Left Front Thigh Pain

by Tim
(Hong Kong)

Pain locations

Pain locations

Pain locations
MRI on my lumbar spine
Written report of the MRI

Left Front Thigh Pain can be a diagnostic saga.

Dear webmaster. It is Tim, male, 41 years old from Hong Kong. I've read several of your articles before writing this query to you. I will keep the descriptions here as neat as I can.

I've suffered from front thigh pain for 6 months now with no back pain or buttock pain. It all started in one morning when I got up from bed I felt a pain in my left front thigh. The area of the pain, at the beginning, was localized just above my left knee (I've made a simple diagram to show the areas of my pains in areas. It is area A shown in the diagram.) There is no pain on the sides or the back of my thigh but just the front area.

The pain was really a bad one and had a burning sensation. At the same time, I felt my left lower leg and foot(top & bottom) had tingling feelings (Area B in the diagram.) My lower leg and foot had no pain at all, but just tingling. I've experienced no weakness on my whole leg so far but both the burning pain and the tingling feeling were persistent all-day-long suffering. Although the pain had low and high magnitudes over time, it usually makes me hard to sleep at night. Sometimes the pain even wakes me up at night and I need to take pain-killer or sleeping pill to manage it.

During this period, I've had two MRI scans to examine (1)the whole left thigh, (2)the lumbar spine; and two X-rays to examine (1)the left hip joint area, (2)the whole spine. The results of my left thigh MRI and 2 X-rays are all normal, no abnormalities are found. However, my lumbar spine MRI turned out to have 2-3mm broad-based disc protrusions at 3 levels: L3/4, L4/L5 and L5/S1. The wording "broad-based disc protrusion" was used by the radiologist who wrote my MRI report, though I don't know how it differs from a disc bulging/slipping etc. I've attached both the written report as well as the relevant MRI image here. At L5/S1 level, the report reads a suggestive annular tear; but there are no cauda equina or focal nerve root compression at all 3 levels.

My doctor, who is an orthopedic trauma specialist, explained to me my condition of disc protrusions is a rather mild one, which is commonly found among my age group. So it is hard to relate this to my severe thigh pain, he said. He guessed the pain is due to my femoral nerve damage. I'm now on Celecoxib(an NSAID) and Gabapentin(a drug work on nerves pain). The front thigh pain and lower leg tingling have subsided a bit but they still last for a whole day long. Two things I need to mention is that (1)the thigh pain area has recently spread out to a higher position (Area C in the diagram). (2) There are burning spot pains along the hip joint, from the very left top hip bone to the inner groin area. The spot pains are indicated as red dots along the line D in the diagram.

I can barely sit now, because once I sit the front thigh pain would slowly emerge. Lying down in bed doesn't seem to help ease the pain. Only slow walking seems to be a better choice for me now because I felt better after I walked for about 20 minutes in the park every night. Strangely, the wind made by a fan can aggravate the pain if it directly hits the thigh area.

Actions that causing pressure on the thigh such as kneeling or lying down on the stomach would make it more painful. Tight pants and high relative humidity(>80%) seem to worsen the pain too.

The front thigh pain and lower leg tingling have changed my whole living in this six months. I even quit my job because the pain makes me hard to concentrate on anything. I can't sleep well at night and the persistence of the pain causes depression on me. I need to go to the psychiatrist every week. Would you have any suggestions on my current condition? Anything I can do to improve my condition now? I would appreciate any suggestions from you. Thank you so much for your reading.

Hello Tim,
I agree with the orthopaedist's conclusion; it's almost certainly a femoral nerve lesion. Has the knee jerk reflex not been affected? Bounce on your knee to see if it's tending to give.

What is unusual is that you have no back pain at all, and the scan to my mind at the expected area is clear. You do have L5/S1 disc degeneration but that would give you posterior thigh pain.

Do bending and twisting in various directions, including backwards have absolutely no effect on the lower back or leg pain?

Ask a strong friend to help with the femoral nerve stretch test, preferably off of all painkillers for 24 hours. Lie on your stomach, with the knee bent, foot towards the ceiling. Ask him to first raise the healthy knee towards the ceiling stretching the front of the thigh; now repeat with the naughty leg. Is there a significant different; describe it as accurately as possible.

No abdominal issues?

Prod around in the groin; any lumps or bumps, is much more tender than the other side?

What you describe is typical of meralgia paresthetica, but the location of the pain is not typical; that would affect the outer thigh.

Lie on your back and pull your knee to the chest; is it stiff or painful in the groin and around the hip joint?

Give me 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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