From the Guidelines
Thigh pain on hip flexion with tension to touch is best evaluated with an MRI, as it provides detailed images of soft tissues and can identify muscle tears, inflammation, or joint damage, according to the American College of Radiology Appropriateness Criteria 1. When considering the diagnosis of thigh pain on hip flexion, several conditions come to mind, including muscle strain, tendonitis, bursitis, or a labral tear.
- The initial step in evaluation should be radiographs to rule out bone abnormalities or fractures.
- However, given the symptoms of thigh pain on hip flexion and tension to touch, an MRI is the most appropriate next step, as it is highly sensitive and specific for detecting soft tissue abnormalities, including tendonitis and bursitis 1.
- MRI can also evaluate surrounding soft tissue entities such as iliopsoas or subiliacus bursitis, athletic pubalgia, trochanteric bursitis, abductor tendinosis or tears, calcific tendonitis, and hamstring injuries 1.
- Ultrasound may also be useful for evaluating superficial structures and can help visualize inflammation in real-time, but it is not as sensitive as MRI for detecting labral tears or deep tissue abnormalities 1.
- CT scans might be ordered if bone pathology is suspected but not clearly visible on X-ray, but they are less sensitive for soft tissue evaluation compared to MRI 1. While awaiting imaging, conservative management with rest, ice application, compression, and elevation can help manage pain and inflammation.
- Over-the-counter pain relievers like ibuprofen or acetaminophen may provide temporary relief, but their use should be guided by the patient's medical history and current medications. These imaging tests are crucial because proper diagnosis requires visualization of the affected structures, especially when physical examination reveals pain and tension, which could indicate various underlying conditions requiring different treatment approaches.
From the Research
Thigh Pain on Hip Flexion
- Thigh pain on hip flexion can be caused by various factors, including musculoskeletal conditions such as greater trochanteric pain syndrome (GTPS) 2.
- The pain can be tense to touch, indicating inflammation or irritation of the surrounding tissues.
Possible Imaging Tests
- Ultrasound (US) is an ideal modality for imaging guidance in hip pain diagnosis and treatment due to its low cost, portability, and lack of ionizing radiation 3.
- US-guided interventions, such as platelet-rich plasma (PRP) injections or corticosteroid injections, can be effective in treating hip pain conditions like GTPS 2.
- Magnetic Resonance Imaging (MRI) can also be used to correlate with US findings and provide a more detailed assessment of the hip joint and surrounding structures 3.
Treatment Options
- US-guided PRP injections have been shown to be more effective than corticosteroid injections in treating GTPS, with better and longer-lasting clinical results 2.
- Corticosteroid injections can provide short-term pain relief, but their long-term effectiveness and potential adverse effects need to be considered 4, 5.
- The choice of treatment depends on the underlying cause of the thigh pain and hip flexion, as well as the patient's overall health and medical history.