Evaluation of Posterior Thigh Pain

Differential Diagnosis

Most Common

1. Hamstring Muscle Strain

2. Referred pain from lumbar spine

3. Hamstring Muscle Contusion

4. Gluteal Trigger Points

Less Common

1. Referred pain from SI joints

2. Tendinopathy

3. Bursitis of Semimembranosis or Ischiogluteal

4. Fibrous Adhesions

5. Hamstring Syndrome

6. Chronic compartment syndrome of the posterior thigh

7. Apopysitis or Avulsion fracture of the Ischial Tubersosity

8. Nerve Entrapment of Posterior Cutaneous Thigh or Sciatic Nerve

9. Adductor Magnus Strain

10. Mysositis Ossificans of Hamstring

Not to be Missed

1. Bone Tumors

2. Iliac artery endofibrosis

History

• Activity level and recent changes

• Onset: acute or insidious

• Aggravating factors

• Releif or excacerbation by activity

• Night Pain

• Exact site of pain

• Neuro symptoms

Examination

Always remember to examine the joint above (Lumbar Spine and hip) and below (Knee)

Inspection

1. Standing

2. Walking

3. Lying prone

Palpation

1. Hamstring Muscles

2. Ischial Tuberosity

3. Gluteal Muscles

Motion

Note that range of movement is measured determined actively first, if there is a deficiency, move on to passive range of motion. Any deficits should be measured with a goniometer. Note should be made of discrepence between active and passive movement.

1. Lumbar spine movement

2. Hip Extension

3. Knee Flexion

4. Knee Extension

Also include the passive motion of Hamstring Muscle Stretch

Muscles

Measurement of muscle strength using the Oxford (MRC) Scale.

1. Knee Extension

2. Hip Flexion

3. Eccentric Hamstring Contraction

Funtional tests may include kicking, running, and Sprint Starts

NeuroVascular

1. Check and Grade reflexes, sensation, and strength of lower limb nerve roots

2. Check Pulse

Special Tests for Sciatic Nerve Irritation

1. Straight Leg Raise

2. The Prone Knee Bend Test for Femoral Nerve Stretch

3. Slump Test

Special Tests for Sacroiliac Joint Irritation

1. FABER Test

2. Sacroiliac Compression Test

Other Special Tests

1. Jackson Hyperextension Test for Sacroiliac Joint Disease

2. Test for Femoral Stress Fracture

Investigations

1. Plain Films: For persistant thigh pain, it may be helpful to rule-out Myositis Ossificans or Femoral Stress Fracture. Plain films of the hip may also be necessary to evaluate for referred hip pain.

2. Ultrasound: May reveal a muscle contusion.

Appendix

Muscular Anatomy of the Hip Joint

Index

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