Doctors disagree on femoral neuropathy diagnosis/50yr old post meno..female
Doctors disagree on femoral neuropathy diagnosis/50yr old post meno..female
Going on 8 months with significant pain in the left groin radiating to the inner thigh, knee and now low back pain with "tightness" when bending forward. The pain is like electricity going throughout the pelvis and groin and radiates to the anterior and inner thigh.
Tests performed at the beginning of the acute onset were ultrasound of abd/pelvis, CT of abd/pelvis, then CT of spine, followed by MRI of the pelvis. Findings include incidentals like small gallstones, 2 sigmoid diverticuli, a 4mm lesion on the tail of the pancreas, a solitary small lung nodule, and a 3x3cm adnexal mass on the RIGHT side thought to be a benign pedunculated fibroid.
The pain is controlled by Ibuprofen 400mg qid,Tylenol #3 one tab qid, and a low dose of gabapentin added 4 months in.
The pain is always there and quite severe if medications are not on time. Gaba makes it hurt and sting more even if increased .Neurologist says that the nerve studies suggested femoral neuropathy with vastis medialis looking very unhappy. Iliopsoas did not look affected.
The sports medicine doctor did not agree with femoral neuropathy because although weaker than the right side, the leg and feet do not show severe impairment. I do have a limp and knee buckling but not severe.
An MRI of the lower back ordered by the neurologist was just done a few days ago, so it may show a cause that the other tests have not.
The main problem aside from pain is that I am unable to sit for more than 10 minutes without triggering a " fit" of pain for which only laying down can help.
I should mention I am doing physiotherapy exercises to keep stable and maintain quads, but I now have a tender area in one of my vertebra, high up the lumber area.
What I would like to know is if chiropractic therapy would be of benefit to thiis situation, since sports medicine would not advise and no longer can suggest/help me?
Hello Shelley, All in all a very distressing situation. Femoral nerve pain is severe.
One thing I would like to rule out is a hip condition, though unlikely. If you pull your knee to the shoulder and then opposite shoulder, no pain? Sometimes early hip arthritis or a condition called Femoro Acetabular Impingement Syndrome (FAIS) may be the underlying cause of the back condition that then causes the nerve pain in the leg. Greek, I know, but that's the way it sometimes is.
Do you know if anyone did a Femoral nerve stretch test? Usually done lying on the side, and pulling the hip into extension and knee into flexion? It stretches the muscles and Femoral nerve in the front of the thigh. Should be the same bilaterally.
It's good that you've had the other causes ruled out. An abscess in the Psoas can for example cause this, rare though.
The most important sign is that your knee is giving. That means quad weakness. Were the knee jerks equal? I'm afraid that I don't agree with the Sports medicine physician. The severity of the condition doesn't affect the diagnosis. If you have a mild case of diabetes, you still have diabetes. And in any case if the knee is buckling then it is severe. We call it a "hard" neurological sign. At the Femoral nerve page at C-H, scroll down until you come to a Youtube link for testing the Sciatic and Femoral nerve muscles. Is there significant weakness of the Quad, or other?
You make no mention of sensory. Rub your fingers lightly down both thighs and inner lower leg, then with a pin prick. Same bilaterally?
Oddly, I've just suffered myself from these exact symptoms just recently, so I know what pain you are experiencing. It hurts, in my case the worst at night.
I consulted a colleague, my daughter in fact, who did, and is still doing a combination of McManus traction, and what we call roll-drops, using the traditional chiropractic lumbar roll but with a Thompson drop. In my case L3, but yours sounds like it could be the L3 or L2 nerve root. Only the clinical spinal examination, together with the scans will make a precise diagnosis of the level.
The pain in my case is nearly gone, but my inner leg is still hypersensitive. Fortunately, because this is something we see all the time, we caught it before the knee started to buckle.
So, my answer is a whole-hearted yes, but because you've been sore for so long, it will take time and you will have to be patient.
Ask your doctor/ chiropractor to palpate where the Lateral Cutaneous Femoral nerve emerges from under the inguinal ligament. It should be equally tender bilaterally. This is a condition called Meralgia Paresthetica, but the LFCN is sensory only and would not cause the knee to buckle. So unlikely diagnosis.
I treat this often in my clinic, Shelley, you probably saw one of the pages. It definitely can get better, but probably will as I said because it's chronic take time.
1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.
2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.
3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree.
Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.
4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.
He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.
5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.
6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.
7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.
8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.
9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.
10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.
11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.
12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.
13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback
since working above his head. Trapped nerve tests are negative but he
has advanced degenerative joints of Luschka; after just two treatments
he is 50 percent better. Can we reach 90?
And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.
Greetings, Dr B. You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.
The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.
MONTHLY NEWSLETTER. Signed up yet? It's free. BACK ISSUES
"Wow, fantastic newsletter." Dr Leah Remeika-Dugan DC
Issue #50: Make time for breakfast / Scrambled eggs and parsley
Issue #49: Consulting a locum / Green salad /Eggs Florentine
Issue #48: Hips and the sacroiliac joints/ Bacon and eggs
Issue #47: Life without medication/ Eight coloured foods
Issue #46: Lower backs and ankles/ kaempferol and cancer prevention
Issue #45: Tingling, weakness and malaise/ vitamin B1
Issue #44: Applying general chiropractic principles to the hand / Omega-3
Issue #43: Art and science of chiropractic / Kale
Issue #42: Tum sleeping / Flaxseed
Issue #41: Adult potty training / Beetroot constipation
Issue #40: Ominous lumbar signs / Too much medication?
Issue #39: Swapping chiropractors / Butter is back
Issue #38: Making a correct diagnosis / Make your own pesto in five minutes.
Issue #37: Have your wisdom teeth out in the chair
Issue #06: Safety on the Stairs / Ginger
Issue #05: Safety in the home / Red foods
Issue #04: Whiplash and the Joints of Luschka / Parsley
Issue #03: How to stop falling / Danger of a low fat diet
Issue #01: Tingling in the arms and hands / Apples
(PS. If you find them irrelevant to your needs or an exercise in tedium, one click will UNsubscribe you.)
This site is not intended to diagnose, treat, cure, or manage any illness. Please consult your chiropractor.
The information is to the best of my ability at the time of writing accurate and correct. Queries, comments and corrections are very welcome.