Doctors disagree on femoral neuropathy diagnosis/50yr old post meno..female

by Shelley
(Canada)

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.

Fraid it's a long way from Canada to SA!

Look forward to your answers.

dr B

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