Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis

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 as Avascular 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
• Nerve-related symptoms
• Numbness
• Tingling
• Shooting pain
• Pins-and-needles sensation
• Muscle weakness
• 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 Inability

Walking gait is complicated with both conditions which is a major cause behind the misdiagnosis.

Limping

Individuals often limp with both 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.

Hip Pain

The tributaries/veins of the sciatic nerve also supply the hip area and often cause confusion between the two conditions.

Differences

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.

Location

• 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.

Restricted Movement

• 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.

Risk Factors

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
• Alcoholism
• Trauma
• Radiation damage
• Steroid use

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 the sciatica or refer the patient to the proper specialist.

Lower Back Pain

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References

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