Differential Diagnosis for Pain in the Superior Aspect of the Medial Knee to Thigh Insertion
Single Most Likely Diagnosis
- Medial thigh or knee pes anserine bursitis or tendinosis: This condition is characterized by inflammation of the bursa or tendons at the insertion of the sartorius, gracilis, and semitendinosus muscles on the medial aspect of the knee. It is a common cause of medial knee pain, especially in individuals who participate in activities that involve running, cycling, or climbing stairs.
Other Likely Diagnoses
- Medial collateral ligament (MCL) strain: Although the knee exam is reported as normal, a mild MCL strain could still cause pain in the medial aspect of the knee without significant instability.
- Sartorius or gracilis strain: Strains of these muscles can cause pain in the medial thigh and knee area, especially with activities like walking.
- Quadriceps or hamstring tendinosis: Tendinosis of the quadriceps or hamstring tendons can cause pain in the anterior or posterior thigh, respectively, and may radiate to the knee area.
Do Not Miss Diagnoses
- Deep vein thrombosis (DVT): Although less likely, DVT can cause pain in the thigh and knee area, especially with walking. It is a potentially life-threatening condition that requires prompt diagnosis and treatment.
- Osteonecrosis of the femur or tibia: Osteonecrosis can cause pain in the knee and thigh area, and may not always be apparent on a normal knee exam.
- Infection or abscess: Infections or abscesses in the soft tissues of the thigh or knee can cause pain and may not always have obvious signs of infection on exam.
Rare Diagnoses
- Nerve entrapment (e.g., obturator or saphenous nerve): Nerve entrapment can cause pain, numbness, or tingling in the medial thigh and knee area.
- Stress fracture of the femur or tibia: Stress fractures can cause pain in the thigh or knee area, especially with weight-bearing activities like walking.
- Tumor or cyst: Although rare, tumors or cysts in the soft tissues of the thigh or knee can cause pain and may not always be apparent on a normal knee exam.