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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