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Sports Medicine

Leg pain

05/14/2009

Question:

I have rheumatoid arthrtis but I don`t think that this is what this is. I started with pain behind one of my knees. Now it goes up the back of my thigh to my hip. When I try and straighten my leg I get pain up by my hip and if I straighten it right out I get pain right in the middle of the muscles in the back of my thigh. It is tender and very painfull where it wakes me up at night. I also get alot of pain when going up stairs. I have been taking Tylenol Arthritis and putting ice on it for 4 weeks. The ice helps while it is on. Once I take off the ice and give it about a half hour the pain is back. I have also been getting muscle spasms in those muscles. I seen a doctor and all he said that it was musclar. It is not getting any better. Any ideas what I can do to help with the pain or what is causing the pain?

Answer:

A diagnosis and appropriate treatment recommendations requires a medical history and physical exam, as well as possibly diagnostic testing, which in your case could include imaging studies (X-rays of your knees and possibly hips, and possibly later an MRI scan of your knee - including your thigh) as well as possibly electrodiagnostic studies (EMG/NCS - which refers to electromyography and nerve conduction studies).

Pain behind the knee in a person with Rheumatoid Arthritis raises the possibility of a Baker's cyst, which is a collection of fluid in a bursa (sac) which arises from the back of the knee. However, pain from a Baker's cyst would not typically travel up the thigh into the hip. A hamstring muscle strain is another cause of pain in the back of the thigh, but this would be unlikely in your case unless you've had an episode of trauma due to overstretch. Pain can be referred into the thigh from the hip joint, the sacroiliac joint, or the lumbar spine (lower back)... in particular, nerve irritation in the lower back can "refer" pain into the back of the thigh, and can become worse when the knee is straightened (which stretches the lower lumbar nerve roots).

If your symptoms persist or worsen but your primary care physician has no other suggestions, consider consulting with your rheumatologist or a PM&R (physical medicine and rehabilitation) physician.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University