Leg pain

Answer 1

DefinitionHip pain involves any pain in or around the hip joint. Alternative Names

Pain - hip

Considerations

Hip-related pain is not always felt directly over the hip. Instead, you may feel it in the middle of your thigh or in your groin. Similarly, pain you feel in the hip may actually reflect a problem in your back, rather than your hip itself.

See: Low Back pain

Common Causes

Hip fractures are a significant and serious cause of sudden hip pain. Hip fractures become more common as people age because falls are more likely and bones become less dense. People with osteoporosis can get a fracture from simple, everyday activities, not just a dramatic fall or injury.

A hip fracture can change the quality of your life significantly. Fewer than 50% of those with a hip fracture return to their former level of activity. In addition, while recovering from a hip fracture, several possible complications can be life-threatening. These include pneumonia and a blood clot in the leg, which can dislodge and travel to cause a clot in the lungs. Both are due to immobility following a hip fracture and hip surgery.

Other possible causes of hip pain include:

• Arthritis -- often felt in the front part of your thigh or in your groin
• Osteonecrosisof the hip
• Trochanteric bursitis -- hurts when you get up from a chair, walk, climb stairs, and drive
• Tendinitis from repetitive or strenuous activity
• Strain or sprain
• Low-back pain such as sciatica
• Infection

Home Care

• Try to avoid activities that aggravate the pain.
• Take over-the-counter pain medication, like ibuprofen or acetaminophen.
• Sleep on your non-painful side with a pillow between your legs.

A hip fracture is considered a medical emergency. Therefore, if suspected, you should get medical help right away.

As the pain improves, gradually begin to exercise. It is best to work with a physical therapist to learn proper exercises and how to advance your activity. Swimming may be a good option because it stretches the muscles and builds good muscle tone without straining your hip joint. However, swimming does not build bone mass. When you are ready (a physical therapist can help determine that), slowly and carefully resume walking or another activity against the resistance of gravity.

Call your health care provider if

Go to a hospital or call 911 if:

• Your hip pain is caused by a fall or other injury
• Your hip is misshapen, badly bruised, or bleeding
• You are unable to move your hip or bear any weight

Call your doctor if:

• Your hip is still painful after 1 week of home treatment
• You also have a fever or rash
• You have sudden hip pain, plus sickle cell anemia or long-term steroid use
• You have pain in both hips or other joints

What to expect at your health care provider's office

Your health care provider will perform a physical examination, with careful attention to your hips, thighs, back, and gait.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Do you have pain in one or both hips?
• Do you have pain elsewhere like your lower back or thigh?
• Do you have pain in other joints?
• Did your pain begin suddenly, or slowly and mildly?
• Did the pain begin after an injury, fall, or accident?
• Does any particular activity make the pain worse?
• Have you done anything to try to relieve the pain? If so, what helps?
• Are you able to walk and bear weight?
• What other medical problems do you have? Osteoporosis or other signs of bone loss? Sickle cell anemia?
• Do you take any medications? If so, which ones? If on steroids, for how long have you been on them?

X-rays of the hip may be necessary.

Your doctor may tell you to take a higher dose of over-the-counter medication, or give you a prescription anti-inflammatory medication.

Surgical repair or hip replacement may be recommended for osteonecrosis. Hip replacement is necessary for hip fracture and severe arthritis. With current technology, an artificial hip should last at least 10 to 15 years. Expect recovery from surgery to take at least 6 weeks. Plates and screws may be used to fix fractures around the hip.

Complications can occur from surgery. A blood clot in the leg is the most common complication, which can lead to a blood clot in the lungs.

Prevention

• Avoid activities that raise one of your hips above the other for extended periods of time, like running on an uneven surface. Running on a treadmill can keep your hips level.
• Warm up before exercising and cool down afterward. Stretch your hips, low back, and thighs.
• Avoid falls.
• Wear hip pads for contact sports like football and hockey. For those at high risk for a hip fracture, pads with a streamline design can be worn in undergarments.
• Learn how to prevent osteoporosis.

References

Daboy G. Miscellaneous nontraumatic disorders. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 25.

LeVelle DG. Fractures and dislocations of the hip. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 52.

Cornell CN, Sculco TP. Orthopedic disorders. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 37.

Wong TK, Lee RY. Effects of low back pain on the relationship between the movements of the lumbar spine and hip. Hum Mov Sci. 2004; 23(1): 21-34.

Dohnke B, Knauper B, Muller-Fahrnow W. Perceived self-efficacy gained from, and health effects of, a rehabilitation program after hip joint replacement. Arthritis Rheum. 2005; 53(4): 585-592.

Tak E, Staats P, Van Hespen A, Hopman-Rock M. The effects of an exercise program for older adults with osteoarthritis of the hip. J Rheumatol. 2005; 32(6): 1106-1113.

Answer 2

Definition

Leg pain is a common symptom and complaint.

For more specific information, see:

• Foot pain
• Knee pain
• Joint pain
• Hip pain
• Muscle pain
• Shin splints

Alternative Names

Pain - leg; Aches - leg; Cramps - leg

Common Causes

Leg pain can be due to a muscle cramp (also called a charley horse). Common causes of cramps include:

• Dehydration or low amounts of potassium, sodium, calcium, or magnesium in the blood
• Medications such as:
  • Diuretics, which can cause you to lose too much fluid or minerals
  • Statins, which lower cholesterol and can cause muscle injury
• Muscle fatigue or strain from overuse, too much exercise, or holding a muscle in the same position for a long time

An injury can also cause leg pain from:

• A torn or overstretched muscle (strain)
• Hairline crack in the bone (stress fracture)
• Inflamed tendon (tendinitis)
• Shin splints -- pain in the front of your leg related to overuse or repetitive pounding

Other common causes of leg pain include:

• Atherosclerosis that blocks blood flow in the arteries (this type of pain, called claudication, is generally felt when exercising or walking and relieved by rest)
• Blood clot (deep vein thrombosis) from prolonged bed rest
• Infection of the bone (osteomyelitis) or skin and soft tissue (cellulitis)
• Inflammation of the leg joints by arthritis or gout
• Nerve damage -- common in diabetics, smokers, and alcoholics (symptoms include numbness, tingling, or a sensation of pins-and-needles)
• Varicose veins

Less common causes include:

• Benign tumors or cysts of the femur or tibia (osteoid osteoma)
• Drugs such as allopurinol and corticosteroids
• Legg-Calve-Perthes disease -- poor blood flow to the hip that may stop or slow the normal growth of the leg
• Malignant bone tumors (osteosarcoma, Ewing sarcoma)
• Sciatic nerve pain (radiating pain down the leg) caused by a slipped disk in the back.
• Slipped capital femoral epiphysis -- usually seen in boys and overweight children between 11 and 15 years old

Home Care

If you have leg pain from cramps or overuse, take these steps first:

• Rest as much as possible.
• Elevate your leg.
• Apply ice for up to 15 minutes. Do this 4 times per day, more often for the first few days.
• Gently stretch and massage cramping muscles.
• Take over-the-counter pain medications like acetaminophen or ibuprofen.

For leg pain caused by varicose veins, leg elevation and compression with elastic bandages or support hose can help.

For leg pain caused by nerve disorders or claudication, control diabetes, eliminate alcohol and tobacco, and avoid ill-fitting shoes.

Call your health care provider if

Call your doctor if:

• The painful leg is swollen or red
• You have a fever
• Your pain worsens when walking or exercising and improves with rest
• The leg is black and blue
• The leg is cold and pale
• You are on medications that may be causing leg pain. DO NOT stop or change any of your usual medications without talking to your doctor
• Self-care steps do not help

What to expect at your health care provider's office

Your health care provider will perform a physical examination, with careful attention to your legs, feet, thighs, hips, back, knees, and ankles.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Where exactly is your pain?
• Do you have pain in one or both legs?
• How would you describe the pain? Dull and aching? Sharp and stabbing? Do you consider it to be severe?
• Is the pain worse at any particular time of day, like in the morning or at night?
• What makes the pain feel worse? For example, does exercise or long periods of standing worsen your pain?
• Does anything make your pain feel better like elevating your legs?
• Do you have any other symptoms like numbness or tingling? Back pain? A fever? Weakness?

The following diagnostic tests may be performed:

• Arteriogram to check blood flow
• Blood tests for specific diseases
• Bone biopsy if tumor is seen on MRI which may be malignant
• Bone scan
• Duplex Doppler/ultrasound exam to look for a blood clot
• MRI if a malignant tumor is suspected
• X-ray of your back or legs

Treatment depends on the cause. Medications may include pain medicines, anti-inflammatory drugs (NSAIDs), anticoagulants (blood thinners) such as Coumadin if there is a blood clot, and others. Cellulitis and osteomyelitis are each treated with antibiotics. Osteomyelitis will require extended use of antibiotics.

For some causes of leg pain, physical therapy may be recommended by your doctor. If you have a blocked artery, inserting a balloon catheter into the artery to improve blood flow may be advised.

Prevention

To prevent claudication and nerve damage:

• Don't smoke or use tobacco.
• Limit how much alcohol you drink.
• Keep your blood sugars under good control if you have Diabetes.
• Reduce other Heart disease risk factors, including high cholesterol and high blood pressure.

To prevent overuse injuries, like shin splints, muscle cramps, and other causes of leg pain:

• Warm up before physical activity and cool down afterward. Be sure to stretch.
• Drink plenty of fluids throughout the day, especially before, during, and after exercise.

References

Huddleston JI, Goodman SB. Hip and knee pain. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 42.

Nagaraju K, Lundberg IE. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 78.

Andrish JT. The leg. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2003:chap 29.

Ginsberg J. Peripheral venous disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 81.

Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 446.

Answer 3

A sad fact of getting older is that muscles and joints start hurting on a more regular basis. This is especially true on the extremities. One of the hardest pains to deal with on a daily basis is leg pain because most people can not avoid using their legs for very long. The different kinds of hurt that can be felt in this area are numerous and are caused by many different issues.

For an individual that is very active, this type of issue can be the result of muscle exhaustion. No matter how good the condition of a person's body, it will get injured. As the body ages, it becomes more susceptible to random injuries and the most common of these occurs to the muscle of the leg. Anyone that runs knows this pain well but less active runners may find it concerning. This type of pain is nothing to be worried about unless it is so severe that one can no longer walk.

Other leg pains can be caused by much more serious issues. Poor nutrition or lack of physical activity can actually cause the muscles in the leg to atrophy. An atrophied muscle is a huge issue that should be addressed immediately by a medical professional. Other issues could be the result of plaque in the veins located in the legs or cancer. If someone's leg starts hurting for no obvious reason, it is vital that they are taken to the hospital immediately. It could be an early indicator of a heart attack and the earlier such issues are addressed makes it more likely that the person is going to survive the heart attack or stroke.

Leg pain is an unfortunate fact of growing older but it should not be ignored just because it is expected. Sudden onset issues should be immediately addressed with a medical professional as quickly as possible. Emergency Rooms are well prepared to handle any issue that might be causing the pain and it is far better for an individual to be completely sure that their pain is benign. Often the more major issues come with these minor warning signs.

Answer 4

DefinitionHip pain involves any pain in or around the hip joint. Alternative Names

Pain - hip

Considerations

Hip-related pain is not always felt directly over the hip. Instead, you may feel it in the middle of your thigh or in your groin. Similarly, pain you feel in the hip may actually reflect a problem in your back, rather than your hip itself.

See: Low back pain

Common Causes

Hip fractures are a major and serious cause of sudden hip pain. Hip fractures become more common as people age because falls are more likely and bones become thinner. People with osteoporosis can get a fracture from simple, everyday activities, not just from a big fall or injury.

A hip fracture can change your quality of life significantly. Fewer than 50% of people with a hip fracture return to their former level of activity. While you recover from a hip fracture, several possible complications can be life-threatening. These include pneumonia and a blood clot in the leg, which can break loose and travel to cause a clot in the lungs. Both are due to lack of movement after a hip fracture and hip surgery.

Other possible causes of hip pain include:

• Arthritis -- often felt in the front part of your thigh or in your groin
• Bursitis -- it hurts when you get up from a chair, walk, climb stairs, and drive
• Infection
• Low-back pain such as sciatica
• Osteonecrosisof the hip
• Strain or sprain
• Tendinitis from repetitive or strenuous activity

Home Care

General tips:

• Try to avoid activities that aggravate the pain.
• Take over-the-counter pain medication, like ibuprofen or acetaminophen.
• Sleep on your non-painful side with a pillow between your legs.

For hip pain related to overuse or physical activity:

• Always warm up before exercising and cool down afterward. Stretch your quadriceps and hamstrings.
• Avoid running straight down hills -- walk down instead.
• Bicycle or swim instead of run.
• Reduce the amount of exercise you do.
• Run on a smooth, soft surface, such as a track, instead of on cement.
• Lose weight if you are overweight. Ask your health care provider for help.
• If you have flat feet, try special shoe inserts and arch supports (orthotics).
• Make sure your running shoes are made well, fit well, and have good cushioning.

If you think you may have Arthritis in your hip, see your health care provider before exercising your hip.

Tips to relieve hip bursitis pain:

• Use ice three to four times a day for the first 2 to 3 days. Cover your hip with a towel and place ice on it for 15 minutes. Do not fall asleep while using ice -- you can leave it on for too long and get frostbite.
• Try not to stand for long periods of time. If you must stand, do so on a soft, cushioned surface. Stand with an equal amount of weight on each leg.
• When you sleep, do not lie on the side that has bursitis. Place a pillow between your knees when you lie on your side to help decrease your pain.
• Wear flat shoes that are cushioned and comfortable.
• If you are overwegiht, losing weight may also help.

Call your health care provider if

Go to a hospital or call 911 if:

• Your hip pain is caused by a serious fall or other injury
• Your leg is deformed, badly bruised, or bleeding
• You are unable to move your hip or bear any weight on your leg

Call your doctor if:

• Your hip is still painful after 1 week of home treatment
• You also have a fever or rash
• You have sudden hip pain, plus sickle cell anemia or long-term steroid use
• You have pain in both hips or other joints

What to expect at your health care provider's office

Your health care provider will perform a physical examination, with careful attention to your hips, thighs, back, and gait.

To help diagnose the cause of the problem, your health care provider will ask medical history questions, such as:

• Do you have pain in one or both hips?
• Do you have pain somewhere else, like your lower back or thigh?
• Do you have pain in other joints?
• Did your pain begin suddenly, or slowly and mildly?
• Did the pain begin after an injury, fall, or accident?
• Does any activity make the pain worse?
• Have you done anything to try to relieve the pain? If so, what helps?
• Are you able to walk and bear weight?
• What other medical problems do you have? Osteoporosis or other signs of bone loss? Sickle cell anemia?
• Do you take any medications? If so, which ones? If you are on steroids, for how long have you been on them?

X-rays of the hip may be needed.

Your health care provider may tell you to take a higher dose of over-the-counter medication, or give you a prescription anti-inflammatory medication.

Surgical repair or hip replacement may be recommended for osteonecrosis. Hip replacement is necessary for hip fracture and severe arthritis.

Prevention

• Avoid activities that raise one of your hips above the other for extended periods of time, like running on an uneven surface. Running on a treadmill can keep your hips level.
• Warm up before exercising and cool down afterward. Stretch your hips, low back, and thighs.
• Avoid falls.
• Wear hip pads for contact sports like football and hockey. For those at high risk for a hip fracture, pads with a streamline design can be worn in undergarments.
• Learn how to prevent osteoporosis.

References

Daboy G. Miscellaneous nontraumatic disorders. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 25.

LeVelle DG. Fractures and dislocations of the hip. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 52.

Shah A, Busconi B. Hip, pelvis, and thigh: Hip and pelvis. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 21, section A.

Huddleston JI, Goodman SB. Hip and knee pain. In: Firestein GS, Budd RC, Harris ED Jr, et al, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 42.

Reviewed By

Review Date: 06/04/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept. of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 5

Definition

Leg pain is a common symptom and complaint.

For more specific information, see:

• Foot pain
• Knee pain
• Joint pain
• Hip pain
• Muscle pain
• Shin splints

Alternative Names

Pain - leg; Aches - leg; Cramps - leg

Common Causes

Leg pain can be due to a muscle cramp (also called a charley horse). Common causes of cramps include:

• Dehydration or low amounts of potassium, sodium, calcium, or magnesium in the blood
• Medications such as:
  • Diuretics, which can cause you to lose too much fluid or minerals
  • Statins, which lower cholesterol and can cause muscle injury
• Muscle fatigue or strain from overuse, too much exercise, or holding a muscle in the same position for a long time

An injury can also cause leg pain from:

• A torn or overstretched muscle (strain)
• Hairline crack in the bone (stress fracture)
• Inflamed tendon (tendinitis)
• Shin splints -- pain in the front of your leg due to overuse or repetitive pounding

Other common causes of leg pain include:

• Atherosclerosisthat blocks blood flow in the arteries (this type of pain, called claudication, is generally felt when exercising or walking and is relieved by rest)
• Blood clot (deep vein thrombosis) from long-term bed rest
• Infection of the bone (osteomyelitis) or skin and soft tissue (cellulitis)
• Inflammation of the leg joints caused by arthritis or gout
• Nerve damage -- common in people with diabetes, smokers, and alcoholics (symptoms include numbness, tingling, or a sensation of pins-and-needles)
• Varicose veins

Less common causes include:

• Cancerous bone tumors (osteosarcoma, Ewing sarcoma)
• Drugs such as allopurinol and corticosteroids
• Legg-Calve-Perthes disease -- poor blood flow to the hip that may stop or slow the normal growth of the leg
• Noncancerous (benign) tumors or cysts of the femur or tibia (osteoid osteoma)
• Sciatic nerve pain (radiating pain down the leg) caused by a slipped disk in the back
• Slipped capital femoral epiphysis -- usually seen in boys and overweight children between ages 11 and 15

Home Care

If you have leg pain from cramps or overuse, take these steps first:

• Rest as much as possible.
• Elevate your leg.
• Apply ice for up to 15 minutes. Do this 4 times per day, more often for the first few days.
• Gently stretch and massage cramping muscles.
• Take over-the-counter pain medications like acetaminophen or ibuprofen.

For leg pain caused by varicose veins, elevate the leg and wear elastic bandages or support hose.

For leg pain caused by nerve disorders or claudication:

• Control diabetes
• Stop using alcohol and tobacco
• Wear well-fitting shoes

Call your health care provider if

Call your health care provider if:

• The painful leg is swollen or red
• You have a fever
• Your pain gets worse when you walk or exercise and improves with rest
• The leg is black and blue
• The leg is cold and pale
• You are on medications that may be causing leg pain. DO NOT stop taking or change any of your medicines without talking to your doctor.
• Self-care steps do not help

What to expect at your health care provider's office

Your health care provider will perform a physical examination, with careful attention to your legs, feet, thighs, hips, back, knees, and ankles.

To help diagnose the cause of the problem, your health care provider will ask medical history questions, such as:

• Where exactly is your pain?
• Do you have pain in one or both legs?
• How would you describe the pain? Dull and aching? Sharp and stabbing? Do you consider it to be severe?
• Is the pain worse at any time of day, like in the morning or at night?
• What makes the pain feel worse? For example, does exercise or long periods of standing worsen your pain?
• Does anything make your pain feel better, like elevating your legs?
• Do you have any other symptoms like numbness or tingling? Back pain? A fever? Weakness?

The following tests may be performed:

• Arteriogram to check blood flow
• Blood tests for specific diseases
• Bone biopsy if a tumor is seen on MRI that may be cancerous
• Bone scan
• Duplex Doppler/ultrasound exam to look for a blood clot
• MRI if a cancerous tumor is suspected
• X-ray of your back or legs

Treatment depends on the cause.

• Medications may include pain medicines, anti-inflammatory drugs (NSAIDs), anticoagulants (blood thinners) such as Coumadin if there is a blood clot.
• Cellulitis and osteomyelitis are treated with antibiotics. For osteomyelitis you will need to take antibiotics for a long period of time.

For some causes of leg pain, your health care provider may recommend physical therapy. If you have a blocked artery, inserting a balloon catheterinto the artery may improve blood flow.

Prevention

To prevent claudication and nerve damage:

• Don't smoke or use tobacco.
• Limit how much alcohol you drink.
• Keep your blood sugar under good control if you have diabetes.
• Reduce other heart disease risk factors, including high cholesterol and high blood pressure.

To prevent overuse injuries, like shin splints, muscle cramps, and other causes of leg pain:

• Warm up before physical activity and cool down afterward. Be sure to stretch.
• Drink plenty of fluids throughout the day, especially before, during, and after exercise.

References

Silverstein JA, Moeller JL, Hutchinson MR. Common issues in orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 30.

Bederka B, Amendola A. Leg pain and exertional compartment syndromes. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 24. Section B.

Ginsberg J. Peripheral venous disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 428.

Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 428.

White CJ. Atherosclerotic peripheral arterial disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 79.

Reviewed By

Review Date: 08/15/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.