Femoral nerve pain shooting down front of thigh when mobilising

by jacqueline dick
(Glasgow,Scotland, uk)

ligthen up as you pass over the femoral nerve and artery.

ligthen up as you pass over the femoral nerve and artery.

ligthen up as you pass over the femoral nerve and artery.
Notice sloping acetabulum and unroofed hip.

I have a right labral tear, diagnosed 7 years ago by arthrogram.
Went on to develop classic paresthetica meralgia in left thigh. Now getting shooting nerve pain of sudden onset when walking which stops me in my tracks and can cause me to fall on occasion. Which leg? Thereafter painful limping for about 5 minutes and have to try and manipulate thigh to relieve nerve pain.
Unpredictable in onset. Can occur after a bout of sitting with first few steps or comes on suddenly after walking for some distance. Appears to be triggered by extension phase of walking but flexion of hip during exercise can also exacerbate. Frequent dull LBP at SIJ. Scan only shows labral tear and mild degenerative arthritic changes.

Orthopaedic consultant states that pain likely to be nerve impingement from poor hip stability and joint hyper mobile syndrome. Feels I will require hip replacement in approximately 10 years on right side. Has no advice on how to manage left nerve pain.

Causing great distress with pain, radiculopathy, particularly at night and fear of falling. Exacerbated by exercise and other activities of daily living. Worried about sustaining my employment as I work in orthopaedics as trained occupational therapist. Physiotherapy has not yielded any success in alleviating pain.

Hello Jacqueline,
It's not absolutely clear, but I'm presuming this is left anterior thigh pain; not classic for meralgia paresthetica by the way, as the Lateral Femoral Cutaneous Nerve supplies predominantly the lateral thigh.

Plus LFCN is sensory only. The big question is whether the falls are due to pain, or weakness in the quad. The knee jerk is normal? Springing on your knee reveals no weakness of the quad?

Lying prone, if your PT extends your hip with the knee bent, do you get much greater tightness or pain in the left ant thigh compared to the right?

Does lumbar flexion, extension, lateral flexion or Kemp's test provoke any anterior thigh pain, or mid lumbar pain?

Pulling your knee to the chest: do you get a pinch in the groin? Does the Fabere test provoke any groin/ hip pain when dropping the knee into the lotus position?

With a little oil on your thumb, beginning at the ASIS, is it very tender as you pass through the groin and particularly in the adductor magnus as you run down the medial thigh?

It's not clear in my mind from what you describe whether this is hip and capsular pain from a hypermobile hip (no signs of dysplasia, no sloping acetabulum, no unroofed femoral ball?) or a true femoral nerve condition. Try and answer the above as accurately as you can to get a more accurate diagnosis.

No family history of hip disease?

Could you try and send me a copy of your pelvic x-ray?

I hope this contributes to your conundrum. 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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