Femoral nerve damage after bike accident

by Diane Ballestas
(Cambridge, MA, USA)

Maigne's syndrome causes groin and butt pain

Maigne's syndrome causes groin and butt pain

Maigne's syndrome causes groin and butt pain

Patrick's test for hip and SI pathology.

Femoral nerve damage must be differentially diagnosed from hip and muscle pathology.


Hi,

I am a 48 year old woman who had a bike accident July 2015. In the accident my right knee was flexed and twisted backwards and suffered a terrible sprain. After three months of my knee not getting better I had an MRI which did not account for all of the pain and symptoms I was experiencing. There were some contusions, patella edema and cartilage damage. All of the tendons, ligaments and meniscus were intact. I decided to have an EMG since I had symptoms of Femoral nerve neuropathy. The EMG found that I had three denervated quads but my psoas was fine. I was diagnosed with femoral nerve mononeuropathy motor only.

The reason I am writing is because I since September 21, 2015 (the accident was July 9th, 2015), been having very strange symptoms and have seen two neurologists who both claim that my pain in muscular. You seem to know more about Femoral nerve issues than my doctors. Here are my symptoms:

Sitting is causing right buttock and rear thigh pain and sometimes right buttock numbness. Burning pain down my side right leg (IT band) at night. Trying any IT band stretches or hip stretches makes the pain worse. The MD says there is no sciatica.

I am having severe groin pain and sometimes when I walk there is burning right where the femoral triangle is. I have a terrible limp that won't go away. Sometimes my right hip goes numb in the front and sometimes I feel all sorts of strange sensations in the front of my upper right leg.

I have had a lumber and pelvic MRI which have not found any evidence of pinched nerves or entrapment.

My sense is that on top of the nerve damage, my femoral nerve is also entrapped in my psoas. Once I was diagnosed with the mononeuropathy my PT advised against stretching my quad and right hip flexor since the injury was a stretch injury. Prior to the diagnosis they were stretching the crap out of my quad and hip flexor from July 23 to October 14.

I am scared because I don't know what is going on. I am scared I may not recover. It has been almost 6 months. I have recently been doing very slight and gentle quad and hip flexor stretching but both cause pain and numbness symptoms.

Do you have any ideas what might be going on? I have a new physiatrist who put me on Norttriptyline and wants to give me an SI joint steroid injection. I will probably start the medicine but am very uncertain about the SI joint injection.

Do you have any ideas what might be going on? I still have a strong patellar reflex and have managed to regain my quad strength by doing my PT every day since late July. I think that working so hard at making my quads strong may have caused some of my symptoms.

Any feedback would be greatly appreciated.

Thanks,

Diane

Hello Diane,
This has been miserable and whilst it's generally not wise to listen to someone who has not had the opportunity to examine you, this certainly does sound like nerve pain, rather than muscular pain.

If it is nerve pain, then stretching the quad can only worsen the condition. It's good that the reflex is intact. Your knee doesn't give on the stairs?

And perhaps a hip condition.

Any severe force applied to one end of the femur can certainly affect the other. So let's start with your hip.

1. Lie on your back and pull your left knee to your chest, then towards the opposite shoulder, and then rotate the hip using the knee as a lever. Repeat gently with the right hip as this can aggravate it. They should be more or less the same. Tell me EXACTLY what you feel.

2. Now do Patrick's test. Again what do you feel?

Having excluded the hip, we'll start to look at the femoral nerve. Meantime, do some reading on the lateral femoral cutaneous nerve at the femoral nerve link below.

Let me have some answers.

Dr B



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Interesting challenges of the day

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.



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