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

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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