from swollen blood vessels, then with a 90% probability their child will inherit this pathology.

• Old age

Gradually the body fades away. The eyes see worse, the skin dries out. Aging also affects the valve system, which becomes more fragile and weak.

Therefore, people over 60 years old often develop varicose veins – worn-out valves simply cannot withstand the load from flowing blood.

The amount of blood in humans is not the same. First of all, it is influenced by body weight – the greater the mass, the greater the volume of blood in the body.

Unfortunately, the increase in weight does not strengthen the valves. They are forced to withstand the overpressure of a huge volume of blood, which increases the likelihood of vein congestion.

The bodies of expectant mothers are exposed to great stress. For many reasons. The pressure on the valves increases due to an increase in the amount of blood, hormonal imbalance and the effect on large vessels.

We have already spoken about the influence of blood. Changes in hormone levels impair the elasticity of the venous walls, which makes them easy to stretch, but slowly return to their original state.

The baby grows next to large veins. Sometimes the fetus pinches them. In such cases, the lumen of the vessels decreases, and the body increases the pressure in the veins to push the blood upward. Therefore, the load on the valves increases.

• Prolonged immobility in a sitting or standing position

When walking, the muscles of the legs help the vessels pump blood to the heart.They contract and constrict the veins. As a result, the blood is pushed upward.

In stationary legs, the muscle pump does not work, which is why the entire load falls on the veins and the valve system.

As you can see, some factors are related to natural processes, while others are related to lifestyle. But the results are the same.

Varicose veins cause many symptoms:

• Fatigue and heaviness in the legs
• Spider-like or tree-like mesh of dilated veins
• Burning and itching
• Convulsions
• Edema
• Pain when walking after long immobility
• Change in skin color
• Twisted thick vessels

Varicose veins develop slowly.

Doctors even distinguish stage zero in him, during which external signs have not yet appeared, but the problem with the venous valves has already arisen.

Usually, patients first suffer from heaviness in the legs, and then others are added to this problem. The strength of the symptoms also changes. In the early stages, the signs of pathology intensify by the evening and disappear by the morning. With advanced disease, they last all day.

But persistent irritating symptoms are not the main danger in the last stages of varicose veins.

Patients may experience complications:

Breakthrough of swollen subcutaneous vessels. In rare cases, the fragile walls of diseased veins cannot withstand pressure, and a bleeding wound occurs. Such damage is difficult to repair. So urgent medical attention is required.

• Thrombosis and embolism

Due to poor blood circulation, blood clots, dense blood clots, often accumulate in the dilated vessels. They close the lumen of the veins.Sometimes fragments of blood clots break off and enter the bloodstream, and then they can get stuck in the vessels of the lungs. This phenomenon is called embolism. Breathing sometimes stops during it.

• Trophic ulcers

Due to oxygen starvation, tissues near diseased veins gradually die off, and non-healing wounds appear in their place. It is very difficult to cure ulcers. They are at high risk of relapse.

Fortunately, complications of varicose veins occur only in some patients – trophic ulcers in 6%, and bleeding and embolism are even less common.

As you can see, without treatment, pathology sometimes causes great inconvenience. And it can even destroy a person.

Therefore, for any of its symptoms, it is recommended to consult a phlebologist. Including when the veins hurt. In order to respond in a timely manner to this threat, it is advisable to understand the reasons for the appearance of such a symptom.

What causes severe pain with varicose veins?

In most cases, people with varicose veins do not experience severe pain.Only with sudden movements. For example, when, after a long immobility, they get to their feet.

But constant severe pain torments patients usually in the later stages of the pathology. Simply because by this time all the symptoms of the disease intensify and do not disappear even at night.

What causes the veins in your legs to hurt?

Mainly due to oxygen starvation. The dilated vessels do not supply neighboring tissues well, which can lead to unpleasant sensations.

Another cause of pain is trophic ulcers.These non-healing wounds are painful to touch, which means that even light contact with clothing will cause severe discomfort.

Pain in the leg with varicose veins can be a sign of thrombophlebitis. This is the name of a pathology in which blood clots form in the inflamed veins.

Let’s summarize.

If mild pain in the dilated vessels is a standard symptom, then it rarely worsens. In the later stages of pathology. With trophic ulcers and thrombophlebitis.

Therefore, when swollen veins hurt badly, this indicates a rapid development of the disease.In such a situation, you should immediately consult a doctor. Although many people put off going to a vascular specialist and try to get rid of the symptoms on their own.

How to eliminate severe pain in the veins with varicose veins?

Heaviness in the legs, slight swelling and other mild symptoms of pathology can be alleviated by simple methods – a contrast shower, some types of massage. However, with developed varicose veins, this will not help.

In addition, if the veins in the legs are very sore, then a delayed visit to the phlebologist will only worsen the condition of the vessels.There is no point in enduring such torment.

Timely treatment of varicose veins will eliminate irritating symptoms and prevent complications. Therefore, choose a reliable clinic and make an appointment with a doctor. One examination will help your veins with more than hundreds of folk recipes.

What treatment is prescribed if you are concerned about severe pain with varicose veins?

First, the doctor will check the vessels. He will conduct an ultrasound examination of the veins and find out the cause of the pain.Only then will the doctor choose a therapy option.

For example, a certain procedure may be effective against varicose veins, but it does not deal well with complications.

When leg veins hurt, accurate diagnosis is essential for proper treatment. Without it, the cause of the symptom cannot be eliminated.

But after the diagnosis, phlebologists often offer patients several therapy options at once to choose from:

• Miniflebectomy
• Endovasal laser coagulation
• Foam sclerotherapy

These methods are less traumatic – that is, they do not damage the skin and do not leave scars.

Now to summarize.

What to do if the veins in your legs hurt?

Go to a doctor immediately.

Yes, some means and methods can reduce pain, but this is only a temporary measure. Sooner or later, the disease must be treated.

And it is better early, because in this case you will get rid of swollen veins before dangerous complications appear.

In addition, if the veins on the legs hurt very badly, then such a picture is not typical for varicose veins.Perhaps another pathology is to blame for the discomfort. The doctor will help identify her.

Which clinic should I go to?

Now ultrasound diagnostics of blood vessels is carried out in many medical centers. But it is best to choose a clinic with experienced doctors. And modern equipment. For example, the Vein Institute.

We will help you get rid of varicose veins

The best phlebologists in Kiev and Kharkov work in our medical centers – specialists who have been eliminating venous diseases for more than 20 years.

We have accumulated extensive experience in conducting low-traumatic procedures. With the help of the latest methods, our phlebologists have removed twisted vessels from over 4,000 patients in 15 years. In this they were helped not only by experience.

The doctors of the clinic are assisted by the most modern equipment:

• Ultrasound system Toshiba APLIO

Displays a high resolution image of puffy veins. Allows you to identify all damage.

• UZ navigation General Electric Logiq E

Used during operations and increases the accuracy of the effect on the vessels.

• Laser coagulator “Lika-surgeon”

Treats veins with dosed laser radiation, which reduces the risk of damage to healthy tissues.

We make a diagnosis in just 30 minutes. And then we choose the most effective seamless method for removing varicose vessels.

Come to the clinic “Institute of Veins” and find out why the veins on the legs hurt so much. Often in one consultation.

Doctors of the clinic “Institute of Vienna”

Surgeon of the highest category, phlebologist

Experience: 21 years

Surgeon of the highest category, phlebologist

Work experience: 20 years

Phlebologist of the highest category

Work experience: 34 years

Dermatologist higher.cat., director

Work experience: 20 years

First category surgeon

Work experience: 15 years

Surgeon, phlebologist

Work experience: 17 years

Surgeon, phlebologist

Work experience: 5 years

First category surgeon

Work experience: 12 years

Vascular surgeon, phlebologist

Work experience: 10 years

Vascular surgeon, chief physician

Work experience: 11 years

Vascular surgeon, phlebologist

Work experience: 8 years

Vascular surgeon, phlebologist

Work experience: 5 years

Radicular syndrome

What is radicular syndrome?

31 pairs of nerves emerge from the spine.These nerves originate from the spinal cord, which is why they are called spinal nerves. Although, before they were called – nerve roots, which, in fact, gave the name to the radicular syndrome.

Spinal nerves

Each pair of spinal nerves corresponds to a segment of the spinal cord (in medicine, it is customary to conventionally divide the spinal cord into 31 segments). 8 pairs of cervical, 12 pairs of thoracic, 5 pairs of lumbar, 5 pairs of sacral and 1 pair (sometimes 2 pairs) of coccygeal nerves.Moreover, each nerve has its own designation. For example, cervical ones are denoted by the Latin letter “C”, from the word Cervix – the neck and the number from 1 to 8 (C1 – C8). Pectorals – “Th” – Thorax – chest and numbers from 1 to 12 (Th2 – Th22). Lumbar – “L” – Lumbus – loin and a number from 1 to 5 (L1-L5). Sacral – “S” – Sacrum – sacrum and numbers from 1 to 5 (S1 – S5). Coccygeal – Co – Coccygeus – coccyx and number 1-2 (Co1 – Co2).

Let’s once again focus on the fact that the root and the spinal nerve are completely different things.But, it just so happened that the pathology that occurs when the spinal nerve is squeezed is called radicular syndrome.

To understand the essence of radicular syndrome and not call any pain in a leg or arm that way, you need, at least in general terms, to understand how the spinal nerve works, what a root is, what types of nerve fibers exist, what a segment of the spinal cord and a segmental zone are innervation. And about all this – read below.

How does the spinal nerve work?

The root is the initial and very short section of the nerve that emerges from the spinal cord, but is located inside the spine.In the same place, inside the spine, the roots of two different types are connected to each other and form the spinal nerve, which, in fact, leaves the spine.

Spine. Cross section

The root, like the rest of the nerve, is made up of many nerve fibers gathered in a bundle, like a stranded wire. There are back and front roots. The dorsal roots are composed of sensory nerve fibers.The anterior roots are composed of motor nerve fibers.

Sensory fibers transmit pain impulses and all other sensations to the brain, for example, heat and cold, touch of objects, vibration, etc.

Motor fibers transmit commands from the brain to our muscles.

Connecting with each other, the anterior and posterior roots form the spinal nerve. Pay your attention to this – the spinal nerve combines both types of nerve fibers – sensory and motor, that is, it is a mixed nerve.Please remember this fact. We will need it to further reveal the essence of the radicular syndrome.

What is the segmental innervation zone?

Segment of the spinal cord. Roots. Spinal nerve

Coming out of the spine, each spinal nerve branches out into nerves, like the trunk of a tree into branches. Further, these nerves go to a specific area of ​​the body to provide innervation (nervous regulation) there.The area of ​​the body that nerves from one segment innervate is called the area of ​​segmental innervation.

For example, the C5 spinal nerve innervates the C5 zone, the L4 nerve innervates the L4 zone, etc. Moreover, note that the nerve branches extending from each spinal nerve provide both types of innervation in their zone – both sensory and motor. Let’s take a closer look at this figure. It shows the zones of segmental innervation. As you can see, everything is simple and straightforward.

Zones of segmental innervation

What is the essence of radicular syndrome?

As we found out, the spinal nerve contains sensory and motor fibers. Therefore, if something presses on the nerve, for example, a herniated disc, this will affect both the sensitive and motor spheres. Violation of sensitivity will manifest itself as numbness, burning sensation, needles, goose bumps and severe pain. And in the motor sphere, there will be a weakening of the muscles, their tone and reflexes will decrease.By the way, sensations with radicular syndrome, exactly, resemble those that arise if you “sit” a leg. The leg becomes wadded and, as it were, falls through when you try to stand on it, it goes numb and pricks with needles. Only with radicular syndrome, these sensations are much stronger and, in contrast to the “out-of-date” leg, do not go away on their own, but require urgent treatment.

With radicular syndrome, in addition to pain and numbness, muscle weakening always occurs.

Where does radicular syndrome appear?

As we have already found out, nerve impulses from the spinal nerve diverge along the entire innervation zone of this nerve.Consequently, when the nerve is squeezed, pain, muscle weakening, numbness, needles and goosebumps will cover the entire area. It does not happen that radicular syndrome gives pain only in places, and in the rest of the zone – there is no pain. Remember radicular syndrome – these are the simultaneous manifestations of pain, muscle weakness, numbness and other symptoms that cover the entire innervation zone.

In medical terms, radicular syndrome is:

• Sensory impairment (needles, goose bumps, pain)

• Muscle hypotension (weakness)

• Decreased or complete loss of muscle reflexes

All of these symptoms develop within the innervation zone of the corresponding spinal nerve.

Causes of radicular syndrome

For most people, the phrase “radicular syndrome” is associated with a herniated disc, protrusion or osteochondrosis. But, contrary to such a widespread and equally erroneous opinion, radicular syndrome is not at all a key symptom of these particular diseases. The presence of radicular syndrome, only, indicates that the spinal nerve is under the influence of a certain pathology, and which one exactly is a matter of further clinical analysis.

Radicular syndrome is the main clinical sign of a spinal nerve lesion.

Usually radicular syndrome occurs with more severe pathologies than osteochondrosis. The most common causes of radicular syndrome are either circulatory disorders (radicular-vascular syndrome, spinal stroke, ischemic radiculopathy), or mechanical action (bone fracture in a spinal fracture, benign or malignant tumor, cyst, etc.).etc.). Although, in fairness, it must be said that in osteochondrosis, disc herniation and protrusion, radicular syndrome also occurs, but it is extremely rare and, mainly, in the cervical spine.

Errors in the diagnosis of radicular syndrome

A common mistake is that radicular syndrome is often confused with pseudo-radicular syndrome.

Pseudo-radicular syndrome is pain caused not by compression of the spinal nerve, but by muscle disease.

There is a muscle disorder called myofascial syndrome. There is a detailed article about him on our website. And, in short – with myofascial syndrome, small spasmodic areas appear in the muscles – trigger points that cause very severe pain. Sometimes the zone of myofascial pain can cover rather large areas of the body and resemble the defeat of the zone of segmental innervation in radicular syndrome. For example, pain from the lower back can spread down the leg to the thigh and lower leg.In such cases, it is customary to use the term “pseudo-radicular syndrome”. The figure below shows the area of ​​radicular syndrome L4 – highlighted in blue and the area of ​​pain in gluteus maximus myofascial syndrome – in red. Moreover, the localization of myofascial pain in the gluteus maximus muscle can have two options.

Areas of pain. Root – blue. Myofascial – orange

Isn’t it true that the area of ​​radicular pain L4 and the area of ​​myofascial pain of the gluteus maximus muscle are very similar to each other? Therefore, in this and many other cases, inexperienced doctors often confuse the manifestations of radicular and pseudo-radicular (myofascial) syndromes.Just like an inexperienced mushroom picker runs the risk of confusing real and false honey.

It is important to be able to distinguish radicular syndrome from pseudo-radicular syndrome!

Sign up for a radicular syndrome diagnosis

• Let us find out what caused the symptoms – radicular or “pseudo-radicular” myofascial syndrome, we will test the muscles for the presence of active and latent trigger points.
• Duration of diagnostics – 30 minutes.This is a full-fledged examination, and not a 2-minute “feeling” for show.
• The diagnosis is carried out personally by Dr. AA Vlasenko, a doctor with 30 years of experience, an expert in the treatment of myofascial and radicular syndromes.

Radicular Syndrome Treatment

The treatment of radicular syndrome depends on the reasons that caused it.

• If radicular syndrome is caused by compression of the root by a tumor, cyst or fracture, then these problems can be eliminated only by surgery.And then the neurosurgeon deals with these issues.

• If the picture of the disease is dominated by radicular-vascular syndrome, then drug treatment comes to the fore. And then your doctor is a neurologist.

• If you have been diagnosed with osteochondrosis – radicular syndrome, as well as in cases where radicular syndrome is associated with a herniated disc or its protrusion, the leading physician should be a chiropractor.

And, of course, it is superfluous to talk about how important it is, in the event of pain and suspicion of radicular syndrome, to consult a doctor promptly and in a timely manner and take all possible measures to treat and prevent the critical development of the disease. It only remains to add that this should be an experienced and knowledgeable doctor.

When choosing a clinic, the main thing is to see an experienced and knowledgeable doctor.

We will be able to understand the symptoms of your disease, establish an accurate diagnosis and eliminate not only the disease, but also its causes.