Femoral nerve injury from a PICC line

by Linda
(MN)

I contracted viral meningitis in August, 2013. Breathing became severely constricted overnight so sent to hospital in Mpls., MN. Was immediately intubated. Developed ARDS. Sepsis, and Mechanical pneumonia. In coma for 31 days. Had a tracheotomy, feeding tube placed and a catheter. I also had a PICC line placed in right Femoral artery. PICC line removed and transferred to Rehab hospital to recover. Eventually had trachea sleeve removed as well as feeding tube from stomach and catheter removed.

After about three days at rehab, the nurses started to put a large strap around me and under the arm pits and would have me try to stand up from sitting position on edge of bed. I noticed something was wrong with my right leg, it felt paralyzed and I couldn't lift it so I sort of dragged it and used my upper body to pull myself along with a walker. This went on for a couple of weeks.

I really just wanted to go home so I would hook my toes under the bar at the end of my bed and do sit ups to try to strengthen my legs, stomach muscles etc. I was able to go up and down the halls with a walker and no longer needed the strap and just one assistant to help me. My knee felt like it was going to buckle on me each time I would need to switch directions walking. After three weeks I insisted that they discharge me. I had to pass some tests with the physical therapy person and then I could leave.

I was in a full sweat by the time I finished the tests. She had me stand in front of her then she pushed me square in the chest backwards. Needless to say I fell down. I told her I wanted another try and this time I willed myself not to fall. All the other tests went fairly well but then she told me I had to walk up 3 steps, across a landing and down another 3 steps which were a different height on one side than the other.

I didn't know until right then that I was not able to lift that foot and leg to climb the steps. I flunked and had to wait another 5 days to try again. I don't know why I lied to her and said that the front steps at my house had a railing(they don't) but I think I just wanted to get out of there. I used all the strength I could muster in my upper body, hung onto the railing and got that leg to go up and down those stairs. I got to go home.

By the time I rode the 80 miles home I was in agony from the right groin, down center of thigh, drifting over and down the inside of thigh to back of knee. My shin hurt really bad and my foot was fuzzy yet stinging.

I saw my primary physician about 10 days later and mentioned the leg problem. I thought it was a blood clot. She ordered an ultrasound, no clot. a couple weeks later went back to Dr. still having lots of pain in groin, leg, foot. Had an MRI focusing on hip and thigh bone. Why? I don't know. Showed nothing. Dr. ordered aquatic PT. Did that for a month. Really improved my balance but did nothing for leg pain. Had an MME(?) needle conduction test. Person who gave it said I had a high pain tolerance and may want to see a neurologist because he suspected FNI probably from bad placement/removal of PICC line. Went to a specialist. He said my Dr. sent me to the wrong Dr. He did spinal issues not tissue/ nerve issues.

So, I have been limping, falling down on occasion and living with a LOT of pain. I can't walk more than 1/8 mile and I am in agony, standing more than 10 minutes causes pain also. My marriage is suffering, as you can imagine, because intimacy has almost been taken off the table at this point in time. Not worth the days of pain afterward. I could really use some advice, guidance, HELP! I will follow whatever you recommend because you seem intelligent and have had a lot of success treating your patients. Me,I am at my wits end but I'm not a quitter. Thanks for your time. Sorry this was so long! Linda

Hello Linda,
You've certainly had a tough time.

You make no mention of back pain. If you bend slowly forwards, backwards and then to the side do you get no significant LBP, and no radiation down the leg?

If you sit in a kitchen chair, flex your head onto your chest, and then straighten the naughty leg parallel to the ground is it much tighter and painful than the other leg?

You say you were/are unable to lift your foot and leg; this is important; because of pain, or because it was just weak, like paralysed?

If you lie on your back and pull your knee to your chest, is it much more painful and stiff in the hip and groin compared to the other leg? If you drop your knee into the lotus position is it very stiff and sore in the hip?

It would seem to me that there is more than one thing going on here. Any injury to the femoral nerve in the groin would not cause pain behind your leg and the outer side of the shin.

The real question is whether this is a spinal issue, or an injury to the nerve in the groin, or both.

If you very gently around the area of the femoral nerve and artery run your thumb though the groin as shown above, is it extremely tender compared to the left side?

For better or for worse... try and work out exactly what it is about intercourse that make you sore, and where. Is the opening of the hips? Is it movement of the back and pelvis or a deep contraction of the deep pelvic muscles?

Answers to all these questions, print this out, and write your detailed answers down will help your doctors come to a diagnosis; only then is there the possibility of real healing.

Meantime, do our gentle back exercises and keep up that aquacise.
Good luck, and keep in touch.

Dr B

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