Upper thigh pain is a diagnostic nightmare; careful examination is essential.
There are two immediate first thoughts that enter the clinician's mind when confronted with upper front thigh pain.
Or, could the patient have both? That's always an outside possibility. There are of course many other less likely causes of anterior thigh pain. One of which is a fracture through the pars, as seen below; another is severely worn lumbar facet joints both allowing a forward slip of the vertebra.
The first of these two conditions, known together as a spondylolisthesis, is caused by trauma, usually in childhood; the second is caused by repeated lumbar facet syndrome episodes which if uncorrected allow for degenerative change of the hyaline cartilage in the joint. Starved of oxygen and nutrients, it is the main cause of immobilization arthritis.
See more lower down at our lumbar facet arthropathy causing spondylolysthesis page.
So, lets look at these two common causes of proximal thigh pain, the first of which is a pinched nerve in the mid to upper lumbar spine. This does not affect the sciatic nerve but the other large group of fibres supplying the leg called the femoral nerve.
It affects the front of the upper thigh and the inner lower leg.
Our elderly lady is 82 years old, and I would have believed her had she said 72. But two months ago she stumbled over a shoe. Within a day she had severe upper thigh pain; in the front of her thigh just below the groin.
For two months she had various treatments and then sensibly her doctor ordered an xray. These showed how the third lumbar vertebra had slid forwards, called in radiographic jargon an anterolysthesis or sometimes a spondylolisthesis. Forget the words, what she had was a subluxated vertebra, and the femoral nerve stretch test was strongly positive.
Happily she is responding well to chiropractic care.
A month later my file notes report as follows. She is doing fine. She has no pain
in her left thigh, what brought her to me initially, though she does have right
buttock pain for about half an hour in the morning, until she has done
the exercises I have prescribed, and again in the evening, something she
has had for years. It's to be expected; she is elderly and has a very
arthritic back, to be helped but not cured alas. The wise person at this age accepts that they are aging, and some of the discomforts of old age should be accepted. It's a heap better than the alternative; death in the fifties or sixties.
One year later she has some stiffness in the neck for the last few weeks. It's a whole year since she hurt her back. She has no upper thigh pain, no tingling in feet and legs, and minimal back pain. She does her exercises very faithfully, so she tells me. Hers is the more common worn lumbar facet forward slippage of the vertebra.
These exercises bring fresh nutrients to the hyaline cartilage that lines the joint surfaces, helping to reduce the progressive arthritis.
Six months ago Mr P traveled 1000 km to a luxury resort in South Africa's famed Eastern lowveld to see the big five and play some golf. By the end of the week he could barely walk; severe upper thigh and groin and buttock pain; was it hip arthritis?
Eventually he ended up with a neurosurgeon who found a bulging disc on an MRI and said only a back operation would fix him. Mr P was doubtful, and this week appeared on my doorstep.
Things didn't fit with the pinched nerve theory. He could bend and move his back with no discomfort. Nerve stretch tests were negative. Reflexes were all fine. He could ride his bicycle for miles with no pain, but couldn't get on or off without difficulty in the hip; but it wasn't in the muscle.
The neurosurgeon never examined his hip apparently, forgetting
that it goes hand in glove with thigh pain. He has all the
classic signs of ball and socket arthritis; loss of adduction and internal
rotation, and a positive Fabere sign. Now to see what chiropractic has to
The upper thigh pain associated with a Kellgren Lawrence Grade 1 and 2 often respond well to chiropractic mobilisation of the hip and sacroiliac adjustments; weight loss, if necessary, is mandatory and fish oil.
I'll update this page once I've seen his xrays and we've had some treatment.
Here's the update after looking at his xrays; he has a Kellgran Lawrence grade 3. That's nasty.
Mr P's buttock pain? It's hard to be sure whether the sciatic tests were all positive 6 months ago and he indeed had a slipped disk. It's interesting that 20 percent of absolutely healthy young men have a bulge on MRI. Whatever, it's going to be a chiropractic coalface challenge.
Update; his hip is much looser with the exercises, and the thigh pain is much less, but he is still having considerable buttock pain. That arthritic hip is being a bugger but then Rome wasn't built in a day, was it? He's adamant; no surgery, it's improving. So we soldier on, even though in my mind after four weeks the progress is less than satisfactory and I am not altogether sanguine of his prospects. In Chiropractic we expect miracles, but sometimes it really is a long drawn out process.
Update; alas a Kellgren Lawrence III was too far gone. Whilst he got to about 30 percent better, it wasn't enough. He's been for a hip replacement, we'll see how that progresses.
Update 2: The total hip replacement is doing well.
Mr P had the classic signs of a Pincer deformity in a condition called Femoro Acetabular Impingement syndrome; Had somebody examined his hip twenty years ago we could have prevented his present miserable upper thigh pain. Anyway, he is slowly improving ...
It's because of cases like Mr P that I now examine every patient's hip, young/ old, symptoms or not, even if you consult me for a headaches. FAIS is a silent cause of premature hip arthritis. A stitch in time thirty years ago when Mr P would have had a stiff, painless hip would have saved him this present misery.
There is now heaps of evidence that omega-3 oil helps with arthritis. The best sources are flaxseed oil and
FISH OIL ...
More interesting research shows that eating strawberries regularly has powerful anti arthritic properties, as does investigation from Harvard about a chicken bones broth; not to be taken together, eh. Read more of these interesting facts lower down.
Alas, none of my interventions were successful. The total hip replacement was for the present. I'm a believer in good hip surgery.
Much has to do with the chiropractor's ability to convince the patient that this is just one of many conditions that need occasional but regular care and that surgery may not be necessary. Whilst it's a relatively successful operation today, with great benefit for many, the danger of a long general anaesthetic and huge cost is sobering. In today's world where many people have no medical insurance, the steady care but not cure of our care comes into its own.
Just ten years ago the mortality in England within three weeks of the operation was one in two hundred, but that's now been halved by the use of a spinal versus general anesthetic and other protocols.
That's one death in four hundred cases currently; however, don't assume that it goes swimmingly for the other 399. I've treated many failed hip operations over the years who didn't die but swore they would never have had the procedure if they knew what lay ahead.
The South African medical journal in 2013 reports that the risk of deep vein thrombosis is an astonishing 40 to 60 percent prevalence after hip and knee replacement surgery. That was reduced in England by the introduction of anticoagulation treatment but many doctors are reluctant because of the moderately increased risk of bleeding during and after the procedure.
The probability of a venous thromboembolism is greatly increased in those over sixty who have a
previous history of clot, immobility and hormone replacement therapy; there are other conditions also. Ten percent of all deaths in South African
hospitals, the journal reports, are due to such a blockage in the
Here's another potentially successful case to my mind but a hip replacement was an easier option for the patient. Femoro acetabular impingement syndrome case file.
Another consideration when treating the older woman with upper thigh pain is whether she is taking medication for osteoporosis. Men too, of course, if they have a history of taking corticosteroids, perhaps for asthma or a chronic inflammatory bowel condition.
Recent research reveals that the Merck's latest magic bullet is not all it's cracked out to be. Fosamax not only increases the risk of a stress fracture in the hip and bone death in the mandible, but also increases the risk of oesophageal cancer and aggravation of an incipient stomach ulcer.
Of course the patient experiencing upper leg pain from Fosamax is likely to start taking anti inflammatory drugs such as Brufin and aspirin; then you have serious double risk of a stomach bleed.
Read more about it at Fosamax Reviews.
Enjoy a good novel? You'll love my fourth book, a trilogy, A Family Affair ... read here an excerpt about June and her grandfather, an upper thigh pain specialist, Dr Scott Thomas; he knows all about the side effects of Fosamax.
Granny and Grandpa Thomas
‘I really don’t think you’ve done the right thing agreeing to this woman’s request for an interview, Sandra. We doctors have to keep our names out of the press, you know.’
‘Oh, go on, Scott. You’re not a private person at all. You’ve got thousands of patients out there and I bet there are hundreds of women who even know what kind of after-shave you use.’
‘Yes, that may be so, but I just don’t feel comfortable about it. Call it a hunch, if you like. I really don’t want to be getting letters from the Medical Council.’ Despite his antipathy, Dr Thomas had dressed quite smartly for the occasion. For the first time in several weeks he had donned a tie, and Sandra was astonished when he asked her to press his shirt.
‘Oh, you and your cosmic fishing! How you men like to exaggerate! Fancy that, at sixty-five do you honestly think somebody will try to accuse you of drumming up patients in an unethical and unseemly manner? You are being ridiculous. And in any case, I love a surprise!’
The doorbell rang and Mrs Thomas sprang to her feet and strode out of their formal lounge, her high heels click-clacking over the tiles in the hallway. Left to his own devices Scott struggled to his feet out of the deep rocker and strode off to his study. Ridiculous, huh! Well, they’ll have to drag me out.
Thomas thought it the most exciting thing that had happened to them in months.
Their lives were pretty humdrum now, what with Peter being so busy at
Astonhouse, and so morose when he visited during the holidays. It was a pity
about that lovely girl Gill. I wonder what became of her? she thought, gazing through the peephole. One
olive-green eye glittered into another olive-green eye only centimetres away.
Both women sprang back ....
Purchase A Family Affair for your Kindle, tablet or smartphone... only 99c*. My books rely on ridiculously low prices and huge turnover... join the party. Less than a dollar for huge enjoyment! If you like reading spicey controversial stuff... * Amazon fudges the price without consulting authors.
Whatever's in season, right now it's zucchini and apple, an interesting combination, and leek and potato; quite soon it's going to be green bean and potato... butternut, sweet potato and ordinary potato is my favourite, but that's late summer... these are all very easy recipes, nutritious, very tasty, and like I said, mostly using chicken bones bouillon. Easy. And if arthritis is the cause of your upper thigh pain then there's a good chance these soups will help the chiropractic treatment of your hip pain or the lower back degeneration associated with repeated lumbar facet syndrome episodes.
Even more so if you use your chicken bones bouillon to make a chicken broccoli recipe ... currently there's fascinating research going on in the UK to confirm that the sulforaphane in broccoli actually does reduce the inflammation of arthritis.
It may come as a surprise, it certainly did to me, that research shows that hip pain, diabetes, vitamin D and Metabolic Syndrome are all closely linked. Folk living far from the equator often suffer from a chronic deficiency of vitamin D. Sunshine and fatty fish are the best sources. Hip pain and vitamin D ...
Meralgia Paresthetica is another cause of leg pain and tingling in the legs. It's a pinched sensory nerve - in the upper lumbar spine AND in the groin.
The delicious strawberry
If spring is coming then make sure you get a few punnets of strawberries this year. They are about the cheapest medicine in your kitchen. There is an astonishing amount of research that shows just how important the strawberry is for just about everything from alopecia to ingrowing toenails! Seriously though, the strawberry is truly a gem. Read more at interesting facts about strawberries; especially arthritis and eyesight.
Useful links @ upper thigh pain
Smoked salmon dip recipe
I always look for easy ways to increase the absolutely essential nutrients that our bodies demand. This
smoked salmon dip you can throw together in a jiffy, and I can promise
you it's always a success ... smoked salmon dip recipe ... rich in vitamin D and omega-3.
Looking for vegetable sources of Omega-3? Think no further than freshly ground fax seed, walnuts and pecan nuts.