Osteonecrosis is a condition that causes the death of bone tissue from temporary or permanent loss of blood supply to the affected area. It is commonly known asAvascular necrosis and can lead to miniature/tiny breaks in the bone and the bone/s eventually collapsing. Specifically, it affects the upper part of the femur or femoral head and surrounding joints.
It can occur in any bone however, osteonecrosis typically affects the hip/s. Pain associated with osteonecrosis of the hip can be localized to the center of the groin, thigh, or buttock. Because of the hip joint’s close proximity to the sciatic nerve, misdiagnosis for sciatica is common.
Mimicking Sciatica Symptoms
Unfortunately, many health care providers can misdiagnose osteonecrosis hip pain as sciatica. Whatever the cause of the hip injury, most individuals with hip pathology report pain in the groin, upper thigh, and buttocks.
That is why a trained medical professional that knows the differences in the symptoms of each condition can make all the difference in making a proper diagnosis. And a proper diagnosis leads to proper and complete treatment of whichever condition it may be. With osteonecrosis, misdiagnosis often delays the proper treatment and continues to progress. Common symptoms of sciatica:
Leg pain is the primary symptom can be mild to severe
Low back pain is secondary can be mild to severe
Hip pain especially flexion and internal rotation of the hip.
Leg or foot weakness
Osteonecrosis Symptoms and Similarities
For many, there are no symptoms in the early stages of osteonecrosis. As the condition worsens, the affected joint could present pain symptoms only when weight is placed on it. Eventually, individuals begin to feel the pain even when lying down. Pain can be mild to severe with a gradual development. Other symptoms that mimick sciatica:
Walking gait is complicated with both conditions which is a major cause behind the misdiagnosis.
Individuals often limp with osteonecrosis of the hip and spinal disc problems. This is another reason that the condition is misdiagnosed as a spinal disc problem or nerve root compression of the sciatic nerve.
The tributaries/veins of the sciatic nerve also supply the hip area and often cause confusion between the two conditions.
Despite all of the similarities. There are differences in both conditions.
Nature of The Pain
With sciatica, the pain is related to the nervous system. Movement can complicate the pain. While rest helps to reduce the pain.
With Osteonecrosis the pain is geared toward the muscular. Rest does not help reduce the pain. In fact, the pain increases at night.
Sciatica pain can radiate through the whole leg from the low back to the toe.
Osteonecrosis pain is confined to the hip joint, groin, and radiates to the knee joint only. Osteonecrosis pain does not radiate below the knee joint.
Osteonecrosis of the hip joint, means the movements involving the hip joint are restricted. Individuals cannot rotate the leg to the right and left. Individuals cannot bend or fold from the hip.
With sciatica, the rotation of the leg is not affected. Movements involving stretching the sciatic nerve can cause relief or pain.
Walking Gait Differences
Gait is the way an individual stands and walks.
Osteonecrosis of the hip joint causes individuals to not be able to open the hip joint properly or to step properly.
With sciatica, an individual tends to lean on their side to relax the compression on the nerve.
More than 20,000 people enter hospitals for the treatment of osteonecrosis of the hip yearly. Other than the hip, areas of the body likely to be affected are the shoulder, knee, hand, and foot. The condition can occur for a variety of reasons. A few of these include:
Fracture – a broken bone can interrupt the blood flow to other sections of the bone.
Dislocation of bone or joint/s
Some individuals can have more than one condition or injury that contributes to hip flexor pain. An example is that it is possible to have both hip osteoarthritis and hip impingement. Without proper treatment, the condition can worsen, causing joint or hip pain from the degradation of the bone.
Anyone can be affected, but osteonecrosis is most common in individuals aged 30 to 50. Treatment options include a total replacement of the hip known as arthroplasty. And if it is sciatica then chiropractic treatment is a first-line treatment protocol. However, a chiropractor can make the distinction between the two and treat sciatica or refer the patient to the proper specialist.
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The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Li, Wen-Long et al. �Exploring the Risk Factors for the Misdiagnosis of Osteonecrosis of Femoral Head: A Case-Control Study.��Orthopaedic surgery, 10.1111/os.12821. 16 Oct. 2020, doi:10.1111/os.12821
With the increase of osteoporosis in older adults, the diagnosis and treatment�of abnormal hip fractures, such as�bisphosphonate-related proximal femoral fractures,�has become more important. According to Dr. Edward J. Fox, MD, obesity is often managed through the long-term�use of bisphosphonate treatment, which can inhibit�osteoclast-mediated bone regeneration. Over the prolonged utilization of bisphosphonate, patients� may develop atypical proximal femoral fractures.
Understanding Atypical Femur Fractures
Atypical femur fractures are characterized as stress fractures which commonly occur in the proximal one-third of the diaphyseal bone, although they might also occur more distally, developing in the lateral cortex and slowly progressing medially. “With irregular fractures, a small ‘beak’ of bone can form on the lateral surface of the femur and that is where the fracture generally begins,” explains Dr. Fox. This contrasts with stress fractures which occur laterally in the medial portion of the bone.
As a result, when a patient with osteoporosis reports feeling hip and knee pain without previous damage or injury, healthcare professionals will ask about bisphosphonate treatment. It is essential for the�doctor to request x-rays of the hip and femur shaft for proper diagnosis.�It is also important to request x-rays of the opposite femur, as atypical bisphosphonate-related proximal femoral fractures frequently occur bilaterally. Dr. Edward J. Fox urges patients to discontinue bisphosphonate use in the case of hip fractures,�followed by the subsequent use of crutches or a walker. Patients will eventually be able to resume regular physical activities.
Approximately more than 250,000 hip fractures occur in the United States, causing significant patient disability. The variety of hip fractures in older adults, including bisphosphonate-related proximal femoral fractures, often need several treatment approaches which depend on different considerations, such as the mechanism of injury, location and degree of the fracture, as well as the patient’s age and overall health and wellness.
Dr. Alex Jimenez D.C., C.C.S.T.
The precise mechanism of injury by which bisphosphonates cause atypical femur fractures is unknown. Research studies have demonstrated that the suppression of osteoclast activity prevents the clearance of bone fragments which build up on the bone surface during regular daily tasks; decreasing the strength of the bones which lead to fracture. “We all know that the threat of those fractures increases with the extended duration of bisphosphonate exposure, particularly after five decades. Bisphosphonates are stored with a half-life of at least eight decades in bone matrix. To reduce over-exposure and risk of atypical fracture, passing medication discontinuance has been speculated to be beneficial,” explained Dr. Fox
Dr. Edward J. Fox, MD, stated that until research studies find the exact mechanism of injury and treatment for bisphosphonate-related proximal femoral fractures, healthcare professionals should continue to determine the best treatment option for each patient, carefully weighing the benefits and risks of individual patients. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain is the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
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