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Differentials of Painful thigh
Related Subjects: |Analgesia and Pain management |Sedation and Analgesia on ITU |Neuropathic Pain Management |Codeine |Dihydrocodeine |Diamorphine |Morphine
| Cause of Painful Thigh | Comments |
|---|---|
| 🦴 Fractured Femur | May be atypical in elderly, especially with delirium/dementia. Consider pathological fracture if trauma is minimal. Always get an X-ray. |
| 🦴 Fractured Pubic Ramus | Common in frail elderly women. Pain may be subtle; mobility often impaired. X-ray or CT pelvis may be required. |
| 🩸 Haematoma | Often in patients on anticoagulants or after trauma/femoral puncture. Monitor haemoglobin. May see bruising/swelling. |
| ⚡ Necrotising Fasciitis | Severe “pain out of proportion.” Rapid progression with erythema, necrosis, bullae. CK markedly raised. Surgical emergency. |
| 💊 Rhabdomyolysis | Muscle pain with elevated CK. May follow crush injury, statins, seizures. Risk of AKI → monitor U&E. |
| 🦵 Diabetic Amyotrophy | Thigh/hip pain with wasting and weakness. Seen in poorly controlled diabetes. Often asymmetric. |
| 💉 Abscess | May follow penetrating trauma or haematogenous spread. Look for fever, swelling, fluctuant mass. Confirm with ultrasound; drainage usually required. |
| 🩻 Proximal DVT | Pain, swelling, venous dilation. Risk factors: immobility, malignancy, surgery. Confirm with Doppler ultrasound. |
| ⛔ Arterial Occlusion | Pale, cold, painful leg with absent pulses and poor capillary refill. Acute limb ischaemia → urgent vascular referral. |
| ⚡ Meralgia Paraesthetica | Lateral thigh burning pain/numbness due to lateral femoral cutaneous nerve entrapment. Risks: obesity, pregnancy. May need neuropathic pain relief or nerve block. |
| 🌸 Fibromyalgia | Chronic pain syndrome with trigger points. Associated fatigue, poor sleep, mood disturbance. |
| 🦠 Cellulitis | Localised pain, erythema, warmth, and swelling with systemic features. Entry site often visible. Requires antibiotics. |
| 🦴 Bone Sarcoma | Persistent, localised bone pain (may worsen at night). Consider if unexplained, especially in younger patients. |
| 💢 Myositis | Muscle inflammation with pain and weakness. Often autoimmune (e.g. polymyositis, dermatomyositis). ESR/CK raised. |
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