Femoral nerve pain shooting down front of thigh when mobilising
by jacqueline dick
ligthen up as you pass over the femoral nerve and artery.
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.
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.