Orthopedics-Online

Inner thigh pain

introduction

In the case of pain on the inside of the thigh, a number of causes are possible triggers due to its location.

Large muscles and nerves run in the thigh that can cause discomfort. Diseased joints can also cause pain. In addition, due to the proximity to the genitals and the pelvis, pain can emanate from there and radiate into the thigh.

causes

Muscle injuries of the adductors

Most often, inner thigh pain is caused by overloading the so-called adductors.

Overuse of the muscles can lead to cramps immediately or after a delay. The adductors are a group of muscles that run down the inside of the thigh. These muscles attach to the pelvis on the ischium and pubic bone and pull up to the back of the thigh on the part of the thigh bone remote from the trunk. The job of the adductors is to bring the legs together.

In addition, the adductors are stressed, especially in soccer players, since a large part of the shooting of a ball occurs through these muscles. However, since humans are by nature not designed to continuously shoot balls, soccer players in particular tend to develop adductor strains, especially if they are insufficiently warmed up before sports. The pain caused by straining the adductors is particularly felt under strain. If the legs are to be brought together against resistance, the pain is particularly severe. Since the muscle attachments are particularly irritated during exercise, the areas on the pubic bone and the distal end of the thigh are particularly painful.

Additional signs of an adductor strain are swelling in the area of the inner thigh. If a torn muscle fiber of the adductor develops from the strain, bleeding into the muscles can also occur. As with most sports injuries, if you have adductor pain and torn muscle fibers, you should first take a break from sports to give the body time to recover. In the acute phase, cooling is also helpful, for example with ice packs or special disposable cooling bags. When the pain subsides, the sport can slowly be resumed, whereby no attempt should be made to “train away” pain, since false ambition is out of place and harmful. In severe cases, you may be unable to exercise for up to six months.

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Thigh fracture

A so-called thigh fracture can also cause pain in the inner thigh.

Parts of the intestine pass through a gap in the floor of the abdomen through which the leg artery and leg vein normally run. This gap is also "Femoral canal" called. The femoral hernia is very similar to the inguinal hernia, but the hernial canal is different. While men are particularly affected by inguinal hernias, almost only women suffer from fractures. This is because the inguinal canal in women is much narrower and therefore very rarely affected by fractures. On the other hand, women's connective tissue, which is usually somewhat softer, generally favors the occurrence of fractures.

The fracture of the thigh is usually noticeable as a swelling in the upper, front part of the thigh and is often painful. In contrast to the inguinal hernia, the femoral fracture is often not retractable. Therefore, you should not try to push back the break yourself, but consult a doctor immediately.

Thigh fractures occur more frequently in women with known weak connective tissue and with increased pressure in the abdomen. Increased pressure in the abdomen arises, for example, from pressing when defecating, when coughing, and when there is fluid in the abdomen, a so-called "ascites". In addition, the pressure in the abdominal cavity also increases during pregnancy, which is also associated with a temporary, non-pathological weakness of the connective tissue that makes childbirth easier. However, both factors favor the occurrence of fractures.

Since thigh fractures almost never regress on their own, surgery usually has to remedy the situation, since even painless fractures run the risk of entrapment of the fracture contents, which in the worst case can be life-threatening. There are basically two different approaches to operating a fractured leg: On the one hand, the fracture can be operated on openly, i.e. with a skin incision on the affected area. The contents of the hernia are reduced, the hernial sac removed and the gap sutured.

Another approach is the minimally invasive technique, in which instruments are inserted through three small incisions in the abdomen and the surgeon can view the operating area with a camera. The individual surgical steps are very similar to the open technology, only the access route changes. Both methods have existed side by side for a long time without any real differences in quality. Ultimately, the patient, together with the doctor, must decide which method to use.

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Surgery for an inguinal hernia

Venous disease

When standing for a long time in everyday life, there is particularly high pressure on the vessels of the legs. This leads to pathological changes in the veins, which then become visible as varicose veins, especially in people who work in jobs that involve long periods of standing (salespeople, operating theater staff, sometimes soldiers). In simple terms, varicose veins are caused by the fact that the blood builds up in the veins and the vessels expand as a result.

Usually, veins have valves that prevent blood from flowing back into the veins from the body. The flaps therefore have a valve function. However, if the veins are dilated, the valves are too far apart to prevent gravity flow back into the leg veins. This will further increase the pressure in the veins. If the veins are permanently dilated, one speaks of varicose veins, whereby these can also become inflamed, which can be associated with considerable pain.

In addition, inflammation of the superficial veins can usually be felt. The inflamed vein is hardened and can be felt as a superficial cord. Since only superficial veins are affected in so-called thrombophlebitis, there is practically no risk of pulmonary embolism, as can occur in thrombosis. It is usually a very painful condition, so you should see a doctor. They will usually prescribe you pain relievers such as paracetamol or ibuprofen, which in addition to being effective against pain are also anti-inflammatory.

As with any inflammation, you can cool the affected area at home. This is best done with a cooling pad wrapped in a clean cloth that has been frozen in the freezer. Disposable pillows, which produce cold through a chemical reaction, are easier to store. The disadvantage, however, is that these disposable pillows cannot be reused after use. In an emergency, you can of course cool the painful area with a wet cloth or other suitable contents from your freezer. The effectiveness of ice sprays is rather controversial, as they are extremely cold, but only have a superficial effect.

Once the strongest inflammation is over, the function of the veins can be improved with compression stockings. Putting on the stockings is not easy, but compression is one of the most effective means of preventing clots from forming in the veins. However, this only applies if the compression stockings are worn consistently. In addition, in severe cases, a doctor can also perform anticoagulation in order to accelerate the healing process. Ointments with heparin are generally ineffective. Heparin is an anticoagulant agent, but it only works when it's in the blood. However, the function of the skin as a protective barrier for the body is so good that the heparin only remains on the skin, where it is unfortunately completely ineffective.

thrombosis

A thrombosis is a blood clot that forms in a vessel and can possibly clog it. The veins in the leg are a common site for the development of thromboses.

There are some key symptoms that can indicate the presence of a thrombosis. Pain emanating from the affected structure is one of the main symptoms of the disease. In contrast to muscular pain, this is usually permanent and independent of the load and is usually described as dull pain.
A dark discoloration and swelling of the affected leg are also noticeable.

A number of factors favor the occurrence of thrombosis. Smokers, women, especially those taking the contraceptive pill (see: Thrombosis risk of the pill), and people who are bedridden are particularly at risk. In addition, if the arms and legs are immobilized for a long time, for example with plaster splints or after long-distance flights, thrombosis often occurs in the affected limbs.

Pregnant women also tend to develop a pelvic vein thrombosis in the final phase of pregnancy, i.e. a thrombosis that occurs particularly close to the trunk. With all thromboses there is also the risk that the blood clot will detach and swim via the large veins and the heart into the pulmonary vessels, where it can obstruct the pulmonary vessels and thus cause a so-called pulmonary embolism. Here parts of the lungs are no longer supplied with blood, which, depending on the size of the embolism, can also be life-threatening. It is therefore important to keep the affected leg still when there are signs of a thrombosis and to consult a doctor promptly in order to avoid a pulmonary embolism.

The probability that a thrombosis is the cause of the pain in the inner thigh is generally classified as low. Nevertheless, especially if typical risk factors for the development of a thrombosis (e.g. pregnancy, taking medication, prolonged immobilization) as well as other characteristic symptoms of a thrombosis occur, a doctor should clarify the symptoms promptly in order to prevent serious complications of the disease.

You can find further information under our topics:

thrombosis
This pain causes thrombosis

Pubic cystitis

The pubic branch is a bony structure of the human pelvis. In total there are two branches that unite to form the pubic symphysis.

Inflammation of a pubic branch often leads to inflammation of adjacent structures. The pain of the inflammation is felt in the groin and from there on the inside of the thigh. Small microtraumas are almost always responsible for pubic branch inflammation, as they can occur as a result of intense sporting activities. Sports with quick changes of direction are particularly ideal for this. These small bone injuries can then - if they do not have a chance to heal through relief - lead to inflammation. The penetration of pathogens that cause inflammation is only in the rarest of cases the cause of a pubic branch inflammation.

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Pubic branch

Adnexitis

Due to their close proximity, ovaries and fallopian tubes are also occasionally triggers for thigh pain in women.

The cause of the pain in this case is often an inflammation of the fallopian tubes or the ovaries. The doctor then speaks of adnexitis. Ovarian cysts, which are usually harmless, can also cause pain. The inflammation in this area irritates the obturator nerve. This nerve arises from the second to fourth segment of the lumbar spine and, together with other nerves, forms a network of nerves in the pelvis known as the "lumbar plexus". The task of the obturator nerve is, on the one hand, to innervate the adductors by motor, i.e. to give them the commands to contract or relax. It is also responsible for the sensitivity of the hips and inner thighs. This means that tactile and pain sensations in these areas depend on the obturator nerve. If the obturator nerve is irritated in its course, for example by an inflammation of neighboring organs, this leads to pain in the area of the hip and inner thigh. This all happens even though there is actually no pain stimulus in the painful area.

In addition to the pain described, pain in the lower abdomen is the main focus of adnexitis. Other important diseases that can cause similar symptoms and must be excluded are, for example, appendicitis or an ectopic pregnancy, such as an ectopic pregnancy.

The suspicion of adnexitis can be confirmed by a gynecologist with a smear. If the course is uncomplicated, it is usually sufficient to take antibiotics that work against the typical pathogens of adnexitis. If these do not provide sufficient improvement, as soon as the pathogens are known, they are specifically fought with the appropriate antibiotics. If an inflammation of the fallopian tubes becomes permanent or an abscess, i.e. an encapsulated inflammation, forms, an operation may be necessary. Medicines such as ibuprofen or paracetamol usually work very well against the pain. However, ibuprofen must not be taken during pregnancy, especially in the last trimester. If in doubt, you should ask your doctor in charge for advice. Paracetamol, on the other hand, is also seen as unproblematic during pregnancy.

Localization of the pain

Pain in the thigh and groin

The groin is in a close anatomical position to the inner thigh and the muscles and tendons running there, which is why pain in the inner thigh can certainly occur with diseases of the groin. The inguinal ligament is a ligament that runs from the hip bone to the pubic bone. This ligament is in close contact with the tendons of the muscles of the inner thigh and the abdominal muscles. If a groin disease occurs, the tendons of the surrounding muscles may be impaired and this can be perceived as pain in the inner thigh.

Typical diseases of the groin region, which can cause painful symptoms in the inner thigh, are hernias or the so-called "soft groin" in athletes. The compression of certain nerves that run in the groin can also lead to pain in the inner thigh area. Performing certain sports or sitting for long periods of time can cause nerve compression and cause discomfort.

Hip pain

The hip is in a close anatomical position to structures that run on the inner thigh and is therefore a common cause of pain in this area.

In most cases, there is an overuse of the muscular structures or tendons of the hip. The muscles on the inner thigh run between the hip and knee joint. If these muscles are now irritated in the hip area, pain can occur throughout the muscle. Degenerative changes in the hip joint can also be responsible for the symptoms that occur. A typical degenerative disease that is responsible for pain in the inner thigh is hip arthrosis. Due to the irritation of certain nerves and tendons, the pain, which originates in the hip, is transferred to the area of the inner thigh.

Pain in the tendon

In pain that occurs in the inner thigh, the tendon that runs there often plays a major role. Especially when there is excessive strain, the tendon can easily become inflamed and cause discomfort, which is usually perceived as pain in the inner thigh.
The inflammation is usually not caused by an infection, but can be a sign of improper or excessive stress as well as wear and tear and leads to degenerative changes in the tendon substance and consequently to pain.

Athletes in particular are relatively often affected by tendinitis, which is difficult to treat. In order to treat the pain associated with the tendinitis and the disease itself, certain behavioral measures can be used in conjunction with drug therapy.
It is important that the muscles of the inner thigh are spared, as straining them can worsen the inflammation. The period of relief should be generous (weeks to months instead of days!), Even if the symptoms should have improved to such an extent that pain no longer occurs at rest. If you start exercising too early, there is a risk of relapse.
Painkillers can also be taken, which ideally have an anti-inflammatory effect. In particular, drugs that fall into the group of so-called NSAIDs are therefore widely used in this disease.
However, do not be fooled by the pain-relieving effect of the medication and start training again too early!

Cortisol, which counteracts inflammation very effectively, should be strictly avoided as it has a negative effect on the robustness of the tendons and in the worst case can even lead to tendon ruptures.

You can read more information on this topic here:

Tendonitis of the thigh
Tendinitis in the groin

Concomitant symptoms

bruise

A bruise is always an indication that open bleeding must have occurred below the skin level.

Either torn muscle fibers, torn ligaments or injuries with a blunt object can be responsible for this. The blood leaks from the injured blood vessels and runs into a space between muscles, tendons, and ligaments. However, the space of this gap is limited. This enables the bruise to compress the blood vessel itself due to the pressure that builds up in the limited space. So you don't bleed any more. However, the increase in pressure in the space also leads to a painful feeling of pressure.

Dent in the muscle

An accompanying dent on the inside of the thigh is usually an indication of a muscle injury.

Usually you can feel the dent more clearly than you can see it from the outside with the naked eye. Usually a torn muscle fiber is the reason for the dent. A small layer of the musculature detaches from its original attachment point and contracts more than the rest of the muscle, so that a small gap is created in the muscle course that can be perceived as a dent.
In the absolute majority of cases, muscle injuries and muscle fiber tears are due, in particular, to excessive exercise. The adductors, which are located on the inside of the thigh, can be affected, especially in sports with rapid changes of direction.

Numbness or tingling sensations

Numbness or tingling on the inside of the thigh are symptoms that suggest nerve irritation.

This region in particular is typical for the symptoms of a herniated disc in the lumbar spine. Most of the time, the tingling area can be clearly demarcated from the person affected and its characteristics correspond to a so-called dermatome. Due to the herniated ligament, a piece of the intervertebral disc presses on the spinal nerve. This gives the patient a tingling or numb feeling. The herniated disc can also lead to pain. Much more common, however, is numbness or so-called tingling paresthesia.

Pain in the inside of the thigh during pregnancy

Pain in the area of the inner thigh and in the groin region are often described complaints that can occur during pregnancy. A number of different causes can be responsible for the appearance of the complaint during pregnancy. The symptoms can be primarily or only secondary to the existing pregnancy.

Especially in the advanced trimesters, pregnancy puts stress on the leg muscles, which can lead to irritation of the tendons of the muscles on the inner thigh or to overloading them. The excessive strain on the muscles increases the risk of cramps in the thighs. Tendonitis can be responsible for the symptoms, especially if the thigh muscles are irritated by sporting activities or exercise during pregnancy.

During pregnancy, more hormones are produced, which lead to changes in the connective tissue in the body. This becomes more elastic and is less stable. While this is useful for the natural birth process, it can also lead to complications. For this reason, inguinal hernias are common during pregnancy. This process is also promoted by the fact that the child growing in the uterus creates unusually high pressure in the mother's abdomen. An inguinal hernia can cause pain in the inner thigh area by irritating certain nerves and tendons.

therapy

The treatments vary depending on the underlying disease. Therefore, each cause should be briefly discussed here.

Above all, the torn muscle fiber needs relief. For the ambitious athlete, this usually means a break in sports of at least 4, but no more than 8 weeks. Surgical treatment is only indicated if the muscle fiber tear expands into a muscle tendon tear.
You are powerless against the bruise and you simply have to give it time until the body has reabsorbed the blood on its own. However, if the hematoma is causing severe pain, pain medication may be taken for relief.

Pubic inflammation also needs relief. In addition, anti-inflammatory (anti-inflammatory) drugs should be used. If the pain and signs of inflammation are not noticeably less, cortisone can be used. Only in the worst case will an operation be necessary.
If the tingling sensation is really a symptom of a herniated disc, one would first try to get it under control with the help of physiotherapy. If this does not improve or if the symptoms get even worse, the defective disc should be treated surgically.

Forecast and duration

The healing time also depends on the causal disease, whereby a duration of approx. 4 to 6 weeks can be assumed for both pubic branch inflammation and muscle fiber rupture, until you are pain-free again and can go about your normal everyday life.
Depending on the extent, the bruise takes about one to two weeks to go away. The different colors of the bruise are a sign of the different degrees of degradation of the hemoglobin contained in the red blood cells.
It is difficult to predict how long it will take to heal a herniated disc. Just like the prognosis, it depends on many factors, such as the location of the herniated disc, the age of the patient, state of health or physical fitness and many other influencing factors. Nor is it said that every patient loses their tingling paresthesia again. However, the consequences of the herniated disc usually do not remain.