Tendinitis of the thigh

introduction

Tendinitis of the thigh often occurs as a result of sports injuries or sports overload. Another cause may be congenital or acquired malalignment of the thigh, which overstretches the tendons and causes pain. Much rarer causes of tendinitis are rheumatic diseases and bacterial infections of the tendon.
By sparing and only light exercises to strengthen the muscles tendon inflammation usually heals within a few weeks. Anti-inflammatory analgesics are usually used for therapy, which among other things should also ensure that the inflammation does not lead to tendon calcification for a long time.

definition

Tendinitis describes the inflammation of the attachment or origin of muscle, the tendons. These muscles are attached to bones or other structures. In addition to pure tendinitis, there is also tendovaginitis (inflammation of the tendon), an inflammation of the tissue channel that surrounds the tendon like a tunnel.

causes

There are different causes of tendinitis on the thigh.
A common possibility is the acute or chronic Fehlbelastung or irritation of the inflamed tendon. Chronic mishandling may be due to malposition of the knee or hip, resulting in the tendon being used permanently and in a non-physiological (unnatural) manner. Malpositions may exist from birth or may be caused by injury or surgery. Of course, also uneven-burdening activities, such as certain sports (eg football) can be a trigger.

An acute inflammation can be caused by an injury during sports, work or accidents, where the tendon is exposed to sudden and strong forces, such as failure or stumbling.

Furthermore, in inflammation of the thigh tendon to think of rheumatic diseases, ie processes in which the body recognizes the tendon tissue as foreign and it tries to fight. In these cases, abnormalities in other parts of the body are usually present, such as, for example, morning joint inflammation.

Much rarer is an infectious cause - ie the infection of the tendon by, for example, bacteria that have penetrated through an open spot or injury in the surrounding tissue (the tendon sheath).

symptoms

Patients with tendonitis in the thigh complain of pain in the affected area. The pain is usually indicated as burning, pulling and stabbing. Often the tendon hurts when the affected muscle is stretched. This can be conscious in the form of a stretching exercise or in the course of the normal movement process while running. In addition to the pain, overheating and redness of the skin over the inflammation may be less common. Furthermore, hardening and pressure pains fall on. In acute cases (eg stumbling) it can take up to 24 hours before pain and other symptoms appear.

In case of chronic thigh tendon inflammation (eg due to poor posture), calcification of the tendon may occur due to the long-term inflammatory process. This is noticeable by crunching or crackling noises during movement and can be painful. In addition, the long-term restraint of the thigh (to avoid pain) can cause movement restrictions during running.

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Place of inflammation

Inflammation on the inside

An inflammation of tendons on the inner thigh is not uncommon and common in competitive sports. On the inside of the thigh are the adductors, which are the muscles that cause the legs to contract towards the middle. These muscles have their origins in the area of ​​the pubis. The adductor tendons can inflame during quick and unfamiliar movements. In footballers and other ball athletes from the power sector, inflammation of the adductor tendons occur again and again as a sign of overload, stress and lack of regeneration.

The pain that the sufferers complain about, are often stress-dependent and then occur when the adductors are used. Since these are also claimed during normal running, it also comes in everyday travel to pain. It is important that with an inflammation of the adductor the affected muscles and tendons are spared. Acute treatment with ibuprofen, cold compresses and also with Voltaren ® envelopes. In the course can be treated with heat.

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  • Pain on the inside of the thigh

Inflammation on the outside

Pain on the outside of the thigh may be due to an inflammatory process on the greater trochanter. The greater trochanter is part of the femur and is located near the hip. It is caused by tendons of various muscles (buttocks and hip muscles). Overloading may result in inflammation of the bursa (bursitis trochanterica) on the thighbone. The purpose of bursae is to absorb the pressure of tendons and ligamentous structures so that they do not rub on the bone. In bursitis, in addition to the bursals, the tendons that are attached to these bursa tend to become inflamed.

The so-called iliotiablis tract pulls over the trochanter. This is a strong tendon band that runs the entire length of the thigh from the hip to the knee. If due to poor posture or overloading of the iliotibal tract must counteract strong shear forces (eg O-legs), it may happen that the bursa inflamed at the greater trochanter, since the iliotibal tract then rubs very strong along. This disease is called runner knee or ITBS.

If the inflammation is due to malocclusion, it must be corrected to prevent recurrent inflammation due to unphysiological (unnatural) stress. If the inflammation is triggered by an acute event, such as bruising or a wrong movement, then the immobilization, cooling and treatment with anti-inflammatory agents is indicated.

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  • Pain on the outside of the thigh

Inflammation at the front

On the front of the thigh sits the quadriceps muscle. He is primarily responsible for the extension in the knee.

Patients with femoral tendonitis on the front of the thigh do not always have to be very much in pain. There is sometimes talk of a slight stiffness or weakness in the quadriceps. With only mild inflammation, the complaint can be reduced by a good warm-up. With stronger inflammations, the pain and problems during exercise (eg the training session) but then often stronger.

Again and again affected are people who do sports in which fast braking, start-up and direction changes take place (such as in tennis, basketball or other sports in which short sprints include).
In principle, however, any kind of sport can be the cause of longer running sessions, jumping, squatting and short sprints. All these movements result in a long, continuous or short, abrupt and intense strain on the quadriceps tendon.

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Inflammation at the back

Pain on the back of the thigh may have different causes depending on the location.

Musculoskeletal tendonitis is often associated with inflammation of the bursal in the area of ​​the greater trochanter (thigh bone) of the femur. Reasons for this can be a fasting tendon or Schnapphüfte - while a tendon slips or jumps over the rolling hill again and irritates this or the bursa, which lies there. In the course of the tendons can also ignite.In such cases, must also be thought of a possible leg length difference.
But again, excessive exercise may be the cause.

A femoral tendon inflammation, which is located approximately in the middle or lower third of the posterior aspect, affects the tendons of the hamstring muscles. These are the muscles that stretch the hips and bend the knee.
The tendons of this muscle group are shortened in many people. This is because nowadays we sit a lot and do not walk that much anymore.
Cause can also be a malposition of the leg. Frequently, however, people are affected who are active in running or who have newly entered into running training.

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Figure thigh muscles: A-muscles of the front, B-muscles of the outside and C-muscles of the back

thigh muscles

  1. Thigh Tensioner -
    Tensor fasciae latae
  2. Iliac muscle -
    Musculus iliacus
  3. Big loin muscle -
    Psoas major muscle
  4. Comb muscle - M. pectineus
  5. Slender muscle - M. gracilis
  6. Tailor's Muscle - M. sartorius
  7. Straight thigh muscle -
    Musculus rectus femoris
  8. Outer thigh muscle -
    Musculus vastus lateralis
  9. Inner thigh muscle -
    Musculus vastus medialis
  10. Ilium-tibia tendon -
    Tractus iliotibialis
  11. Patella - patella
  12. Long attractant - adductor longus muscle
  13. Big attractant - adductor magnus
  14. Two-headed thigh muscle, long head - Biceps femoris, Caput longum
  15. Two-headed thigh muscle, short head - Biceps femoris, Caput breve
  16. Semirigid muscle - Semitendinosus muscle
  17. Semi-membranous muscle - semimembranosus muscle
  18. Thighbone - femur
  19. Gluteus Maximus - gluteus maximus muscle

An overview of all pictures by Dr-Gumpert can be found at: medical pictures

Inflammation in the area of ​​the knee

Inflammation of tendons on the knee is not uncommon, especially on the front. It is the tendon of the large knee extensor, the quadriceps muscle. Its tendon may also be subject to long-term degenerative damage, then it is called a tendinosis.
A permanent occupational stress or an acute trauma (eg during sports or in the course of a lunge) can be the cause.

Knee pain should always be considered for injuries of the cruciate ligament, collateral ligaments or menisci. This can be ruled out by an orthopedist. If pain is indicated in the popliteal fossa, inflammation of the tendons of the hamstring muscles - these are the muscles that run on the back of the thigh and attach to the knee - is possible, although this is rare. A scan examination by the doctor can rule out a baker's cyst (buckling of the knee capsule into the popliteal fossa) as the cause of the condition.

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  • Inflammation in the knee joint

Tendinitis in the groin

The tendinitis in the groin is usually characterized by pain and swelling, redness and overheating of the affected groin noticeable.

The cause of the tendonitis is usually an overload, which is why especially athletes (especially runners) are affected by the disease. In the tendinitis in the groin, in principle, all muscles can be affected, which pull from the pelvis to the thigh, but usually makes the hip flexors (Muscle Iliopsoas) the complaints.

The treatment of tendinitis in the groin initially consists of physical protection, the leg should be stored high. The cooling of the groin and the intake of anti-inflammatory and analgesic agents is useful at the beginning of the disease. During the course of physiotherapeutic observation the strain should be resumed piece by piece.

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Quadrizepssehnenentzündung

The quadriceps is the largest muscle on the thigh front. At the hip he contributes to the hip flexion. At the knee he causes an extension.

The quadriceps tendon is located at the bottom of the quadriceps and from there to the kneecap, where it merges into the patellar tendon. Inflammation of the quadriceps tendon is in most cases caused by chronic overstressing of the tendon. Especially in professional groups that work a lot kneeling (eg tilers) is often affected by the inflammation of the patella tendon.

The tendonitis is usually noticeable by pain, which become stronger under stress. The basic treatment consists in a protection of the affected leg and a subsequent slow load build-up.

How long does the inflammation last?

For smaller tendonitis, the problem with appropriate treatment often already subsided within a few days.

In larger and more heavily loaded muscle groups, such as those found on the thigh, inflammation can persist for several weeks and prolong even further, if not adequately protected and cooled. As a rule, however, it should regress within a few days to a few weeks.
A chronification must be avoided if possible. Accordingly, for complaints that last more than a week or in case of an acute incident, a doctor should be consulted to deal with the problem.
Since premature stress often causes the problem to flare up again, it is important that the closed seasons discussed with the doctor are observed.

diagnosis

To diagnose a femoral tendon, the history is a central issue. By describing the symptoms, as well as their nature and timing of the onset of the discomfort, the doctor may decide to draw conclusions that help him make an initial diagnosis or working hypothesis. Furthermore, the clinical examination can help to differentiate at which point in the thigh the problem lies exactly, as it is quite possible that the pain radiates from another place, and projected by the patient only at the place described (felt there).

For further diagnostics, the ultrasound and also the MRI (nuclear spin) can be used to visualize the tendons and the surrounding soft tissue. With these methods, injuries, cracks and fluid retention (edema) as a cause or consequence of the problems can be shown or excluded.

If an infectious cause is suspected, possible accumulations of pus (abscesses) could also be seen. In addition, in the case of suspected infection, a blood sample should be taken to see inflammatory levels in the blood, if necessary.
The same applies to suspected rheumatic causes. Here, so-called rheumatoid factors and various antibodies can be determined, giving the first indications of an expiring rheumatic inflammation.

In the case of muscular complaints on the thigh, other injuries, such as muscle fiber tears and muscle strain, should be excluded.

therapy

In case of femoral tendonitis it is important to eliminate the causes.
In case of an accident-related inflammation is accordingly the protection and if necessary, the bandaging of the thigh in the foreground. Treatment with cold compresses helps to reduce the swelling and inflammation. Should the pain be worse under cold treatment, then this should not be continued.

To relieve the inflammation, analgesics from the class of non-steroidal anti-inflammatory drugs (eg ibuprofen, Voltaren®) are used, as these prevent the release of inflammatory messengers. In addition, they also work against the pain.

After initial sparing of the affected muscles and tendons, slight relaxation and stretching exercises should be initiated as the inflammation decreases. If immobilized too long, there is a risk that muscles will atrophy (regress) and stick to the tendon sheaths. However, this should be discussed with the attending physician, as premature loading of the inflamed tendons may prevent the healing process.

taping

Taping is a sensible method that can support stressed muscles and tendons.

When a tendonitis on the thigh, especially the elastic Kinesiotape is used. At the beginning of the complaints you can not do much with taping. The basis of the therapy is rather the physical protection. However, if increased mobility is possible again during the course of the workout, the muscles can be well supported by the tape. Usually follows a physiotherapeutic treatment in which the thigh muscles should be strengthened again. Again, you can work with tape at first.

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homeopathy

For tendinitis, homeopathic remedies can also be used. At the beginning, Arnica and Rhus toxicodendron are the most suitable.

Bryonia can be used if the symptoms are aggravated by stress. In addition, agents such as Symphytum, Lachesis and Sulfur can be taken. Ideally, the homeopathic remedies are used in addition to the physical protection and subsequent exercise therapy.


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