sudden onset of nerve shooting pain from groin down thigh when mobilising

by jackie
(Glasgow, scotland)

I have a labral tear of my right hip, diagnosed by arthrogram around 7 years ago but probably occurred many years before. I have had 2 pelvic fractures, both sustained in high impact trauma. First fracture sustained at 11 years old when I fell through a roof and sustained a pubic rami fracture. The second when I was a passenger in high impact road traffic accident. Poly trauma. I am joint hypermobile.
For around a year and with increasing frequency I have been getting trouble with my left thigh and groin. Initially I had fairly typical parasthetica meralgia then I started to develop mild, dull LBP around SIJ. Then I started to get a sudden onset of shooting pain down front of thigh, originating in groin so it seemed and would occur when walking and can be after a period of sitting but not always; comes on without warning but extension phase of walking seems to trigger it. Causes great pain stops me in my tracks, and sometimes my leg gives way and I fall. It remains painful and causes me to limp for about 5 minutes until I can manipulate my hip and re position to take pressure off nerve. I get radiculopathy in both legs and the pain is so distracting that I am unable to sleep at night.
My orthopaedic consultant has obtained MRI in his care of labral tear on right side but he has looked at it to see if any disc issues which would be causing this latest presentation and states that I only have mild degenerative changes and that the issue is due to my instability due to joint hyper mobility and a knock on effect from labral tear with nerves likely being irritated. He does not feel there is anything that can be done to rectify this condition. I am at end of my tether with pain and fear of falling and also worried about my ability to continue with my job as orthopaedic occupational therapist.

Exercise exacerbates all my symptoms in both hips and lower back. I am a 56 year old women with 1 daughter born by emergency cesaerian surgery. I have had repeated attendances to physiotherapy with no improvement.

Hello Jackie,
Thank you for a very full report. I'm glad you are writing not speaking it; my only experience with Glaswegians is that you speak pure Gaelic in that neck of the woods!

I take it new x-rays of your pelvis (was that a new MRI, or just the old one?) have been taken and show no significant degenerative change in the hip joint itself.

That fall, and fear of falling, may be very significant. Is the knee jerk intact and if you bounce on that leg does it give at the knee? Stairs? Is there paresis and wasting of the quad occurring? Any sensory change around the thigh compared to the other leg, and is it dermatomal?

If you lie on your back, pull your knee to the chest, opposite shoulder and the drop into the lotus position is it restricted or painful? Where?

If you run your thumb (use a drop of oil) from the ASIS through the groin, over the pubes and down the medial thigh is there extreme tenderness? Local pain, or radiation?

Ask a colleague to stand behind you and place her hands on your iliac crests; are they more or less level? Any scoliosis on lumbar flexion?

Is the SI pain the chicken or the egg. Hard to be sure, but it needs to be addressed, and is there midlumbar fixation, tenderness or pain around L3.

Classically one thinks of lumbar pain radiating down the leg, in this case femoral nerve, but I find that hip joint pain also provokes mid lumbar pain and even degenerative change; interesting research on the subject.

That lateral femoral cutaneous nerve is purely sensory and will not provoke any motor changes, but could also be involved.

I suspect it may be a mixture of all of the above; the SI and rectus femorus are often linked causing severe pain in the latter.

Start some gentle lower back exercises, including the hips, every morning before getting out of bed.

A lot of questions; answer as accurately and thoroughly as you can if you want more informed answers from me.

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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